Voice Rehabilitation After Laryngectomy: The Impact of Breathing and Voicing Exercises

Breathing and voicing exercises can be transformative for people who have undergone a total laryngectomy, helping them to adapt to a new way of breathing and empowering them to reclaim their voice. We spoke to Dr. Thomas Moors, an MD with a special interest in voice rehabilitation, who highlights the significance of these exercises in the rehabilitation process.

Dr. Thomas Moors, MD, DOHNS, is a Belgian medical doctor with a special interest in voice and the integration of art into healthcare. Dr. Moors, who founded the Shout at Cancer charity, is dedicated to helping individuals rebuild their lives post-laryngectomy through workshops that incorporate breathing, singing, and acting techniques. Dr. Moors co-founded the Sound Voice project in 2015 to explore how creative collaboration can support people living with voice and breathing challenges. He received the Points of Light Award from the British Prime Minister in 2017 for his charitable work and achievements.

What is the importance of voice and breathing exercises for individuals who have undergone laryngectomy?

Breathing plays an important role in voice production, especially for those using tracheoesophageal voice. After a laryngectomy, the anatomy changes significantly, and factors like age and smoking can affect lung capacity and function. Optimizing breathing support is crucial as it provides the necessary airflow for our voices. People with a laryngectomy need to adapt to this new way of breathing and voicing, which feels very different from before. Regular exercises can help manage the increased pressure required for speaking.

Could you describe the specific voice and breathing exercises recommended for laryngectomy patients?

The Atos MyLife app offers exercises focused on controlling breathing and optimizing lung volume. These exercises include diaphragm exercises to enhance control of support muscles during exhalation, volume control to aid intonation and emotional expression, and support exercises to strengthen the muscles involved in breathing and voicing.¹ These exercises may also have a calming effect, which is beneficial for patients dealing with anxiety and low mood before and after surgery. Voicing exercises may help patients learn to listen to their new voice and improve control over it through techniques such as breathing support, projection, and articulation. Regular exercises can help patients find out how to control their voice, add intonation, and express themselves more individually.

How do these exercises contribute to the overall rehabilitation process for laryngectomy patients?

Regular voice and breathing exercises can positively impact the recovery of people with a laryngectomy. These exercises may help patients get used to their new voice, improve intonation, and enhance articulation.¹ They also can build confidence and help patients control their breathing, leading to better speech outcomes. Starting these exercises during hospitalization can aid in recovery, especially for those with smoking and age-related lung issues. On the other hand, voicing exercises are complex and involve over 100 muscles.²

Is consistent practice necessary for laryngectomy patients to experience the desired benefits from these exercises?

Yes, consistent practice is necessary to rebuild muscle memory and adapt to the new way of speaking. Regular practice can help patients apply the right techniques, which will eventually become automatic. Patients must be vigilant in applying the right techniques, which will eventually become automatic.

When is the optimal time for laryngectomy patients to start incorporating these exercises into their routine post-surgery?

It's beneficial to start breathing exercises before surgery and continue them during hospitalization. Voicing exercises should begin post-surgery, as recommended by the surgeon. Regular practice, even for short periods, can make a significant difference in the long run.

What potential difficulties or obstacles might laryngectomy patients encounter while performing these exercises?

Patients might face challenges such as keeping themselves motivated to perform these exercises regularly, physical discomfort like reflux, burping, and muscle fatigue, and dizziness from deep breathing. It's recommended to start exercises lying down to prevent dizziness. Consistent practice is necessary to rebuild muscle memory and adapt to the new way of speaking.

Could you provide information about the development of these specific voice and breathing exercises?

The exercises offered by the Atos MyLife app were developed in close collaboration with healthcare professionals. They are designed to be user-friendly and intuitive, allowing patients to train their voice from home effectively.

What role can caregivers or family members play in supporting laryngectomy patients during their exercise regimen?

Caregivers can support patients by assisting with routines, ensuring exercises are performed correctly, preventing falls or dizziness during deep breathing exercises, and providing encouragement.

What locations and times are best for laryngectomy patients to engage in these exercises effectively?

Patients should start breathing exercises before surgery and continue them during hospitalization. Voicing exercises should begin post-surgery, as recommended by the surgeon. Regular practice, even for short periods, can make a significant difference in the long run.

When can laryngectomy patients typically observe positive outcomes from practicing these exercises?

The timeline for observing positive outcomes varies among individuals. Small steps, such as better breathing control and improved coordination, can be motivating. Regular practice leads to better intonation, longer phrases, and overall improved voice quality.

Are the exercises for all users no matter where they are on their rehabilitation journey?

Yes, breathing and voicing exercises can be beneficial for all laryngectomy patients, regardless of where they are on their rehabilitation journey. Consistent practice, along with support from caregivers, can lead to significant improvements. These exercises may improve lung health and can help prevent complications but may also help patients regain confidence and control over their new voice.

References

1. Sesjardins M, Bonilha HS. The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature. J Voice. 2020 Jul;34(4):648.e1-648.e39.

2. Dimonyan K, Horwitz B. Laryngeal motor cortex and control of speech in humans. Neuroscientist. 2011 Apr;17(2):197-208. doi: 10.1177/1073858410386727. Epub 2011 Feb 28.