Chronic pediatric tracheotomy: assessment and implications for habilitation of voice, speech and language in young children.

The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.

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.