Optimizing speech production in the ventilator‐assisted individual following cervical spinal cord injury: a preliminary investigation

Abstract

Background: Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator‐assisted post‐cervical spinal cord injury. Aims: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech. Methods & Procedures: Speech production in the three conditions was compared in two ventilator‐assisted participants using a series of instrumental and perceptual speech measures. Outcomes & Results: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present. Conclusions & Implications: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive pressure ventilation long‐term regarding communication options.

A comunicação do paciente traqueostomizado: uma revisão integrativa

“…When it is associated with mechanical ventilation, it poses a positive impact on the quality of life for supplying patients' psychological and physiological needs 17,22,23 .…”

“…PEEP must be adjusted to obtain proper speaking, without fatigue, associated with the Passy-Muir valve, increasing subglottic pressure and enabling speech production 23 . Deflation of the tracheostomy cuff is necessary for speech (even if not totally), even though patients are in mechanical ventilation 18 .…”

Restoring Speech to Tracheostomy Patients

“…Leak speech can be an effective aid in communication for patients who are ventilator dependent; however, it cannot be used in patients who cannot tolerate cuff defl ation. 20 Leak speech is appropriate only for patients who can tolerate cuff defl ation or have a cuffl ess tube. To provide leak speech, the cuff is defl ated and the ventilator settings are adjusted to accommodate the air leak that results.…”

“…Tidal volume delivery can be increased to compensate for the loss of volume during inspiration through the upper part of the airway. 20 Humans naturally speak on exhalation, but leak speech is the opposite of normal speech: it occurs on inhalation. The leak during the inspiratory phase allows for phonation, so the patient must be coached to speak on inspiration, as the breath is delivered.…”

“…19 Leak speech generally results in short phrases followed by long pauses, so increasing the inspiratory time on the ventilator can allow for more syllables per minute. 20,21 Some patients have reported anxiety or discomfort with the use of leak speech because of an unfamiliar feeling of airfl ow through the upper part of the airway. These patients can be taught to push down, hold their breath, or tighten their throat to increase or decrease the volume delivered to the lungs.…”