Tracheostomy and Ventilator Education ProgramModule 10: Communication Supplies

DisclaimerThis material is intended for use by trained family members and caregivers of children with tracheostomies who are patients at the Alberta Children’s Hospital. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional, so please seek medical advice from an appropriate health professional for questions regarding the care and treatment of any patient. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.

2

• A basic introduction about communication supports for children with tracheostomies

• Children with tracheostomies need to be able to communicate even though they have a tracheostomy tube in placeo They need to express their feelings, needs, and ideaso They need to feel that they are being heard

Communication Supplies

3

• As infants, we learn to communicate non-verbally through facial expressions and body movements

• As we get older, we learn verbal ways to communicate to complement our non-verbal expression

• Our ability to communicate is important for developing relationships, expressing ourselves, and learning

The Importance of Communication

4

Children who have a tracheostomy tube in place may not be able to make sounds or speak because of:• Their medical condition and why the tracheostomy tube was placed• Their upper airway anatomy and airflow (Module 2: Respiratory Anatomy)• The size of their tracheostomy tube• The tracheostomy tube affects how air flows through the upper airway:

o Most air flows through the tracheostomy tube, decreasing the amount of air that flows through the vocal cords

o Depending on the child’s ventilation support, there may be no air movement through the vocal cords at all

Communication with a Tracheostomy Tube7/30/2018

5

• Children who have a tracheostomy tube in place may be able to make sounds or speak by:o By using their non-verbal communication skills such as facial expressions,

body language, and gestureso Moving air through the upper airway and vocal cords o With a communication support like sign language or a tableto With a speaking valve in place

Communication with a Tracheostomy Tube7/30/2018

6

• It is always important for family and caregivers to focus on their child’s non-verbal communication, especially when they are learning how to communicate with a tracheostomy tube

• Many children are not able to speak or make sounds with a tracheostomy tube in place – some can, but get tired and short of breath from the effort

• If they can speak, their voices may sound different – quiet, breathy, low pitched or high pitched

Speaking with a Tracheostomy Tube in Place

7

• An Speech Language Pathologist (SLP) is a member of your healthcare team who will help your child with communication

• They help assess your child’s communication strengths, oral motor skills, and swallowing abilities

• They help determine if your child can use a speaking valve

Speech Language Pathologists

8

• Your SLP will help your child expand their non-verbal communication abilities and find the best ways for supporting your child’s communication strategies

• They help your child learn how to work with communication supports like communication boards, sign language, and communication devices like tablets

Speech Language Pathologists

Photo Used with Permission, JD 2017

9

A speaking valve is: • A medical device that can help with

making sounds and speech in somechildren

• A one way valve that fits on the tracheostomy tube connector to allow air flow into the upper airway

Speaking Valves

Photo Used with Permission, JD 2017

Photo Used with Permission, JD 2017

10

• The valves opens when your child breathes in letting air flow in

• The valve closes as they breathe out which makes the air to go up through the vocal cords and out through the mouth

• This air movement allows your child to make sounds and words

How Do Speaking Valves Work?7/30/2018

11

Photo Used with Permission, JD 2017

Your child’s health care team will assess your child’s ability to try a speaking valve based on:• Their medical stability and respiratory status• Their tracheostomy tube:

o Size - how much air moves through the tube to the vocal cordso Cuffed or not and if cuffed, whether it can be deflatedo How much air leak is around the tube

• Their ability to make some sounds with their tube blocked• Their secretions and suctioning needs

A Speaking Valve Trial

12

• A speaking valve trial can be done safely in hospital or after discharge in clinic with your SLP and your health care team

• During the trial, your SLP and healthcare team will:• Decide on the best type of speaking valve for your child• Watch your child and how they are tolerating the valve in place with their

breathing ( it may feel strange for your child to breath through their mouth again after being used to the tracheostomy tube)

• Watch how long your child can wear the valve• Assess if your child can use the valve to make sounds or speak

A Speaking Valve Trial

13

• If the speaking valve trial is successful, your SLP will create a plan with guidelines for your child to use their speaking valve – when to wear the valve, how long to wear the valve, safety guidelines, and how to care for the valve

• As your child’s needs change, they will need a new speaking valve every few months

• Your SLP will work with you about the costs and funding for your child’s speaking valves

A Speaking Valve Trial 7/30/2018

14

• Strong communication skills are very important with language development, learning to interact with others, learning to read and write, and self expression

• Your health care team will help you with communication strategies for your child

The Importance of Communication

15