An evidence-based rehabilitation program for tracheoesophageal speakers

Objectives: to develop an evidence-based therapy program aimed at improving tracheoesophageal speech intelligibility. The therapy program is based on particular problems found for TE speakers in a previous study as performed by the authors. Patients/Materials and Methods: 9 male laryngectomized individuals were included in the study. Seven had had a total laryngectomy, one had had a PM flap and one a gastric pull-up. Mean age was 64;9 years and mean time after TLE was 5;6 years. A therapy program was developed based on the most common difficulties of TE speakers found in literature and on a previous perception experiment of the authors. Where possible, therapy techniques were based on evidence-based research. TE speakers participated in a nine-session therapy program spread over five weeks. Several pre and post tests were used to measure the effect of the therapy program: the speakers were asked to read out speech material, both before and after the therapy program, including almost all levels of speech: phoneme level, word level, sentence level and spontaneous speech. Different types of raters were used for each of the different tests. Naive, inexperienced listeners rated spontaneous speech in a semantic scaling experiment; naive, but experienced raters (phoneticians) rated phoneme and sentence level; experienced listeners, well known with TE speech, rated phoneme level. Questionnaires were filled out by the speakers themselves and a close relative. A Voice Handicap Index was also used, but will not be discussed here. Results: Scores improved for fricatives in initial position, and for the voiced-voiceless distinction. For medial position, all manners of articulation, except the approximant /l/ improved, as well as the voiced-voiceless distinction. Sentence intelligibility also improved. The questionnaires show that speakers are more positive about their own speech post therapy. The scores for the semantic scaling experiment did not improve. However, the semantic scale results on articulation and intelligibility did improve. Conclusions: Although already effective in its present set-up, some extension of this 5-week rehabilitation program is necessary to ensure an optimal progression from phoneme level to spontaneous speech level.