Slide 1. Slide 2. Slide 3. Introduction to the Electrolarynx. I have nothing to disclose and I have no proprietary interest in any product discussed.

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Slide 1 Introduction to the Electrolarynx CANDY

1 Slide 1 Introduction to the Electrolarynx CANDY MOLTZ, MS, CCC -SLP TLA SAN ANTONIO 2019 Slide 2 I have nothing to disclose and I have no proprietary interest in any product discussed. Slide 3 Electrolarynxes have many names Alaryngeal Device Speech Aid Electronic speech device ALD Talker

2 Slide 4 Three Main Types of Speech Aids Neck type (Transcervical) Intra Oral (tubing in the mouth) Intra Dental (imbedded in upper denture) Pneumatic (uses exhaled lung air transported to the oral cavity) Slide 5 Speech Aids Come In All Shapes And Sizes Slide 6

3 Slide 7 How Does an Electrolarynx Work? Battery operated with on/off switch Some can be remotely operated Many can be converted to an intraoral device Provides sound vibrations that travel transdermaly into the oral cavity to replace/provide voice Most can be adjusted for pitch and loudness Slide 8 Easy to learn Advantages and Disadvantages of Electronic Speech Aids Usually good intelligibility Robot quality Mono pitch and loudness Loudness variability Less Expensive than TEP Placement flexibility Can be used with ES and TEP Requires dexterity Intonation/emphasis a challenge Volume control for HI Requires the use of one hand Expense and maintenance Harder to understand on phone Slide 9 Cost of Speech Aids Cost varies widely, like cars, from $200 to $800. See the Vendors! Cost of batteries Some devices are now rechargeable and sent in when it will no longer hold a charge. Accessories vary from instrument to instrument An amplifier may be necessary or desirable at additional cost

4 Slide 10 Goals in Treatment Choose the best instrument Each type offers a different feel and a different transmission of sound Its best to have a variety to try develop a sample closet Establish a Sweet Spot Placement: 100% consistent voice projection from the same sweet spot Both hands, in every situation Slide 11 Therapy Considerations Use slower speech rate, pitch and stress Proper volume Over articulate for optimal intelligibility Manage the on/off switch in coordination with voice onset time Pay attention to body language Eye contact, facial expression, natural gestures Minimize distractors, like stoma blast, arm posture, environment Slide 12 Let s Begin Therapy Introduce the device and show how it works, how to adjust it Discuss placement and the sweet spot and find it May use a small piece of tape on the spot if there is reduced sensation Discuss rate and articulation They will know more about artic than they ever thought existed! Discuss on/off control and the goal to match the timing of speech Pay attention to non verbal behaviors

5 Slide 13 Therapy Continued Placement: All devices have appropriate placement for best sound transmission. It is trial and error, but must be established and practiced for 100% consistency. Neck placement must be complete and flush with the skin. It may be right, left, just under the chin, or on the cheek. Avoid bone and fibrotic tissue as it will limit the sound transmission. Can use palm of hand to demonstrate good, flush placement. Intra oral placement is ½-2 inches inside the corner of the mouth down the tooth line slightly toward mid oral cavity just above the blade of the tongue. Hand is held lateral to the cheek (to avoid visual obstruction of the mouth). Watch out for oral secretions drowning the device. Avoid occluding the tube tip. Pneumatic device requires complete seal around the stoma and intra oral placement of tubing. Pressure of the placement is important: too much=reduction in sound, too littleextraneous external noise. Beware. Encourage self-monitoring for clean, clear sound production. Slide 14 Therapy Continued Timing is critical Turn on the instrument at beginning of first word, speak in phrases and turn off the instrument at the end of the last word in the phrase. No mid- speech humming aloud! On/off with each syllable or word is very distracting, but so is droning on and on with no break in the sound. A laryngectomee can breath independent of his speech, but the listener can only process phase length material. Minimize distractions and prevent noise production, encourage clear speech production. Turn taking is also a part of effective communication and the timing of the on/off and one s turn to talk are related. We are teaching good communication! Slide 15 Therapy Continued Intelligiblity of Speech Is improved with slower rate of speech Needs attention to and production of initial and final sounds in words Articulation Plosives (p,t,k) and fricatives (sh,th,v,f,s,z) solely uses intraoral air --practice mouthing the words without electrolarynx and then with it Voiced vs. voiceless sounds will affect on-off timing Nasals (m,n,ng) require prolongation Use the hierarchy of single words (v, vc, cvc), two syllables, two words, short phrases Structure therapy incrementally and build in success before increasing complexity Use longer material, i.e., pledge of allegiance, or other memorized pieces with proper phrasing and articulation Lastly, engage in conversational speech and unknown topics

6 Slide 16 Therapy.Practice Makes Perfect Don t be afraid to practice with drill sheets. Many are available and they can be customized by the clinician Remember the importance of good communication skills: Quiet environment Eye contact Face to face 75% facial exposure (similar to lip reading) Facial expression appropriate to topic Use natural gestures Appropriate turn taking Over articulation and proper rate Slide 17 Therapy: Teach the Finer Points Progress from easy to hard: vowels, voiced consonants, nasals, voiceless consonants Use minimal pairs for practice: face/vase, ted/dead, sue/zoo, etc. Single words to phrases to sentences to paragraphs with natural phrasing Rate will be slower for greater intelligibility especially for the novice listener Encourage natural flow of speech Be creative with stress. There are several ways to achieve it: I.E., slow the rate; turn off the electrolarynx just before and after the emphasized word; elongate the emphasized word. There is no perfect device, but one will suit the best. Know and teach how it works, how to adjust it, and to change the battery. Make it look easy!!! Practice with the telephone. Practice out of the office or therapy environment. Slide 18 Quick Review Choose instrument carefully Know the instrument and how it works Use proper placement and pressure Use good communication skills and great articulation Choose the environment----quieter if its important Avoid distractors like stoma noise, buzzing sound Do not be afraid to repeat or ask if the listener understood Be relaxed and make it look easy

Introduction to Standard Esophageal Speech. Texas Laryngectomy Association 2018

Introduction to Standard Esophageal Speech Texas Laryngectomy Association 2018 Disclosure Objectives At the end of this presentation the participant will be able to: Describe the production of standard