One of the most difficult issues many ventilator patients cope with is the loss of the ability to communicate, but Rockcastle Regional employs a number of strategies to help patients regain this ability to the fullest extent possible. One way some patients are able to regain the ability to communicate is through the use of a speaking valve.
Since air moving past the vocal cords is what produces sound, many patients can’t speak when they are placed on a ventilator because air no longer reaches the vocal cords.
But with the help of Rockcastle Regional’s in-house team of speech pathologists and the use of a speaking valve – a one-way valve that forces air up and out of the mouth – many are able to talk again, enhancing independence and quality of life.
“Being able to communicate your basic wants and needs is critical in maintaining a sense of normalcy even when sick,” said speech pathologist Brandy Cable. “We need to make sure our patients maintain this ability, whether through an
Augmentative and Alternative Communication (AAC) device or speaking valve so they don’t feel alone and unheard.”
Once the speech pathologist performs an assessment and determines that a patient is eligible for a speaking valve, a physician’s order is obtained, and the process of inserting it begins.
When the valve is placed for the first time and air enters the patient’s oral cavity, it might take time to adjust – the patient might cough, have watery eyes or experience anxiety.
All the while, the speech pathologist is closely monitoring the patient and keeping an eye on oxygen level and heart rate, looking for signs of respiratory distress or shortness of breath.
“Sometimes they are physically fine, but anxiety keeps them from being able to adjust,” said speech pathologist Amanda Hale. “So we go back, take baby steps, and try again.”
For those who are able to adjust, the next part of the process is teaching them to speak again.
“For some, it’s been months since they last spoke, and it might take time for them to adjust to coordinate speaking with breathing with the assistance of the ventilator,” Hale said.
Therapists monitor voice quality and intensity, whether the patient is speaking intelligibly, or if the patient is experiencing anxiety or stress.
If all goes well, the patient is able to speak again, many times as clearly and with the same tone as in the past.
For other patients, their illness or condition might be more profound. They might also have experienced muscle deterioration to the point that speaking would be impossible even with the use of a valve. Moreover, some may not have the use of their arms and legs, rendering non-verbal communication nearly impossible.
In 2017, Rockcastle Regional began consistently helping those patients communicate as well.
Using a device called a Tobii, residents can communicate merely by using their eyes to focus on the digital keyboard of what looks like a tablet computer. The technology uses near-infrared illumination to create the reflection patterns on the cornea and pupil of the eye of the subject, and image sensors are used to capture images of the eyes and the reflection patterns. Essentially, staring at a letter on the screen for less than a second causes that letter to appear as text. In this way, residents can type messages.
The process takes time, but Rockcastle Regional resident Joe Perciful, who suffers from Amyotrophic Lateral Sclerosis (ALS), began using it during the summer and reports that being able to communicate has given him new hope and optimism.
“I’m happy,” he typed, using the Tobii. “I now can talk with my family and friends even when they are not here.” He noted that the device gives him access to social media, which helps him stay socially connected.
The new devices are the work of “Team Gleason,” said John Lambert, Rockcastle Regional’s development director.
Steve Gleason played for The New Orleans Saints from 2000-2008. In January, 2011, he was diagnosed with ALS, considered a terminal neuromuscular disease. Steve and his wife, Michel, formed “Team Gleason” to help show that patients can not only live but thrive after this diagnosis. The Gleason Initiative Foundation helps provide individuals with neuromuscular diseases or injuries with leading edge technology, equipment and services.
Lambert contacted the organization because he saw the potential for a partnership since Rockcastle Regional has many patients who could benefit from the technology.
"This project is about using technology to restore autonomy our residents lost to illness.” Lambert said. "Our residents are the same people they were before they fell ill. With a little practice, residents can speak through the Tobii at a pace that approaches their pre-illness speech. They can tell staff how they’re feeling or tell family members how they feel about them. It’s a ‘new normal’ made possible by Team Gleason and this technology."
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