Rebecca Wills BA, CRT, CRT-NPS
Does the placement of a tracheostomy tube have an impact on a patient’s physical functioning, for example: trunk control, posture, and movement?
Absolutely! The body is designed to be a closed system. The trunk includes the abdominal and thoracic cavities, separated by the diaphragm. The vocal folds and the pelvic ﬂoor create a closed “cylinder,” with the diaphragm regulating the pressure.
Trunk control, breathing and internal functions are dependent on the ability of the body to generate, maintain and regulate pressure in the thoracic and abdominal cavities. Placement of a tracheostomy tube creates a breach in that closed system, and that changes everything.
In your experience, what beneﬁt does a Passy-Muir® Valve have on physical rehabilitation?
The Passy-Muir® Valve plays a vital role in the rehabilitation of adult and pediatric tracheostomy and ventilator patients throughout the continuum of care. Within 48 hours of admission at Madonna Rehabilitation Hospital, the speech-language pathologists and respiratory therapists assess each tracheostomy patient’s speech, voice and swallow. As part of our tracheostomy weaning protocol, an individualized treatment plan (ITP) is designed. This protocol is utilized with all patients, including our medically complex Long Term Acute Care Hospital (LTACH) ventilator patients.
Communicating with family and caregivers is vital to a patient’s rehabilitation success. Use of the Passy Muir Valve restores the body’s closed system. The resulting positive pressure allows for improved breath support and phonation, and louder, more natural voicing. Early use of the Passy-Muir Valve facilitates participation in and/or the ability to direct one’s own care, another core goal of rehabilitation.
Patients typically rely on tracheal suction for secretion management. Restoring an effective cough can reduce or eliminate the need for this invasive procedure. An effective cough requires adequate inspiratory volume and expiratory ﬂ ow. With the valve on, the respiratory therapist can measure the patient’s Peak Expiratory Flow (PEF) using a peak ﬂ ow meter, and incorporate expiratory training devices and strategies to improve cough strength and quality.
Madonna’s interdisciplinary teams develop ITPs based on research-supported strategies. For example, physical therapist and published researcher, Dr. Mary Massery, demonstrates the relationship between breathing and postural control, and the need to treat them together in her course, “If You Can’t Breathe You Can’t Function”. The expertise of a rehabilitation team that incorporates these strategies with the Passy Muir Valve will allow every tracheostomy patient to maximize their potential and achieve the best possible outcome. Just ask some of our patients.
Shane, a 23 year old with paraplegia following a spinal cord injury, wanted to go home. His rehabilitation goals included being independent in his transfers. With an open tracheostomy, Shane was unable to generate and maintain the internal pressures he needed to lift himself into his wheelchair. Use of the Passy Muir Valve restored his body’s closed system allowing Shane to quickly meet his goal.
Jeremy, an energetic 2 year old with multiple disabilities has had a tracheostomy tube since birth. One of Jeremy’s out-patient rehabilitation goals was to increase his independence through the use of a manual wheelchair. With an open tracheostomy, Jeremy did not have the trunk control to sit upright without assistance and could not generate the internal pressure he needed to propel his chair. Once the Passy-Muir Valve was introduced, Jeremy’s interdisciplinary team of therapists began to focus on postural control and upper body strength and coordination. Jeremy is now able to navigate and explore his world like other 2 year olds.
Jerred, a 37 year old who had a C4 spinal cord injury on August 7, 2011 was admitted to Madonna three weeks after his injury. Ventilator dependent and unable to voice his needs or communicate with his family, Jerred was reliant on others to read his lips. Jerred’s speech therapist and respiratory therapist evaluated him for the use of the Passy Muir Valve within 48 hours of his admission. With the Passy Muir Valve, Jerred is now able to utilize voice activated technology, increasing his independence via his computer. He also uses a voice activated phone so that he can stay in touch with his 11 year old daughter, Taylor, who is at home in Iowa. To watch more patients at Madonna realizing their rehabilitation outcomes with the Passy-Muir Valve visit Madonna Rehabilitation Hospital's Center of Excellence page.
Rebecca Wills BA, CRT, CRT-NPS, Pulmonary Program Manager at Madonna Rehabilitation Hospital, has been a respiratory therapist since 1993 and received her Bachelor of Arts degree in Allied Health cum laude in 2004 and her specialty designation in Neonatal/Pediatric Respiratory Care in 2009. On staff at Madonna Rehabilitation Hospital in Lincoln, Nebraska since 1996, Rebecca is the Pulmonary Program Manager and is responsible for the development, growth, quality and marketing of programs for adult and pediatric tracheostomy and ventilator patients.