By R.E. (Ed) Stone, Jr., PhD,  Director, 2004 IALVI

What is the IALVI?:

Beginning in 1960 as a creation of Speech Language Pathologists Warren Gardner, John Irwin, John McLear, an audiologist, Frank Kleffner who served as Director of the first IAL Voice Institute and laryngectomee, Mary Dohler, the inaugural IAL Voice Institute (VI) began in St. Louis, Missouri.  It and subsequent institutes held as their mission the education of professionals assisted by laryngectomized individuals to provide training in alaryngeal voice and speech.   As an observer at this initial IAL VI, James Shanks began a professional lifetime of service to laryngectomees and he has been affiliated with the program for most of its 44-year history.  Since the origin of the VI preceded the American Speech, Language and Hearing Associations adoption of the title Speech/language Pathologist, professionals at that time were referred to as Speech Therapists (ST).  Later, participants who demonstrated excellence in their own speech rehabilitation and who desired knowledge in helping others were invited to participate as laryngectomized trainees (LTs).  Groups of laryngectomized individuals seeking to develop their own esophageal voices were later added as Voice Institute Pupils (VIPs).  These three categories of registrants continue today. It is estimated that in excess of 860 STs, 301 LTs and 860 VIPs have participated in the VI through the years.  At an average cost of $25,000 to conduct a yearly Institute, the IAL has spent more than $1,000,000, in the training and education of individuals to work with the laryngectomized community and in addressing the voice/speech needs of VIPs.  An expanded historical coverage of the VI is provided by: Reeves, S., Alaryngeal Speech Rehabilitation Training.  Salmon, S. (ed), Alaryngeal Speech Rehabilitation. Austin, Texas: Pro-Ed, 1999.

One of the strengths of the VI is the comprehensive curriculum that is offered.  Although it has varied somewhat through the years it currently resembles what has been typical for most years.  During the latter 1960?s and early 70?s the VI convened for two weeks of instruction and practice in Hands-on delivery of training to laryngectomees, followed by participation to provide speech help for those attending the Annual Meeting.  This was a three week commitment for the trainees.  Economics, however, necessitated an abbreviation of the VI to one week of instruction with faculty providing group training to attendees of the annual meeting.  Present trainees have the opportunity to have directed hands on experience under the supervision of experienced faculty, as well as, the opportunity to observe faculty members in open sessions for IAL Annual Meeting participants.  Even with the shortening of the time to one week, the curriculum is similar in scope and sequence to earlier years, giving nearly equal time to consideration of the use of Artificial Larynx Devices, production of Standard Esophageal Voice and Esophageal Voice Production facilitated by the use of Tracheo-esophageal voice prostheses.  Topics for the 2004 IALVI include:

* ANATOMICAL CONSIDERATIONS FOR SPEECH FOLLOWING LARYNGECTOMY

* SPEECH OPTIONS FOLLOWING LARYNGECTOMEE

* ARTIFICIAL LARYNX OPTIONS AND A CURRICULUM FOR TEACHING THE USE OF ARTIFICIAL LARYNX DEVICES

* LABORATORY ACTIVITY WITH ARTIFICIAL DEVICES

* A CURRICULUM FOR PATIENTS? INCORPORATING TEP USE IN SPEECH

* SURGICAL/MEDICAL TREATMENTS OF LARYNGEAL CANCER

* WHAT IT TAKES TO GET STANDARD ESOPHAGEAL VOICE (SEV)

* GETTING THE FIRST SOUNDS WITH SEV

* A CURRICULUM FOR INCORPORATING SEV USE IN SPEECH

* PROTOCOLS FOR EVALUATING A SPEAKER?S USE OF SEV IN SPEECH

* PROTOCOLS FOR EVALUATING A SPEAKER?S USE OF AN ARTIFICIAL LARYNX

* PROTOCOLS FOR EVALUATING A SPEAKER?S USE OF TEP AND ASSOCIATED DEVICES

* RESEARCH IN LARYNGECTOMEE SPEECH AND SPEAKING

* INTRODUCTION TO TEP: HISTORY, FITTING AND TROUBLESHOOTING

* OBSERVATION OF GROUP THERAPY:

    * Artificial Larynx

    * Getting the first sounds using Standard Esophageal Voice

    * Developing proficiency and acceptability using Standard Esophageal Voice

    * Developing Excellence using Standard Esophageal Voice

    * Learning to use the Nose again for smelling

    * Meeting Problems with TEP

    * Meeting Problems with Hands-Free Valves

* OBSERVATION OF HOSPITAL CLINIC ACTIVITY FOR TEP PROBLEM-SOLVING      

* BODILY CHANGES ASSOCIATED WITH LARYNGECTOMY

* SCAVENGER HUNT FOR FACTS FROM EXHIBITORS RE: THEIR PRODUCTS AND WHO THEY ARE

* TRACHEAL HYGIENE AND STOMA CARE

* IAL TEST FOR STs, GRAD STUDENTS, and (optional) LTs 

* HOW THE FACULTY WOULD HAVE RESPONDED TO TEST ITEMS AND THE RATIONAL BEHIND THEIR ANSWERS.

Benefits of the Voice Institute to Speech-Language Pathologists:
 

An unsolicited evaluation of one of the recent participants summarizes nicely the contribution that the Voice Institute offers STs and LTs.  She wrote, speaking of the 2003 IALVI, ??it was the most educational, intensive, and well run course offering CEU credit I have attended in the past 10 years".

Several factors may contribute to the formation of such a testimonial; some professional, some financial.  The VI represents one of the finest faculties in alaryngeal voice rehabilitation.  Several senior members enjoy international reputations from their combined experiences of providing speech rehabilitation services to an estimated 10,000 laryngectomees in countries including the USA, India, Germany, Turkey, Luxemburg, South America, Canada, and Mexico where they also have lectured and conducted workshops.

VI trainees not only receive 40+ hours of formal didactics from the lecturing faculty  (graduate student trainees may used didactic hours toward academic credit upon approval of their academic institution) but also, trainees receive individual attention as provided in the form of mentoring to supplement the formal presentations.   Practicing SLPs may use these hours toward satisfaction of state licensure and/or CEUs.  Graduate students may also seek approval from their clinical supervisors at their academic institution for clinical hour credit.  All of our supervising faculty members hold Certificates of Clinical Competency from the American Speech, Language and Hearing Association.

Financially, the IALVI offers one of the best values possible.  Registration cost is $400 for practicing clinicians and $150 for graduate students.  Housing cost is usually less than the going rate at the hotel venue because of the bargaining power provided by joining with the IAL Annual Meeting.  Costs can be further reduced by sharing a room with another trainee, if desired and if it can be arranged.  Registration includes coffee breaks, the Annual Meeting banquet and several social events.  Each trainee is provided a course handbook that contains highlights of the lecturers? presentations and each ST, in recent years, has received a TruTone artificial larynx to take back to his/her work facility.

Additional information is available at: http://www.larynxlink.com/Anaheim/Anaheim1.htm.  Directors of academic training programs may wish to contact Dr. R. E. (Ed) Stone, Jr. (Director, IALVI), to arrange logistics and to assure that the VI meets the university requirements.

Benefits of the Voice Institute to Laryngectomees:
 

Whether an observer, an LT or a VIP no laryngectomee would leave their involvement with the Voice Institute without a realization that it has contributed substantially to their understanding of the process of developing functional communication.  LTs enjoy the presentations which, for them, may merely serve as an introduction to how they may assist others.  Many LTs will find the desire to return for one or more years to further their understanding of what is involved in becoming ready to assist in their home peer support group and assist an SLP in speech instruction.

VIPs generally come with less than desired communication skills and seek self improvement and a sense of direction for work at home.  It is not a rare occasion that a VIP comes with a history of having made no voice sounds since the laryngectomy and leaves the VI with success and restored hope for speaking again.  It is rare that a session will not have one or more ?success? stories of what seem to the individuals to be magical moment during the VI.  Let me share three.

Eugene experienced a glossectomy, laryngectomy and partial mandibulectomy.  He was fitted with a TEP but had not achieved success in making any sound.  During the VI he not only made his first sounds but was able to develop duration to support three-syllable phrases.

A man from India accustomed to public speaking as a livelihood came with a history of using only an artificial larynx device in order to continue his preaching activities.  He left the VI being able to produce multiple-syllable productions using standard esophageal voice.

A Bishop from Kenya attended the 2002 VI (after selling the family car to pay travel expenses) and learned to produce voice sounds on an inconsistent basis.  Borrowing money from friends, he returned to the 2003 VI and was able to develop three-syllable productions on one air charge.

Faculty of the VI also provides group instruction for attendees at the Annual Meeting that runs concurrently for part of the week of the VI.  Instruction is offered in:

   * Artificial Larynx Use,

   * Getting First Sounds using Standard Esophageal Voice, 

   * Shaping Sound into Communication using Standard Esophageal Voice,

   * Developing Excellence in Speech using Standard Esophageal Voice,

   * Problem Solving TEP Use, 

   * Problem Solving One-Way Tracheostomal Valves,

   * Spouse Question and Answer and Discussion, and

   * Learning to Smell Again (Appreciating Odors)  

Further, the faculty members of the VI avail themselves for consultation with attendees of the Annual Meeting.  Nowhere else can laryngectomees gain so easily-accessible and personal access to such expertise as provided by the faculty of the VI, and at no additional cost to the laryngectomee seeking help.

Benefits of the Voice Institute to IAL:
 

In the Voice Institute Director?s report on the 2003 IALVI to the Board of Directors in July, 2003, it was pointed out that IAL receives substantial non-tangible contributions as well as tangible benefits from sponsoring the VI. 

First, it should be noted that conduct of the VI is, and has been, a venture of the IAL that is a financially ?break-even? operation.  It provides an avenue for serving laryngectomees that does not deplete the funds available to IAL.  Thus, the VI is a self-sustaining outreach program that benefits not only the IAL membership but also laryngectomized non-members and the professional community.  It gives legs and arms to the goal of IAL to advocate and further the education of professionals in the area of laryngectomee rehabilitation and at the same time provide such rehabilitation to laryngectomees.

Aside from the financial revenues generated by contributions, grants, and registration to offset the expenses of the VI, approximately $90,000 in indirect benefits are received by IAL.  This amount comes in various forms. 

From the various employers represented by the faculty approximately $80,000 in lost patient revenues, salaries and benefits are donated for employed VI faculty members during the time that the members are assuming duties for the VI and AM.

A value of more than $2800 is represented by the ?clinical fees? that selected faculty members might charge for services rendered in providing break-out (group) training sessions for AM attendees.  Through the generosity of Distributors of TEP products who provide products during the TEP Hands-on Clinic Thursday evening more than $5,600 essentially is distributed to participating laryngectomees.  Hallway and other private consultations provided by faculty members to attendees of the IAL AM is a contribution valued at about $4,000.   Thus, in clinical services that do not necessarily relate to educating SLPs, the IAL receives more than $10,000 worth of benefits.   

Over the past few years, five research projects based upon work done at the VI and AM have been reported in the professional literature.  Consequently, the IAL received public visibility in venues that cannot be purchased.  Such ?Public Relations? on behalf of the IAL derived from the VI cannot be valued but is none the less most significant.