IMPROVING SPEECH IN VENTILATOR-SUPPORTED PATIENTS

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In most patients who are tracheostomized and supported with positive- pressure ventilators, speech is characterized by phrases that are too short, silent pauses that are too long, and loudness and voice quality fluctuations that are too large. The research proposed in this application is designed to determine how to improve the speech of such patients, particularly those with neuromuscular disorders. Its focus will be to identify effective interventions that are simple, inexpensive, and safe. This research will be conducted in two phases, one that will evaluate short-term outcomes and another that will evaulate long-term outcomes. The first phase will examine the influence of a variety of different ventilator adjustments on speech. Those adjustments that are found to be most effective for improving speech without compromising cardiopulmonary function on a short-term basis will be examined further in the second phase of the research. The second phase will test the long-term efficacy of selected ventilator adjustments by monitoring cardiopulmonary status and speech behavior over many consecutive days. Functional outcome also will be assessed in appropriate cases. This research will have direct clinical applications. It will offer those professionals involved in the clinical care of ventilator-supported patients (e.g., pulmonologists, respiratory therapists, and speech- language pathologists) a data-based approach for determining ventilator settings for individual patients that will take into account not only cardiopulmonary needs, but speech-related needs as well.