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UltraVoice has been used successfully to
enable patients on ventilators to speak, especially in cases
where the Passy-Muir valve has failed. Although the Passy-Muir
is the first option to try, it is not always successful for a
variety of reasons. Some of the reasons for failure would be
too much saliva and secretions leading to valve clogging,
problems with a person’s anatomy which would prevent the
Passy-Muir valve from fitting properly and so forth.
Patients may be on a ventilator due to ALS or
Lou Gehrig’s disease, post polio syndrome, head or neck
injury, chronic obstructive pulmonary diseases (asthma,
bronchitis, emphysema, etc.), obstructive sleep apnea,
congestive heart failure, neuromuscular paralysis, etc.
What follows below is the account of a speech
pathologist who was trying to assist a postpolio patient on a
ventilator to speak after his Passy-Muir had failed.
Trying
to find an effective means for my ventilator-dependent postpolio
patient, S.K., to communicate independently was a big challenge,
but I finally found the UltraVoice, an intraoral artificial
larynx originally developed for laryngectomy patients. S.K.
had recovered from childhood paralytic poliomyelitis with
mild right facial weakness, and had Postpolio Syndrome with
progressive paralysis. He was quadraplegic and ventilator-dependent.
Except for the facial weakness, his speech musculature was
intact. He was referred to me after attempts with independent
communication systems failed.
LIMITED
OPTIONS
As
a former RRT with much ventilator experience, I knew most
of S.K.'s options. His ENT doctor had tried a conventional
ventilator speaking valve but, because of apparent anatomical
difficulties and copious pulmonary and oral secretions, it
didn't work. So, I decided against a speaking valve. I also
felt his family might have problems with possible volume changes
each time his cuff was deflated and the valve was placed.
Someone
had lent S.K. an electrolarynx, but it didn't give him the
independence he desired. He was upset that conversation partners
had to place the electrolarynx on his neck. He tried a hands-free
electrolarynx with a headset and latching switch, but had
problems using the mouth tube. Again, he felt dependent, and
was hard to understand.
Creative
Solution
I
saw an advertisement for the UltraVoice in ADVANCE for Speech-Language
Pathologists and Audiologists. The device, available from
UltraVoice Ltd., in Paoli, PA, consists of three basic components
specially mounted in an upper denture or orthodontic retainer
placed in the patient's mouth: a built-in loudspeaker, a control
circuit, and rechargeable batteries. The loudspeaker creates
a natural voice tone that simulates sounds produced by the
larynx. The patient shapes this tone into speech patterns
the way he or she would naturally. A flexible membrane protects
the loudspeaker from saliva, food and liquids. The control
circuit is a miniature electronic circuit that controls sound
pitch and volume. The rechargeable batteries, similar to those
in watches or calculators, provide the power for the speaker
and control circuit, and allow an average day of talk time
per charge.
Besides
the intraoral unit, UltraVoice also has a handheld control
unit and a charging unit. The control unit allows the user
to remotely control the intraoral unit with a slide button
that turns the UltraVoice on and off, and allows for volume
and pitch control. The charging unit simultaneously recharges
batteries in the handheld and intraoral units in eight hours.
The
UltraVoice seemed like a perfect option for S.K., but I had
to see if it could be controlled by a switch he would be able
to turn on and off with some residual left-arm movement, since
he couldn't work the hand-control unit with his fingers.
David
Baraff, PhD, UltraVoice Ltd.'s general manager, agreed to
try to adapt the hand-control unit to accept a switch for
S.K. Dr. Baraff and his employees were wonderful in their
efforts to make the adaptations, and after some trial and
error, it worked well.
S.K.
controls the on/off hand-control unit of his UltraVoice intraoral
electrolarynx with a latching switch placed near his left
hand. He rolls his arm over and turns the unit on by hitting
the switch once, talks as long as he wants, then turns the
unit off by hitting the switch with his arm again.
It was very gratifying to find a solution
for my client's communication problem and provide him with
a way to talk with anyone whenever he wanted, especially to
convey critical messages regarding his health needs.
Betty
Jeanne Nelson is a speech/language pathologist at St. Vincent's
Special Needs Services, Trumble, CT. She is also coordinator
of the Connecticut center for Augmentative Communication at
SVSNS. She specializes in treating physically and mentally
challenged children and adults.
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