The journey to successful hands-free speaking

Communication plays a vital role in our daily lives, allowing us to express our thoughts, feelings, and needs to those around us. For those living with a laryngectomy, the loss of their larynx, or voice box, can negatively impact their ability to communicate verbally.

One person who is in tune with the feelings of laryngectomy patients is Dr. Ylenia Longobardi, who has been a speech therapist since 2013 and is employed at the Catholic University of the Sacred Heart and Gemelli Hospital in Rome, Italy. She specializes in vocal, olfactory and pulmonary rehabilitation of people living with a laryngectomy and in the rehabilitation of oncological, organic, functional and neurological vocal disorders.

Dr. Longobardi is dedicated to getting the best outcomes for laryngectomy patients. During her final year of undergraduate studies in speech therapy, Dr. Longobardi decided to specialize in the field of ENT oncology. Over the years, her passion has grown and relishes making a tangible difference in people's lives every day. "Restoring the ability to speak for those who have undergone a laryngectomy became one of my greatest sources of satisfaction" says Dr. Longobardi. This passion drove her to engage in research to constantly improve treatment and rehabilitation options for people with a laryngectomy. "Every step forward in my research further motivated me, as I continued to seek ways to offer them a better quality of life," she says.

Why is handsfree speech important?

Verbal communication is a luxury many of us may take for granted. But so is the ability to communicate while having our hands free to make gestures or to cook, for example. Dr. Longobardi believes that hands-free speech is crucial for people with a laryngectomy because simply restoring a mode of communication, such as occluding the stoma with a finger, may not be sufficient. "We must consider this mode of communication is different from their original voice, which presents a range of challenges for the patient beyond intelligibility alone," Dr. Longobardi explains.

By not having the ability to speak hands-free, the patient is required to perform an unnatural gesture of occluding their stoma. This limits the patient’s ability to engage in multiple activities while speaking but also draws attention to their disability during conversation. "Hands-free devices are invaluable tools as they offer a means for patients to communicate more naturally and seamlessly, without the constant reminder of their condition, ultimately enhancing their quality of life and social interactions" says Dr. Longobardi.

What is required for successful hands-free speaking?

The foundation for successful hands-free speaking comes down to timing. Introducing the option too early, when the patient’s voice is not fluent or they lack coordination, can lead to discouragement or even abandonment of the therapy. Conversely, introducing the option too late carries the risk that the patient may have become too accustomed to their current method of communication and may be resistant to change.

"By carefully timing the introduction of these devices, we can maximize the chances of success and ensure that every patient has the opportunity to benefit from them" says Dr. Longobardi. To be successful in hands-free speaking, patients need to be motivated to practice using the device regularly at home to build proficiency. "It's crucial to start gradually to avoid discouragement from fatigue and gradually increase the intensity. Leveraging the benefits of hands-free speaking, such as using it during meals or while cooking, can further reinforce its utility and integration into daily life," Dr. Longobardi explains.

What are the challenges involved with hands-free speech?

One of the main challenges is the adhesive not being the optimal solution due to detachment issues. However, this shouldn’t deter patients from using the hands-free device. Dr. Longobardi recommends a laryngectomy button as an alternative as it bypasses the adherence issue while providing greater stability. It also functions well when combined with a hands-free device.

What is the best approach to the challenges associated with hands-free speaking?

In a recent publication, Dr. Longobardi discusses how respiratory impairment is a significant concern for people with a laryngectomy, particularly during activities that require maximal respiratory effort. "The presence of a voice prosthesis (VP), generating sufficient expiratory pressure becomes crucial for vocalization in these patients, "says Dr. Longobardi. Muscles involved in respiration and vocalization retain the capacity to adapt positively to exercise-induced demands. Consequently, exercise can induce neuroplasticity, facilitating the recovery or enhancement of functions like phonation. "This could explain why movement-based vocal exercises influence the neuromotor control of respiratory and phonatory systems, even in the absence of the larynx, with enduring effects beyond the exercise session," Dr. Longobardi says.

The exercises discussed are tailored to mimic respiratory, phonatory, and articulatory physiology, focusing on enhancing vocal production. Training in the use of a hands-free device requires dedicated time for explanation, detailed instruction, and customized exercises. Specific phonatory exercises performed during movement facilitate hands-free adaptation by simulating dynamic and diverse scenarios, leading to a significant increase in hands-free usage (from 17.27% to 60% in our series) and a decrease in daily adhesive changes, reducing skin irritation.

"Patients found the treatment easy to learn, applicable at home, and reported high satisfaction levels and compliance. Interestingly, the reasons for non-use shifted over time, with fewer patients citing adhesive issues or fatigue and more attributing non-use to situations where speaking wasn't necessary. This suggests that the training enhanced patients' comfort with an automatic speaking valve use across various contexts," Dr. Longobardi concludes.

Ylenia Longobardi is a Speech therapist since 2013, and employed at the Otolaryngology Clinic of the Agostino Gemelli University Hospital Foundation – IRCCS and at the Catholic University of the Sacred Heart. She has specialized in vocal, olfactory and pulmonary rehabilitation of the laryngectomized patient and in the rehabilitation of oncological, organic, functional and neurological vocal disorders. Ylenia also graduated in Psychology in 2010 and obtained a double specialization course in Psycho-oncology in 2013 and in 2016. She has a Master's degree in Rehabilitation Sciences of the Health Professions at the Catholic University of the Sacred Heart in 2019.

Ylenia is a tutor and lecturer in the Speech Therapy faculty of Catholic University of the Sacred Heart in Rome, and holder of the teaching: "Speech therapy in vocal pathologies". She is often a speaker at national and international congresses. She is the author of 32 publications in international scientific journals relating to the rehabilitation of vocal pathologies and, in particular, of the laryngectomized patient with voice prosthesis.

Any recommendations in this educational material are a general guide for best practice, to be implemented by qualified healthcare professionals subject to clinical judgement and availability of healthcare resources.

The information presented should not be considered medical advice for specific conditions. A patient’s individual circumstances and preferences should always be considered and clinical practice should be in accordance with the principles of protection, participation and partnership.