- Recommended Reading
- Esophageal Speech
- Hands-Free Devices
- Text to Speech Apps
- Alternative Communications
- Speech Difficulties
WHAT IS HANDS FREE?
The Tracheostoma Valve, when used in conjunction with a voice prosthesis, enables hands-free, conversational speech. After proper fitting, the diaphragm portion of the valve rests in an open position and may be adjusted by rotating the diaphragm/faceplate for relaxed, quiet breathing, or routine physical activity. During speech, a slight increase in exhalation causes the diaphragm to close and divert air through the prosthesis. At the completion of speech, the diaphragm automatically reopens as exhalation decreases. (InHealth Technologies)
USE CLIP TO HOLD LARY BUTTON
Alligator clip is used to hold the Lary button and is great for hands free.
When I cough the cap sometimes goes flying so I anchor it with a clip to attach it to my clothing.
(Paul Frehner 2009)
USING THE BLOM-SINGER HANDS-FREE
VALVE & VALVE HOLDER
I have found that the edges of the valve holder for the Blom-Singer valve assembly often cut into the skin of my throat. This is particularly true because my reconstruction included placing a flap in place of skin and muscle taken from the throat. (O.K. the fact that I am overweight doesn't help either.). The skin above the valve holder pushes down on the holder. As the holder material ages, it gets harder and eventually irritates the skin. I have found that if I rotate among two or three holders, using a different one each day, I have less irritation because the different holders stiffen at a different rate and at different places. Therefore, the pressure areas change each day with each different holder. This doesn't completely eliminate the problem, but it eases it significantly (or, I believe it does, which is much the same thing for me). (Terry G. Duga)
Video showing an installation
A lot of members have written about having trouble installing their handsfree, so I put a video on youtube demonstrating how I install.
I'm probably the only person to make a video in the bathroom. This is a demonstration of how I do it. I know that it is not recommended to take off the insertion tab, but many do remove it. That's where I got the idea. The maker recommends against taking it off in any circumstance.
This is the link http://www.youtube.com/watch?v=5Wo1z5_n1j8
Hope it helps. [Steve Staton]
When Atos sent the address of a video relating to the use of an electrolarynx, I went to the site and watched a well done video explaining using an oral adapter on the electrolarynx. Then I noticed there were 60 of these videos. You can put them on autoplay or just have them in numerical order and chose the one you wish to see. They are varying lengths from 1 minute to double digits. Some are made for clinicians, instructional videos with professionals demonstrating how they solve problems. Many others, titled "Life as a Laryngectomy" simply tell who they are and a bit of their story. All are interesting and informative.
These links take you to information relating to Hands Free: They are part of the 60 videos.
#4 is Adjusting the Provox® FreeHands HME® for a new user
#10 is Life as a laryngectomee, using Provox® FreeHands HME®
#16 is Using a Provox® voice prosthesis - Sam La Master
SHOWER GUARD TO GO WITH THE HANDS-FREE DEVICE
Imagine my chagrin when I nearly drowned while taking that long awaited first post-laryngectomy shower. I had failed to take into account that my breathing hole was now oriented in the wrong direction relative to the shower stream and the high concentration of soap reduced the water surface tension allowing it to go places it was never intended to go. This was extremely disagreeable and I would suspect that many of you might have experienced a similar event. There are a number of products on the market designed to provide relief, but unfortunately some simply just don’t work very well. For those of us that utilize a tracheoesophageal prosthetic device to produce speech, there is a very effective little gadget available for our use. It is merely a small, upside down snorkel and all you have to do is remove your filter or "hands-free" device from the plastic collar and snap this thing in while you shower. I’ve been using one for two years and have yet to suffer the first leak. It works so well that you don’t even have to take any special precautions and may shower just as you did prior to the surgery.
I use the one designed and produced by ATOS (the blue one) and distributed by Bivona Medical Technologies. It has a clever little internal baffle that may make it slightly more effective. INHEALTH also markets a similar device (the clear one) that should work equally well. These things only cost a couple of bucks and should last forever so you really ought to give one a tryout. (Marvin Whitley)
MUCUS REMOVAL HINT
For you "hands-free" and HME TEP users, this is a tip that you will want to try. The collar that attaches your hands-free or HME device also makes it difficult to remove mucus from the margin of your stoma and the inside edge of the collar. To the best of my knowledge, nobody makes a product for that purpose and if you don't keep that area clean, the mucus will eventually cause the collar adhesive to loosen resulting in a leak or loss of seal defeating the purpose of both devices. Indiscriminately poking around in there exposes you to the possibility of injury or accidental aspiration. Fear not - There is an extremely inexpensive, safe, readily available product that will do a great job of cleaning that area. Try using a small (one-inch) disposable foam paintbrush. That's right - Paintbrush! The thing is made of mucus grabbing, open-cell foam (just like HMEs) so you can actually breathe right through it. Most importantly, it's sized and shaped exactly right to get in there and do the job. You can buy a package of them for about a buck at most hardware or craft stores - fifty cents is the most I've every seen a single one sell for. The technique is extraordinarily simple. Just go to a sink with a mirror, moisten the foam slightly, remove your "hands-free or HME, cover your stoma with the foam brush, cough right into it, rinse the mucus from the brush (recommend you get a black one to make that task easier), and then while exhaling slightly to maintain positive air pressure just insert the clean, moist (not wet) brush into the collar and rotate it with light pressure so as to scrub the pesky remaining mucus free from your stoma area. There are other foam brushes available which are apparently designed for special purposes such as stenciling, but I would recommend that you stay with a paintbrush as they have an internal plastic stiffener that will afford some degree of support while scrubbing. (Marvin Whitley)
instructions for installing base plate
KEEPING A SEAL
There has been a lot of talk on the list about how to keep a seal and the correct use of base plates. I have been a laryngectomiee for 25 years and have used a hands free valve with a base plate most every day. I almost never have an air leek. I have found that keeping the base plate from leaking air is a three fold process. The skin must be prepared properly using the right materials and the amount of back pressure must be limited to using just enough pressure to produce speech and not to much pressure to break a seal.
It is very important to put the base plate on correctly. I first clean my skin with a warm wet wash cloth. I then dry my skin and use an alcohol pad to clean any oil that is on my skin. I then apply a Skin Prep pad. I think of this as putting a layer of plastic wrap on my skin to protect it. After applying the Skin Prep it must dry. I use a short cut and dry it with my hair dryer. After the Skin Prep is dry I use a Skin Tac pad. I have found that Skin Tac is much better for my skin than Silicone adhesive. I take one of the Skin Tac pads and using one side I coat my skin. I then turn it over and coat the area around my stoma again. I then use my hair dryer to make sure that the Skin Tac is completely dry
I then very carefully take a base plate and remove it from it’s paper backing. Holding the base plate in my right hand I spread my skin around my stoma with my left hand so it is as smooth as possible. I then place the base plate on my skin so the hole of the base plate lines up with my stoma. I then press around to make sure that the base plate is firmly in place. I am set to go for the day.
I have found that it is best for me to remove the base plate in the evening. This gives my skin the chance to breath. I NEVER use an adhesive remover. The way an adhesive remover works is to break down the adhesive. If this remover is not fully cleaned off your skin it will continue to break down the adhesive. After I remove the base plate I wash my skin with a warm wash cloth.
If you have put on the base place correctly the next problem you need to address is the amount of back pressure. I like to think of this process as when you learned to ride a bike. You will remember that you would get on the bike and fall off. After doing this several times you would learn to keep your balance and you could ride the bike without thinking about how you were doing it. Learning to keep a seal is a lot like this. You must learn to use enough force or pressure to be able to speak and not so much pressure that you force the base plate off your skin and you get an air leak.
This whole process has a long time learning curve. I have had people tell me that they cannot keep a seal. I ask them have they tried using a base plate. They reply that they have tried using it several times. My reply to them is that I have put the base plate on over 8,000 times. I must admit that it took me about 6 months before I was truly successful.
In summation use the correct materials to put the base plate on, do it correctly, and control the amount of back pressure. When you have mastered these basics it will become as natural as shaving or putting on your make up every morning. I hope this may be helpful for those who chose to use a hands free valve or an HME.
ROUTINE FOR INSTALLING HOUSING
I use the Tru-Seal disposable housings with adhesive (Skin-Tac “H”) and here’s how they work for me. First, I gently clean the area around the stoma with plain soap and water, followed by alcohol. After that dries, I use a protective barrier wipe, either Shield Skin or Skin-Prep. This gives the adhesive a good base and protects the skin from irritation. I then apply a thin coat of adhesive to the area where the baseplate will go and wait about 4-5 minutes. (I use this time to do other grooming things which help the time go faster) I apply a 2nd thin coat and wait another 4-5 minutes. Now, I carefully place the baseplate around the stoma, making sure there are no wrinkles. At this point, I gently but firmly keep pressing the whole baseplate to work the glue in thoroughly. I then pop the hands-free valve in (with HME filter) and it’s done. I’ve also found that waiting about 15 minutes before speaking gives the bonding a better chance. When it’s time to change again, I use adhesive tape remover pads which I pick up at a local medical supply store and that’s that. It should work. Good Luck! (Libby Fitzgerald)
SECURING HOUSING FOR VALVE
When I was introduced to the Hands-Free device, I was given a bottle of glue and some disks. This was messy and unreliable as the glue did not keep the housing secure. I finally found Hy Tape, which is waterproof and has a zinc oxide base and created my own method of securing the housing for my tracheostoma valve, which I use on a daily basis. It has worked very well for me during the past 4 years..
My method is as follows:
Place the valve or housing on the tape disk and use a scissor handle to get a good seal.
Apply Skin Prep "only" around the area that will require tape.
Apply the housing over the stoma using fingers to seal.
Cut a 3 inch strip of Hy Tape and apply to the top of the housing under the chin.
Cut another strip a little longer and apply to the bottom .
The sides seem to take the most pressure so I use two strips on each side overlapping each other.
The housing should be secure. Normally it last several hours depending on use. If it breaks the seal, I simply pull it off, clean the area with "Remove" and put a new housing on with a new disk. I normally have three housings or valves, and remove the tape and disk each night. They can be cleaned with "remove" and washed with water to be used until they become brittle.
I find it quite reliable, easy to apply, and have used it successfully.
TAPE THAT HOLDS
After many problems with tape that came loose while holding the strap of my Blom-Singer prosthesis against my neck, I have found two 3/4" tapes that I can recommend. They both come in rolls that are probably available in every drugstore.
(1) 3M Nexcare Soft Cloth Premium Tape - Advanced Holding Power (White Tape)
(2) 3M Nexcare Foam Premium Tape - Absolute Waterproof (Flesh-colored Tape)
The Foam Tape seems to work the best for me .. although the cloth tape works almost as well. (Dutch Helms)
PREPARING SKIN TO HOLD TAPE
I've used 3M's Transpore tape to hold the strap on my prosthesis with good success for sixteen years. I suggest that you change the tape once or twice daily, and clean off the residual glue with a little alcohol on a Q-tip. You might leave the tape off for an hour now and then to let the skin breathe. Some people might find a thinner strip of tape (3/8" or so) placed alternately high then low on the strap is sufficient to hold the strap, and will give the skin more chance to breathe. (Ron Langseth)
GLUE ON YOUR CLOTHING?
When I first started wearing the hands-free valve and seal, it seemed I was having to re-glue all day long. Unfortunately, when using the glue to repair my seal, I ruined a lot of clothing because of the glue drips. I have finally found an adhesive remover that works really well and have removed the glue from the clothing. It is called "Citrus Magic" - Natural Citrus Stain & Adhesive Remover. I buy mine at a Meijer Store but you could probably find it at Target or Walmart. Also I have found an additional product it is made by Carbona. It is called Stain Devils Spot Remover for removing chewing gum and glue especially from fabrics. You can find this usually in any grocery store. (Kay Allison)
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