Communication development in young children with long-term tracheostomies: preliminary report

Communication development was studied in 77 subjects with long-term tracheostomies ranging in age from two months to 7 years. Children were categorized according to tracheostomy status (cannulated or decannulated), presence of speech practice prior to cannulation, and level of language development (prelinguistic or linguistic) at the time of decannulation. All were aphonic and consequently deprived of speech experience for extended periods while tracheostomized. Twenty-three children have been studied post-decannulation. Results for the children decannulated during the prelinguistic stage revealed that speech and language skills were attained commensurate with intellectual functioning. This evidence led to the conclusion that extensive, audible prespeech practice (cooing and babbling) was not needed for later spoken language development. All children decannulated during the linguistic stage exhibited specific spoken language delays including phonological impairment at the time of decannulation. The presence of speech practice prior to cannulation did not appear to be a factor in the severity of phonological impairment. The children who were cannulated for more lengthy time periods, extending into the linguistic stage, however, demonstrated more severe phonological impairment than those who were decannulated during the prelinguistic stage. With direct speech/language therapy, 20 of the 23 decannulated children eventually compensated for these difficulties, demonstrating appropriate spoken language skills. Alternative communication modalities were felt to be crucial in reducing communicative frustrations during cannulation.