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. Naïve, inexperienced listeners rated spontaneous speech in a semantic scaling experiment; naïve, 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 voicedvoiceless 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 Evidence--based Voice and Speech Rehabilitation in Head and Neck Cancer (Invitational Round Table) Amsterdam, The Netherlands May 15--16, 2008 ISCAArchive http://www.isca-speech.org/archive