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American Journal of Speech-Language Pathology Vol.6 87-96 February 1997.
© American Speech-Language-Hearing Association
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Simple Adjustments Can Improve Ventilator-Supported Speech

Jeannette D. Hoit 1
Robert B. Banzett 2
1 National Center for Neurogenic Communication Disorders University of Arizona, Tucson Brockton/West Roxbury U.S. Department of Veterans Affairs Medical Center, Boston, MA
2 Harvard Medical School, Boston, MA Physiology Program, Harvard School of Public Health Brockton/West Roxbury U.S. Department of Veterans Affairs Medical Center, Boston, MA

jenjen{at}cnet.shs.arizona.edu

Six subjects who were tracheostomized and chronically ventilator-supported because of neuromuscular disease or injury were studied to determine if their speech could be improved. Using subjects' own portable ventilators, adjustments were made that reduced inspiratory flow and added positive end-expiratory pressure (PEEP). These adjustments resulted in increases in speaking time per ventilator cycle, increases in number of syllables produced per cycle, and decreases in peak tracheal pressure. Improvements in speech were perceptible to listeners in 3 of the 6 subjects. Listeners preferred speech produced under the ventilator-adjusted condition primarily because the quantity of speech produced per ventilator cycle increased, loudness fluctuation decreased, and voice quality improved. The only subject who showed no perceptible benefit from the adjustments had a substantial air leak around her tracheostomy tube. Importantly, gas exchange was not compromised in any of the subjects. We believe that adjustments such as prolonging inspiration and adding PEEP, when implemented in collaboration with appropriate health-care professionals, represent a simple, inexpensive, and safe intervention for improving speech in certain ventilator-supported individuals.

Key Words: ventilator dependent, speech treatment, mechanical ventilation, neuromuscular disorders, respiratory insufficiency

Submitted on July 16, 1996
Accepted on November 13, 1996


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