Pretsfelder L H, Izzo K L, Mohr R
Arch Phys Med Rehabil. 1985 Dec;66(12):814-7.
This study evaluated speech rehabilitation outcome and length of training needed for laryngectomized patients who underwent the Blom-Singer tracheoesophageal (TE) puncture procedure. Preoperative patient selection criteria included: 1) acceptable stoma size, 2) adequate motivation and manual dexterity, 3) absence of constrictor spasm. Training focused on coordination of breath control, articulation, muscle relaxation, and proper handling and maintenance of the "duckbill" prosthesis. Speech intelligibility in 12 patients was evaluated following the completion of their speech rehabilitation program, using the CID Everyday Sentences. Each patient was videotaped; the tape then was presented to unbiased listeners who recorded the sentences. The median percentage of intelligibility for the 12 patients was 89.5%; only one patient had a median score less than 60%. The mean length of formal training for the group was only 3.2 hours (range 1 to 7 hours). The percentage of patients attaining speech and the quality of their speech intelligibility was found to be higher than with esophageal speech, which is both time consuming and often difficult to learn. TE puncture followed by proper fitting and training in voice prosthesis usage improves speech rehabilitation outcome for the laryngectomized patient.
本研究评估了接受Blom-Singer气管食管（TE）穿刺手术的喉切除患者的言语康复结果及所需的训练时长。术前患者选择标准包括：1）造口大小合适；2）有足够的积极性和手部灵活性；3）无咽缩肌痉挛。训练重点在于呼吸控制、发音、肌肉放松以及“鸭嘴”假体的正确使用和维护的协调。12名患者完成言语康复计划后，使用《CID日常语句》评估其言语清晰度。对每位患者进行录像；然后将录像展示给公正的听众，由他们记录语句。12名患者的清晰度中位数为89.5%；只有一名患者的中位数得分低于60%。该组患者的正式训练平均时长仅为3.2小时（范围为1至7小时）。结果发现，实现言语功能的患者比例及其言语清晰度质量高于食管言语，食管言语既耗时又往往难以学会。TE穿刺并在使用语音假体时进行适当的适配和训练，可改善喉切除患者的言语康复结果。
