School-based speech therapists work with children with a variety of hearing, communication, and language disorders. Some conditions may require the child to undergo a tracheostomy. Therapists need to have a good understanding of the challenges and impact a trach has on speech and language development in children.
Tracheostomy Basics
A tracheostomy is a surgical incision in the trachea. A tube is then placed through the incision into the trachea to help with breathing. A tracheostomy may be done for a variety of conditions including the following:
- Birth defects that cause airway obstruction
- Severe mouth and neck injuries
- Inability to protect the airway, which could cause aspiration of food into the lungs
- Long-term need for a ventilator for breathing
- Airway burns
Some children may need a tracheostomy long-term. Others may only require the trach temporarily. Whether it is required short-term or long-term, having a tracheostomy effects speaking and swallowing.
Tracheostomies performed at a young age before language skills are fully developed, can especially affect kids. Young children with a trach cannot practice making sounds, which can lead to speech delays.
Speaking Valves
Different types of trach tubes are available, which allow speaking. Also, a Passy-Muir valve placed on the end of the trach tube helps redirect airflow to the vocal cords, which makes speech easier. As a school-based speech therapist, you play an important role in helping children use the valve and learn to speak with the trach. Speech therapists help children adjust to the valve and increase their wear-time tolerance.
Therapy Ideas for Children with a Tracheostomy
If you are providing speech therapy for a child with a tracheostomy, there are several things you may want to work on. The individual goals vary greatly depending on the reason for the trach, the age of the child, and length of time the student has had the tracheostomy. School-based speech therapists may work on the following:
Practice with the speaking valve: Speaking using a Passy Muir valve may take a little getting used to. There are different ways to encourage students to talk including using apps. The Talking Tomcat is a fun app that may be helpful for young children. The app features a talking tomcat that repeats everything the student says, which can stimulate vocalization.
Swallowing exercises: Having a tracheostomy can affect a child’s ability to swallow. Exercises may improve the mobility and strength of the muscles involved in swallowing. Improved swallowing means children are able to eat and drink foods safely and also manage their oral secretions.
Alternative communication methods: Although many children that have a tracheostomy can speak, some may not. School-based speech therapists also work with children to develop alternative or augmentative ways to communicate. Alternative methods may include using a computer, a picture board, or sign language.
The work of a school-based speech therapist is critical for children with a tracheostomy to improve their ability to speak and communicate. What suggestions do you have for therapists working with children with a trach?