Rehabilitation Therapy for Vocal Fold Paralysis Caused by Lung Cancer: A Case Report.

OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can be caused by iatrogenic injury or tumor-induced damage to the recurrent laryngeal nerve. Studies of comprehensive rehabilitation therapies for patients suffering from severe UVFP are limited. The purpose of this case report is to describe an improvement in complete aphonia after comprehensive rehabilitation therapies in a patient with severe UVFP due to a lung tumor. METHODS: An 81-year-old woman with a history of bronchial adenoma had complete aphonia due to compression of the left recurrent laryngeal nerve by the tumor. Dynamic fibrolaryngoscope revealed paralysis of the left vocal fold. The patient was treated with interferential current therapy, vocal training, and kinesiology taping. Indicators of voice recovery were scored according to the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap index. RESULTS: After 10 days of comprehensive rehabilitation treatment, the patient recovered from complete aphonia to normal communication. The hoarseness and breathiness of patient were significantly improved. In addition, the grade, roughness, breathiness, asthenia, strain, and the voice handicap index scores changed from severe to mild or absent. CONCLUSION: This case provided a novel comprehensive treatment for a patient with UVFP, which was safe, cost-effective, and easy to implement in clinic.

Aphonogelia After Recovery From Severe Traumatic Brain Injury: A Case Report.

During rehabilitation from a severe traumatic brain injury, a 16-year-old girl became aware that she had lost the ability to laugh out loud. This rare phenomenon previously has been described as "aphonogelia." A discussion of therapeutic avenues that were explored with this patient is presented in the first case, to our knowledge, of aphonogelia after a traumatic brain injury. LEVEL OF EVIDENCE: V.

Fully Implanted Brain-Computer Interface in a Locked-In Patient with ALS.

Options for people with severe paralysis who have lost the ability to communicate orally are limited. We describe a method for communication in a patient with late-stage amyotrophic lateral sclerosis (ALS), involving a fully implanted brain-computer interface that consists of subdural electrodes placed over the motor cortex and a transmitter placed subcutaneously in the left side of the thorax. By attempting to move the hand on the side opposite the implanted electrodes, the patient accurately and independently controlled a computer typing program 28 weeks after electrode placement, at the equivalent of two letters per minute. The brain-computer interface offered autonomous communication that supplemented and at times supplanted the patient's eye-tracking device. (Funded by the Government of the Netherlands and the European Union; ClinicalTrials.gov number, NCT02224469 .).

Evaluation of Speak for Myself with Patients Who Are Voiceless.

PURPOSE: To describe the creation and initial feasibility study of a new computer application to improve communication with people who cannot communicate by customary means during their hospitalization. DESIGN: This was a mixed-methods, quasi-experimental design. METHODS: This exploratory feasibility study obtained data about the experiences of 20 intensive care patients in three South Florida hospitals who were unable to speak due to mechanical obstruction. FINDINGS: Study participants (20), who ranged in age from 45 to 91 years (M=67.4, SD=12.88) and between -1 to +1 (SD=-0.15) on the Richmond Agitation Sedation Scale, used Speak for Myself from 4 to 16 hours with a mean of 8.86 (SD=2.12). Ninety-five percent of the participants stated that Speak for Myself was helpful for communication. CONCLUSIONS: Speak for Myself was helpful to patients who used it. This was a small study (n=20). It warrants further investigation. CLINICAL RELEVANCE: Patients who are unable to communicate their needs through conventional methods still want to make their preferences and needs known. Speak for Myself is a new application that facilitates ensuring the patient's voice is heard.

Development of a wireless electromyographically controlled electrolarynx voice prosthesis.

The most common artificial voice source for post-laryngectomy speech rehabilitation is the handheld buzzer or electrolarynx (EL). EL speech is often described as mechanical-sounding (robotic), and typically lacks pitch variation, making it monotone and unnatural. Prior studies have shown improved perceptual ratings of speech naturalness when pitch variation is added to EL speech, and a proof-of-concept EL prosthesis has been developed to provide pitch variation and voice on/off control in relation to neck muscle electromyographic (EMG) signals. The goal of the present study was to design a new wireless version of the EMG-controlled EL (EMG-EL) that could provide a flexible mixture of manual (push button) and automatic (EMG-based) control options for voice onset/offset and pitch, and that could be manufactured at a reasonable cost for widespread patient use. This paper describes both technical and human factors considered while designing the new EMG-EL voice prosthesis.

Babbling, vegetative function, and language development after cricotracheal resection in aphonic children.

OBJECTIVE: To determine the importance of prelinguistic babbling by studying patterns of speech and language development after cricotracheal resection in aphonic children. STUDY DESIGN: Retrospective review of seven previously aphonic children who underwent cricotracheal resection by our pediatric thoracic airway team. The analyzed variables include age, sex, comorbidity, grade of stenosis, length of resected trachea, and communication methods. METHODS: Data regarding the children's pre- and postsurgical communication methods, along with their utilization of speech therapy services, were obtained via speech-language pathology evaluations, clinical observations, and a standardized telephone survey supplemented by parental documentation. Postsurgical voice quality was assessed using the Pediatric Voice Outcomes Survey. RESULTS: All seven subjects underwent tracheostomy prior to 2 months of age when corrected for prematurity. The subjects remained aphonic for the entire duration of cannulation. Following cricotracheal resection, they experienced an initial delay in speech acquisition. Vegetative functions were the first laryngeal sounds to emerge. Initially, the children were only able to produce these sounds reflexively, but they subsequently gained voluntary control over these laryngeal functions. All subjects underwent an identifiable stage of canonical babbling that often occurred concomitantly with vocalizations. This was followed by the emergence of true speech. CONCLUSIONS: The initial delay in speech acquisition observed following decannulation, along with the presence of a postsurgical canonical stage in all study subjects, supports the hypothesis that babbling is necessary for speech and language development. Furthermore, the presence of babbling is universally evident regardless of the age at which speech develops. Finally, there is no demonstrable correlation between preoperative sign language and rate of speech development.

[Tracheostomy cannulas and voice prostheses]. / Kanülen und Stimmprothesen.

Tracheostomy cannulas and voice prosthesis are mechanical aids for patients, who for different reasons underwent either tracheostomies or laryngectomies. In this review, indications, surgical procedures, and consequencies of the preceeding surgical intervention are reported for a better understanding of the specific requirements for the artificial aids. In spite of the increasing number of percutaneous dilatation tracheostomies, e. g. in intensive care units, a classical tracheostomy with epithelialized connections between trachea and skin still represents the method of choice for all cases, in which a longer lasting access to the trachea is requested. Special tubes made of different materials, offering different physical qualities are used to keep the tracheostomy open and guarantee an easy access to the lower respiratory tract. For each individual patient the most adequate device must be found out. Voice prostheses allow a fast and effective vocal rehabilitation after laryngectomy. As many models are on the market with differences in terms of material, principle and design of the underlying valve mechanism, size etc., again, in each individual patient the most suitable prosthesis has to be chosen. In combination with special heat and moisture exchangers (HME), such prostheses not only allow a good vocal but also pulmonary rehabilitation. The duration of such prostheses depend on material properties but also on formation of biofilms (mostly consisting of bacteria and fungi) that can destroy the valve mechanism. Whenever possible, and additional valve mechanism covering the opening of the tracheostomy should be used in order to avoid the necessity to close this opening manually during phonation. Each doctor taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost.

Retrospective study of 116 patients with non-organic voice disorders: efficacy of mental imagery and laryngeal shaking.

OBJECTIVE: To report the short- and long-term results of two techniques (mental imagery and manual shaking of the larynx) in patients with non-organic dysphonia or aphonia. DESIGN: Retrospective review of patient records, plus follow-up survey (questionnaire). SETTING: Academic teaching hospital. PATIENTS: One hundred and sixteen patients with moderate to severe non-organic dysphonia or aphonia. OUTCOME: Cure (i.e. normal voice) and improved voice quality, judged by clinicians and patients. RESULTS: One hundred (86 per cent) of the 116 patients were cured. Ninety-four (81 per cent) patients regained their normal voice within one therapy session. The follow-up survey revealed that 43 of the 87 (49 per cent) patients who responded had not had a relapse since therapy ended. Of those patients suffering relapse, 15 successfully applied mental imagery in order to retrieve their voice, compared with three patients who applied shaking of the larynx. CONCLUSION: Mental imagery, combined if necessary with manual therapy, is an effective therapeutic technique in patients with non-organic voice disorders.

Voice, speech, and language habilitation in young children without laryngeal function.

We discuss aphonia in children, secondary to laryngeal obstruction, with regard to the development of a voice, speech, and language system that can be an effective and efficient means of communication while obstruction persists and a precursor to good voice and speech habits if and when the laryngeal function is reestablished. Several methods were considered. A technique of esophageal voice training for children was developed and implemented, which combined the aspects of normal language learning with the mechanical aspects of esophageal voice production. Results showed rapid learning in a 2 1/2-year-old child with severe juvenile laryngeal papillomatosis and normal speech and language at the age of 4 years when laryngeal function returned. A second technique, a communication board, was used with a 4-year-old child with total subglottic stenosis and brain damage.