Facilitating Speech in Stroke Patients with Tracheostomy

Immediate Action and Primary Solutions

The American Thoracic Society recommends consulting a speech-language pathologist immediately and trialing a one-way speaking valve, such as Passy-Muir, Shiley, or Montgomery valve, after ensuring the patient meets safety criteria, as this is the most effective method to enable understandable speech in tracheostomy patients 1
All patients with a tracheostomy should be referred to speech pathology services regardless of diagnosis, age, or expected duration of the tracheostomy, as recommended by the American College of Chest Physicians 1, 2
The speech pathologist should evaluate both communication abilities and swallowing function, as these are interdependent in stroke patients with tracheostomy, according to the American Speech-Language-Hearing Association 1
Speaking valves are the gold standard for enabling speech in tracheostomy patients because they allow exhaled air to pass through the vocal cords and upper airway rather than escaping through the tracheostomy tube, as stated by the American Thoracic Society 1, 2

Before trialing a speaking valve, verify the patient meets all safety criteria, including tracheostomy tube size, medical stability, ability to have the cuff deflated without aspiration, some ability to vocalize with the tracheostomy occluded, patent airway above the tracheostomy, and secretions are not thick, as recommended by the American College of Chest Physicians 1, 3
The speech pathologist should evaluate oral mechanism examination, swallowing ability, cognitive status, and respiratory status, according to the American Speech-Language-Hearing Association 1, 2

Ensure medical stability, verify airway patency, deflate the cuff, downsize tube if needed, trial speaking valve, assess speech quality, and evaluate swallowing safety, as recommended by the American Thoracic Society 1
Speaking valves offer significant advantages and should be strongly considered for all patients who meet safety criteria, with expected outcomes including improved communication quality, better quality of life, and facilitated rehabilitation participation in stroke patients, as stated by the American College of Chest Physicians 1, 3