Question
My baby currently has a trach. She has been seeing a SLP at the hospital. I was wondering if there is any more the SLP can do besides sign language. She is not ready for a speaking valve.
Answer
Sign language is a widely used communication option for children with tracheotomies. Other frequently used communication options include speaking valves, cannula occlusion, and alternative communication.
Speaking valves. Speaking valves permit air to enter the cannula, and then block the air from exiting, so that the air must exit through the mouth. The obvious and most important advantage of a speaking valve is that it permits the child to vocalize. If the child's cognitive development does not yet support the use of speech, she can still exercise her vocal system. If the child is more developed cognitively, she can learn to use spoken language to communicate. A disadvantage of this option is that the child's tolerance of a speaking valve must be strictly monitored. Any signs of respiratory compromise, including decreased oxygen saturation can also be a complication.
Cannula occlusion. Cannula occlusion involves placing the child's hand, finger, or chin over the opening of the tracheal tube. This technique blocks the air from exiting the through the tracheostomy and allows it to pass up through the larynx. The principle advantages of cannula occlusion are that it permits phonation and that its use requires no mechanical devices. A disadvantage of this option is that it requires careful monitoring to guard the respiratory status of the child. Cannula occlusion cannot be used if the child is receiving mechanical ventilation.
Alternative communication. Alternative communication systems exist in a wide variety of forms, from simple communication boards to very elaborate and relatively expensive electronic communication devices. Decisions about which device to use are made by an augmentative communication specialist. In general, manual communication boards can be used long or short term with any child with the prerequisite cognitive development and physical skills. Electronic communication devices are more likely to be used with children who are predicted to have in place tracheostomies for several years. Use of an assistive communication system is not intended to preclude speech. Instead, as with sign language, the major goals of assistive communication systems are to facilitate communication development and to provide the child a method to express her immediate needs, thoughts, and feelings.
These therapeutic options are not exclusive choices. For example, a child can be taught to use a combination of sign language and cannula occlusion in conjunction with an electronic communication device.
Ken Bleile is a professor in the Department of Communication Sciences and Disorders, University of Northern Iowa.
