SPEAKING, DRINKING AND EATING

Speech

You may see a speech-language pathologist for assessments of swallowing, motor speech, and voice. Voice impairment is secondary to poor respiratory support. Your syllables per breath, pitch control, vocal intensity and vocal quality may be impaired. The length of phrases that you can articulate may be shortened.

About a month after I got off the ventilator I attempted to use software to record my speech. I was frustrated with the difficulty and gave up for a time. I couldn't teach the software to keep up with my pauses in the middle of sentences to gasp for breath.

Impaired respiratory and phonatory control correlates with the physical impairment of the C4 and C5 prolapsed intervertebral disc. Lower level quads may not experience this issue.

Speech may be improved by the use of abdominal binders. This is because abnormal chest wall behavior is attributed to loss of abdominal muscle function. Abdominal binders restore abdominal pressure and improve breathing capacity.

Some quadriplegics may have damaged vocal cords during injury or surgery.

In many situations time heals. As breathing becomes stronger with use of the spirometer, nebulizer, and binders, speech may improve.

Eating

Sometimes the swallowing muscles which help keep food and fluids out of the lungs and avoid aspiration and pneumonia do not function following injury. You may have to take fluids through an IV and food through a stomach tube.

If you have been on a ventilator your doctor will determine when it's appropriate to start drinking and eating again. Under careful monitoring you may undergo a "swallow test" in which you'll be asked to swallow various liquids as well as a placebo pill. If the lungs remain undisturbed you may eat and drink again. Your appetite may suffer in the beginning but it is important to eat and get enough nutrition and protein.

Some swallow test advice:

"If it's your first one then just follow the directions and relax. If it is after working with a speech and language coach then try to get them to set you up in a position that works best for you. My swallow return was a long four year process with multiple swallow tests and various results. I swallow liquid best when tilted back and thicker consistency when sitting upright. Pass or fail is not the end; there is work you can put in to try and get it back. The process all begins with that first gulp." Johnny, C4

Drinking

Now that you're allowed to drink again, you'll want to do it without help. Finding a sturdy cup and bendable, yet rigid straw that allows for independent water consumption can be tricky.

Adaptive products of this nature are pricey but worth it. The quadriplegic community highly recommends the bottles found at giraffebottle.com. Pick up a bottle holder that's adjustable and clamps to a round bed rail.

You can also try a hydration pack, a type of hydration system built as a backpack and containing a reservoir made of rubber or plastic. The long straw can be rigged near your mouth.