Rehabilitation of Post-Laryngectomy Patients

Abstract

THE following is a study of the treatment of 123 laryngectomized patients who attended the University of Toronto, Dept. of Rehabilitation at the Princess Margaret Hospital Toronto. It includes discussion of the "tongue lock" method in oesphageal voice, reasons why some patients show "natural ability" in acquiring voice, and comparisons of male and female laryngectomies in surgical procedures, and acquisition of voice. Non-acquisition of voice, and the use of the electro-larynx, is also discussed.The speech unit of this rehabilitation department was set up in 1958 to deal primarily with the problem of laryngectomized patients, i.e. patients in whom the larynx had been removed due to the presence of cancer within the larynx or in an associated area. The centre provides therapy for patients in Ontario who are referred by a medical practitioner-usually the surgeon performing the operation. The aim of the centre is to provide for the total rehabilitation of the laryngectomized patient with his vocal, emotional and social problems which arise due to the nature of this operation.This paper will deal primarily with the vocal re-education of 123 such patients with observations on treatment and rehabilitation and some of the factors which have been found in dealing with their problems.It is divided into four parts as follows : I. The patient. 2. Method of vocal re-education. 3. Therapeutic observations of oesophageal voice 4. Observations on patients. development.I . THE PATIENT The patient who requires removal of the larynx has manifold fears-he is afraid of the disease of cancer and its threat of death. He fears a serious operation which results in a loss of his ability to communicate and he fears the social and economic loss caused by the operation. He will react to these factors according to his personality but he can be greatly aided by careful pre-and post-operative treatment on the part of the surgeon, therapist and relatives. The programme of rehabilitation at the department recognizes the importance of this and the following programme is carried out.(i) Pre-0perativeZy.-When the patient is operated on in the city, the surgeon informs the therapist that the operation is to be performed and where possible the patient is seen pre-operatively by the therapist. This has proved very valuable in making contact with the patient and his relatives as he is able to talk and ask questions which may be worrying him. The therapist can observe the patient's present habits of voice and breathing which helps in vocal therapy. Also she can answer questions, helping to allay anxieties concerning details about which the patient may 54