http://www.msnbc.msn.com/id/41266830/ns/us_news-life/
Rep. Gabrielle Giffords and her family are going through the rehabilitation and recovery process in the eyes of the country. As a victim of a gunshot wound to the head, Rep. Giffords has suffered a traumatic brain injury (TBI). TBI’s result in different problems based upon the location in the brain where the injury occurred. You can find a good map of the brain and its functions here: http://www.msnbc.msn.com/id/10401930. Some of the areas that can be affected after a TBI are speech, language, swallowing, cognition, breathing, and movement on one or both sides of the body.
Often at the time of a severe TBI or other accident a patient is given a tracheotomy - a hole in the throat through which mechanical ventilation (breathing) can be given. A tracheotomy (trach) tube must then be placed in the hole to keep the hole open and clean. Based on this report, Rep. Giffords was given a tracheotomy and now can breathe independently. They cannot immediately remove the tracheotomy tube and must now place a speaking valve to begin a “weaning” process.
The following is information about the weaning process of a tracheotomy tube. I am not involved in the care of Rep. Giffords, so I am describing the traditional process and what I hypothesize may occur with Rep. Giffords. The weaning process is common with all tracheotomies, and the amount of time required to complete the weaning process differs significantly between patients. Because the body has become used to breathing in and out through the hole in the throat, the patient may not be able to take enough oxygen into the body if the doctors closed the hole off immediately. Instead, the speech pathologist and respiratory therapist start with placing a one-way speaking valve over the tube so that the patient can breathe in through the tube and out through the mouth. After the patient is able to tolerate breathing this way for long periods of time, the speech pathologist and respiratory therapist will begin trials of “capping” the tube entirely. This will force the patient to breathe only with the nose and mouth and not through the hole in the neck. They will monitor oxygen saturation (quantities) in the blood, and work toward tolerating closing the hole off permanently.
You may be wondering why this valve is called a “speaking valve” and why speech has not been mentioned yet. The weaning process is important to patient independence and progress, but one of the main benefits of beginning this process is that this valve will also allow a patient to produce voice. When the patient is breathing in and out through the hole in the neck, the patient is not able to speak. No air is passing through their vocal folds (they are located above the tracheotomy site) and therefore speech is not possible unless a speaking valve is added. When the valve is placed, a person is capable of using their vocal folds to make noise (cough, say “ahh,” or speak words). A person may be able to immediately begin speaking after placement of the valve (if they have no injury to the part of the brain that controls speech production) or they may require further speech therapy to begin to speak again. I suspect that, based on reports of where Rep. Giffords was shot, she will have to undergo speech therapy to learn to speak again.
Thankfully Rep. Giffords has a wonderful team of speech pathologists, physical therapists, occupational therapists and doctors working to help in her recovery (I should know – I completed an externship at TIRR in the spring of 2009 and it is a wonderful place!). It appears that she is no longer in the acute (very seriously injured) stage and now can tolerate 3+ hours of therapy a day. As more information comes out regarding Rep. Giffords rehabilitation and recovery, I will try to comment upon it. Here is an earlier article with information about her injury and recovery process - http://www.huffingtonpost.com/2011/01/21/gabrielle-giffords-rehab-houston_n_812313.html.
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