Speech therapy rehabilitation

The speech therapy rehabilitation programme starts with diagnosis and continues during hospitalisation and after the patient's discharge. The distance from the rehabilitation centre can be an unfavourable element for the correct application of the whole protocol and the achievement of optimal functional results , particularly from a vocal point of view. Psychological support is important for controlling and respecting the anxiety and depression that arises following the diagnosis of a tumour. it is, therefore, essential that the speech therapist is able to meet the patient before the procedure in order to establish that relationship of trust which is fundamental for rehabilitation programme compliance. during the pre-operative meeting, the speech therapist will explain to the patient the functional issues connected with the procedure and the re-education strategies used to restore compromised function. Adequate post-surgical rehabilitation is essential for all functional cancer surgery that, with the exclusion of cor-dectomies, in which it is conducted on a purely outpatient basis, involves a phase during hospitalisation and a subsequent post-discharge, outpatient or day hospital, phase. Cordectomies Post-cordectomy speech therapy is aimed at recovering the voice and to be fully efficacious, it must favour the meeting of the cord and neocord, to prevent disadvantageous non-spontaneous compensations. it is precisely for this reason that re-education starts early and, in any case, after full surgical healing. in cases in which non-optimal vocal compensations and/ or markedly dysfunctional attitudes are present, work will focus on eliminating these problems before adopting the best phonatory mode. in those cases in which the new anatomical laryngeal situation does not make it possible to achieve physiological cord-neocord compensation 1-4 , phonatory exercises will aim to strengthen the false cord or arytenoepiglottic (sphincteric) voice, which will, in any case, allow the cor-dectomy patient to obtain enough voice for normal inter-personal relationships. The first step is always to achieve a correct respiratory dynamic (costo-diaphragmatic breathing) and good pneu-mophonoarticulatory coordination 5. To obtain a voice produced in the glottis (cord-neocord), vocal sounds (vowels and syllables with surd and sonant occlusive phonemic components) are used at acute pitch but moderate intensity constantly using laryngeal manipulation which will favour compensation by the healthy vocal cord. This will be followed by vocal exercises to prolong and strengthen the sound through the repetition of syllables (surd and sonant occlusives), monotonous variable combined vowels, pitch changes with vowels and syllables, disyllabic words, reading of words, sentences and stories. in those …