_ It is very common for patients to want the ability to speak without having to manually seal their stoma/HME. We are all accustomed to having both hands available when speaking and once this ability is altered, many patients find their normal routines disrupted.
More recent advancements in laryngectomy rehabilitation have allowed many patients the ability to speak without having to use their hands to cover their stomas during speech. In this practice, there are many patients using the Provox FreeHands HME that allows for hands-free speech. The SLP staff can discuss your own personal potential for using this device but here you can find a basic discussion before considering if hands-free speech is a good option for you.
_ Benefits of Hands-Free Speech
_ Speaking with both hands available, allows for increased communicative freedom on many levels:
Driving: Many patients find it difficult to hold a conversation while driving in the car, as they have to use one hand to close their stoma, leaving only one hand on the steering wheel. As it is always safer to have both hands on the wheel, using a FreeHands will allow for optimized communication in this manner, leaving both hands free for safe driving.
Mealtime: Although laryngectomees have different challenges affecting their ability to speak while eating, the inability to use two hands for cutting, napkin use etc, while continuing to hold a conversation, can be lost without the use of a FreeHands device. This valve helps to restore more typical mealtime conversations when the laryngectomee has both hands available for meal purposes.
Writing: Although it is possible to write and speak while manually closing your stoma, many patients find this a bit challenging without both hands available for typing or writing/securing the paper. A laryngectomee whose profession is teaching, felt the FreeHands allowed him to better teach as he was able to write freely on the classroom board, while fielding questions and pointing out important concepts.
Speaking: Many of us are very accustomed to using our hands when we communicate. This is a non-verbal portion of communication that is very important to both how we communicate, as well as how our message is received. The FreeHands help to restore this important part of communication style.
Recreational Activities: There are many activities, such as playing cards, knitting, sewing, playing musical instruments, etc, that are done best with the use of two hands. In some cases, however, this limits the laryngectomee’s ability to communicate and more actively interact with others during such activities. Although many of these activities can be adapted to the use of a single hand, the FreeHands helps to restore the level of activity in this regard while still allowing the patient to actively communicate. Our own NTLS choir director uses the FreeHands HME to allow her to direct the music and guide the choir, while also singing along!
_ Some Considerations with the FreeHands HME
_ Although it is an excellent goal that all patients be able to utilize a FreeHands HME, there are some considerations to take into account that may not make it a viable option for every patient.
Seal: The FreeHands HME requires, just as typical TEP speech, an adequate tracheostoma seal. Patients who have difficulty achieving and/or maintaining a reliable seal may not be successful FreeHands HME users. This is particularly true if the topography (shape) of the neck near the stoma is irregular due to extensive surgery, reconstruction, etc. In these cases, it is often challenging to achieve a seal with a typical adhesive. If so, maintaining that seal while using a FreeHands HME may be very difficult. Without an adequate seal, the FreeHands HME will not function properly.
Adhesive Life: For many reasons, some patients struggle to maintain an adhesive seal over a typical period of time. Although the SLP staff can assist in optimizing your seal, if you are not able to maintain a seal for ~24 hrs using a typical HME, it is unlikely you will be able to use the FreeHands HME for extended periods of time.
Remember:When closing the stoma using a typical HME, your finger applies pressure against the stoma, thus helping to maintain a seal. When using the FreeHands HME, the opposite forces are exerted against the adhesive, which serves to often decrease the life of the adhesive seal.
Difficulty Speaking: It is never advised in this practice to attempt using a FreeHands HME before you are able to communicate well using a standard HME. It is very important you are able to produce easy and reliable speech on a consistent basis as speaking with the FreeHands requires some technique to assist with valve closure. Knowing how to control your new TEP voicing will help when it becomes time to trial the FreeHands. The SLP staff will determine when your speech has progressed sufficiently to consider using a FreeHands HME.
Backpressure: Excessive “backpressure” can make using a FreeHands HME extremely difficult, if not nearly impossible. Backpressure refers to the amount of pressure generated while transferring air from the lungs through the pharynx and out of the mouth. If you have difficulty transferring air in this manner (feeling as if you have to “push” somewhat to talk), the FreeHands will not likely work well for you, as this pressure then becomes exerted directly against the device and the adhesive housing, which will drastically limit the life of the seal, often causing the seal to blow very quickly.
Although excessive backpressure can be an issue when considering the FreeHands HME, some causes of excessive backpressure can be treated effectively. The SLP staff will work closely with you to optimize your overall speaking ability and ensure the lowest level of backpressure possible.
Although anatomical causes of backpressure are typically not alterable, should the backpressure be arising from a degree of esophageal stricture, muscular spasm, or excessive muscle tension, there may be very successful treatment options available to you. The SLP staff will work closely with your doctor to ensure this is best addressed.
Although the HME portion of the FreeHands device is typically reimbursed as any HME, the cost of the FreeHands itself is typically not covered by insurance or Medicare. Atos Medical Inc. can provide you with a quote regarding the cost of the device (1-800-217-0025). If your insurance will cover the HME component, typically there is not much additional cost beyond the initial investment in the valve. It is important to understand, however, that many patient also experience shorter adhesive lifetime, which causes them to use their adhesive supply at a quicker rate. This may be an additional financial consideration for you.
_ Provox FreeHands HME: How it Works
_ The FreeHands Speech Valve allows for hands-free speech by auto-closing the stoma using a magnetized valving system. It attaches to a designated HME (designed specifically to fit together with the speech valve), allowing for continued HME use, while also wearing a hands-free speech valve.
_How “easily” the valve closes in the speaking position is determined by the weight of the membrane used in the valve. The SLP staff will determine which membrane is best appropriate for you.
A “cough relief” valve ensure you are able to cough comfortably, without sudden pressure increases within the airway that might otherwise occur. This also reduces the pressure against the adhesive housing during coughing which should ultimately improve seal longevity. The cough relief valve is an adjustable feature the SLP staff can modify if necessary.
The Free Hands HME is secured to the stoma with an adhesive housing, just as a typical HME cassette is secured, although the speech valve extrudes slightly more than the standard HME cassette as the valve is a combined unit of both an HME as well as the speech valve.
It is removed from the housing as a typical HME cassette would be. Mucous should be cleaned/wiped from the HME as normal. Just as a standard HME, the FreeHands HME cassette should be replaced every 24 hrs. The FreeHands Speech Valve portion of the device is designed to be durable in nature and should not require frequent replacement. If needed, the Speech Valve Membrane component of the valve can be replaced, should that component need replacing while the remainder of the device remains functional.
_ Use and Care of the FreeHands
_ Although may patients are able to use the FreeHands HME daily for their regular use, there are more patients who find the FreeHands HME is helpful to have for more intermittent use.
Those who have difficulty maintaining a seal, for example, may decide to use the FreeHands when going out to dinner, attending a party or other social occasion. Some choose to wear the FreeHands while at work or at church, but using a standard HME the remainder of the time. Another patient uses it when she visits her grandchildren, since this allows her to hold, hug and otherwise interact with them more normally while speaking.
The FreeHands HME should only be used while awake!! It should always be removed for sleeping. A specially designed Provox HMEcap can be snapped onto a FreeHands HME cassette to allow you to sleep with an HME, although many patients choose to have XtraMoist cassettes on hand for sleeping.
The Speech Valve should be cleaned at the end of its use each day. Once the HME cassette has been removed, the speech valve should be cleaned, according to manufacturer specifications as directed in the “Instructions for Use” manual that accompanies the device. Although you should refer to the manual for specific instructions, cleaning is not difficult, using the provided cleaning container and a standard effervescent denture cleanser tablet.