Preoperative augmentative and alternative communication enhancement in pediatric tracheostomy

Area of Science:

• Pediatric communication disorders
• Augmentative and Alternative Communication (AAC)
• Tracheostomy management

Background:

• Tracheostomy placement significantly impacts communication abilities in pediatric patients.
• Early intervention by speech-language pathologists (SLPs) is crucial for managing communication needs.
• Assessing communication tools and strategies before tracheostomy is vital for patient outcomes.

Purpose of the Study:

• To describe augmentative communication tools and strategies used by pediatric patients referred to inpatient SLPs before tracheostomy.
• To evaluate the utilization of various AAC modalities in this population.

Main Methods:

• Retrospective review of 46 pediatric patients who underwent initial tracheostomy between 2013-2016 at a tertiary pediatric center.
• Inclusion criteria: referral to SLP prior to tracheostomy for communication support.
• Data collection: patient demographics, speech-language disorders, and interventions; chart review and billing data analysis by two SLPs.

Main Results:

• 24% of patients had baseline speech-language disorders; 83% were nonspeaking pre-tracheostomy.
• 70% utilized electronic communication tools (high-technology).
• 78% used low-technology strategies, and 70% used no-technology or speech-enhancement strategies pre-operatively.

Conclusions:

• Consultation with SLPs before tracheostomy is recommended for all pediatric patients.
• Assessment should include high-technology, low-technology, and no-technology augmentative and alternative communication strategies.
• Multidisciplinary tracheostomy teams should integrate SLP expertise for optimal communication support.