December 2004
(Note: Due to high graphic content, this issue will take a little while to fully load - be patient!)


 

Name Of Column Author Title Article Type
WebWhispers Columnist Dutch's Photos One Lary's Collection Experiences
Musings From The President Murray Allan Honor Thy Caregiver Experiences
VoicePoints Dietrich-Burns, Messing, Farrell Part III:  Transcervical Artificial Lary Education-Med
Bits, Buts, & Bytes Dutch Helms Computer Tips Experiences
Welcome New Members Listing Welcome News & Events

 

 

   WebWhispers Columnist
                                                                                  
Contribution from a Member
 

Boys and Their Toys! One Laryngectomee's Hobby
by Dutch Helms, WebWhispers Webmaster

      As many kids of my generation did, I grew up assembling and painting plastic model kits; in my case, mostly 1/72 and 1/48 scale airplanes.  By the time I graduated from high school my bedroom was overflowing with aircraft on shelves and even hanging from the ceiling.  My interest in this avocation, however, waned during my college years, replaced, as I recall, with interests in academics, "beer", "dating", and "girls".      After joining the USAF and after returning from a tour of duty in Vietnam my interest in "military modeling" returned, though it shifted from aircraft to, of all things, armored vehicles and soldiers (my USAF buddies were appalled!).  Thus, in the early 1970's, I began to build and collect 1/35 scale battle tanks and military figures associated with them.  This soon expanded into building the kits into homemade dioramas.  Below are two pictures of my work of that period, one from 1973 (left) and another from 1976 (right).

    

In creating these dioramas, I found that I really began to enjoy building and painting the figures much more than simply the machines.  This discovery made me expand my hobby to now include 54mm military miniatures.  Back in those days, suppliers of these miniatures were very limited; my sources back then were primarily Imrie-Risley kits and unpainted Britains miniature castings.  You can see a few of these 54mm miniatures in the above picture on the left. Below are some pictures of the 1/35 scale dioramas I made in the mid 1970's.


Panzer II & Kubelwagen
Afrika Korps - Tunisia - 1942


Flak 88mm Gun
3rd SS Panzer Div. - Russia - 1942

Panzer 38 Hetzer
2nd Panzer Div. - Kursk, Russia - 1943

Semi-Tracked Transport 7
3rd Waffen SS Div. - Russia - 1943

     In 1977, as I finished a Masters Degree program at the Naval Postgraduate School in Monterey, CA, I received orders for attach duty in Bonn, Germany.  Fearing that these delicate models would be destroyed in the move, I donated my entire tank and diorama collection to a leading professor in the school's history department, Dr. Russ Stolfi.  The good professor quickly obtained glass cases and put the entire collection on display in his classroom building, where it may still be today.  I then packed away the remaining military miniature figures into storage boxes where they remained for years.  For reasons unknown, my interest in and passion for miniatures disappeared and remained buried in my soul for over 20 years.

     Then, one weekend in the autumn of 1999, I was up in Ohio visiting my brother, Richard.  In the guest bedroom where I stayed, I noticed HIS growing collection of miniatures and was fascinated by how much the scope and range of this hobby had grown over the years.  Reinspired, I returned home, rummaged through my storage boxes and rediscovered my long-lost 54mm figures, amazingly still in relatively good shape.  I found some room on my living room shelves and put these relatively few figures out for display.  In short, I got the ITCH for military miniatures again and over the past five years it has grown exponentially.     Currently, my collection now numbers somewhere around 490 54mm figures along with around 190 30mm "flats" (old-fashioned two-sided flat figures from Europe).  The range of my figures run from a Sumerian Heavy Infantryman from 2500 BC, to a Japanese infantry squad as would have been found on Iwo Jima in 1944.  My 54mm figures are now displayed in 5 display shelf units in my living/dining area and my 30mm "flats" are in four diorama boxes on my living room walls.

     As a military miniature collector, one has two choices: (1) procure pre-assembled and pre-painted figures or (2) procure kits and assemble and paint them yourself.  While many companies now offer completed figures, these can be very expensive since it is labor-intensive work.  The really well-done single figures, mostly now done in Russia, England, Hong Kong and Latvia, can be purchased starting at around $60 to $100 ; mounted knights, etc., can, however, go for as much as $500 each.  Many other companies offer only kits.  These are generally white metal castings of varying quality, good to fantastic, and come unassembled. That is, a typical kit would consist of: head, helmet, torso, two arms, two legs, rifle, sword, dagger, canteen, backpack, and the figure's base.  Kit prices generally range from $10 to $30 for foot figures, slightly more for mounted figures.  For me, the kit route is the best. It is more challenging, more creative, and more fun.  The vast majority of pieces in my collection are miniatures I have done myself.

 


Egyptian Nobleman

1066 BC



Greek Hoplite

Marathon - 490 BC



Republican Tribune
Rome - 50 BC

 


Greek Hoplite
Athens - 450 BC

 


Praetorian Guard

Rome - 50 AD



Gothic Warrior

475 AD

 


Viking Warrior
10th Century AD

 


Frankish Warrior
850 AD

     Assembling and painting a kit is a time-consuming process.  First, one needs to know HOW to paint it.  While most kits come with painting guides, it is often necessary to do further uniform research to make sure your completed figure is historically accurate.  Uniform references abound, though one of the best is the Osprey series.  Once one knows how the finished figure should look, the real work begins.  In general, a typical figure is produced as follows:

(1)    Using a small file, each part is finished/smoothed to remove any metal flash or casting seams that were created when the part was made.

(2)    Each part is then painted with a primer to seal the surfaces and to better prepare the part to accept the actual painting.

(3)    Each part is then painted, working from inside out - like getting dressed; undershirt first, then shirt, then jacket, then backpack straps, etc., and then details like buttons, lace, insignia, braid, shading, etc.

(4)    The face and other exposed flesh parts are painted.  Painting the face is detail work, especially eyes, eyebrows, lips, mustaches, etc.  The goal is to make the figure look like a real person, not a doll.

(5)    Almost finally, all the parts are bonded together, generally using a variant of super-glue.

(6)    Then finally, the assembled figure is retouched to cover any seams, to complete or add further details, and to make sure it is as perfect as possible.  (Some collectors, as a final step, add a coat of clear semi-gloss or flat acrylic varnish, to further protect the figure's finish.)

 


Norman Knight

Hastings -1066



Richard I (Lionheart)

England - 1190



Bavarian Knight
Germany - 1350

 


Welsh Chieftain
Wales - 1270

 


Regiment 6
Giant Grenadiers

Prussia -1714


 


Kaiser Wilhelm II
Germany -1900

     Depending upon the individual figure, the entire above process can take between 8-15 hours, spaced out over a period of several days (to allow for drying times, eye-strain, etc.).  Painting the figures requires specialty paints, made specifically for military miniature purposes.  Also, one needs very SMALL brushes because of the detailed painting required.  Good lighting is an imperative, so you can SEE your work.  Also, especially at MY age, I find that using head-mounted magnifying glasses a real advantage.  They are comfortable to wear and really help when painting details.

     As you can probably tell, assembling, painting, and collecting military miniatures is NOT a cheap hobby.  In addition to the kits, you need glues, primers, paints, brushes, files, painting accessories, and reference materials, etc.  Several months ago, just for fun, I attempted to determine what I had spent on this hobby since 1999 for miniatures, kits, materials, and display cases, etc.  My best guess approached just over $10,000.00.  Yes, that is a LOT of money but I don't regret a penny of it.  It has been and remains an enjoyable, challenging, interesting, educational, and therapeutic hobby and I do not have to TALK to anyone while doing it!!  J


3rd Regiment Prinz Karl
Bavaria - 1815

St. Petersberg Grenadiers
Russia - 1815

     You can see more pictures from my collection on my Personal Web Site, beginning at: 

http://members.aol.com/FantumTwo/photos2.htm      For those interested, below are some very good online sources for figures and kits:Arquebus Military Miniatures:  http://www.arquebus.com/
Michigan Toy Soldier Co.: http://www.michtoy.com/
Dutkin's Collectibles: http://www.dutkins.com/
Bryerton's Military Miniatures (Tradition figures): http://www.bryertons.com/tradition_54mm_.html
GJuss/Art I.G.: http://www.gjuss.lv/
Tin Soldiers: http://soldiers.spb.ru/
AeroArt OnLine: http://www.aeroartinc.com/milminhome.asp
Saratoga Soldier Shop: http://www.saratogasoldier.com/
Andrea Miniatures: http://www.andrea-miniatures.com/
W. Britains: https://www.ashdown.co.uk/tgp/eden/britshop.asp
King and Country: http://www.myweb2s.com/ecat/servlet/EcatCatg?comp_id=7
Real Miniatures: http://www.realminiatures.com/
Links to Dealers worldwide: http://www.btinternet.com/~model.soldiers/linkman.html

 

                Murray's Mumbles ... Musings from the President

On The Mend - Slowly ...  HONOR THY CAREGIVER!

Many thanks to all the members that were kind enough to send me cards and their good wishes during my recent spinal surgery.  Unfortunately a nerve was stretched during the procedure which left me with a non-functioning right arm which in my case is the dominant one.  They tell me that time and physiotherapy are the only cures so I am waiting impatiently for both to take affect. I would never had believed how much a person couldn't do on their own without the aid and assistance of their caregiver. The simplest tasks are impossible.  Showering, shaving, getting dressed, proper stoma care are a distant memory.  Brushing your teeth and combing your hair with your left hand are a simple exercise made almost impossible unless your ambidextrous. Without my wonderful wife June to cut my food I would look like a low-carb advocate.  June is a treasure and without her kindness and thoughtfulness in helping me eat, clean up and dress, etc, etc, and being entirely supportive, I would be totally lost.  We never miss our independence until it is taken from us.Typing is also a great challenge.  I hold my right hand with my left and pound away.  I will not be winning any speed contests.  I am trying to train my big orange cat Rusty to lay in front of the keyboard so I can use him for a wrist rest. Rusty is not cooperating!Thank you again for your kind thoughts, prayers and good wishes.  They were truly appreciated.  Now, let's hear it for our caregivers!!Take care and stay well.

Murray


 VoicePoints [ ©  2004 Dan H. Kelly, Ph.D. ]
  
  coordinated by   Dr. Dan Kelly, Retired Associate Professor ( dy_kelly@msn.com )
                                Department of Otolaryngology, Head & Neck Surgery
                                7700 University Court, Suite 3900, West Chester, OH  45069

© November 2004 Katie Dietrich-Burns, M.S., CCC-SLP,
Barbara P. Messing, M.A., CCC-SLP
& Stephanie Sulc Farrell, M.S. CCC-SLP


 

Third of a Three Part Series:

Foundation Skills for the Artificial Larynx

Part III:  Transcervical Artificial Larynges

 

 All authors are affiliated with the

 Milton J. Dance Head and Neck Rehabilitation Center

 at the Greater Baltimore Medical Center, Baltimore, Maryland

This article is the third installment of a three-part series intended to provide information on the various types of artificial larynges and the foundation skills necessary for optimal use.   The most common artificial larynx in the United States is the transcervical or neck-type. Transcervical artificial larynges are battery powered electromechanical devices that move a plastic or metal head, which generates a sound, or tone.  When the head is held against the tissues of the neck or cheek, this tone is transmitted into the oropharynx, where sound is shaped into meaningful speech by movements of the lips, teeth, tongue and jaw.   This article will focus on foundation skills for use of electromechanical, battery-powered, artificial larynges and their transcervical use.

There are many brands of transcervical electrolarynges from which the laryngectomee may choose. As stated in the second article of this series, many transcervical devices such as the Servox Inton, Servox Digital, Trutone, and NuVois may be adapted for intra-oral use.  This modification is typically used in the acute post-operative phase, when the tissues of the neck are edematous, and risk of suture line breakdown is paramount should the device be applied to the region of the neck as originally designed.  Early introduction of a transcervical electrolarynx with an intra-oral attachment allows the patient to learn the basic functions of the device and to start communicating orally as soon as possible. Once these acute problems have resolved, and medical clearance has been obtained, the majority of laryngectomees are able to begin using an artificial larynx transcervically. As with other types of artificial larynges, patients will require practice to achieve proficiency.  

In 1983, Shirley Salmon developed a protocol for training laryngectomees in the use of artificial larynges. Dr. Salmon describes the important elements and hierarchy of teaching patients how to use an artificial larynx with the intent of maximizing speech intelligibility using the mnemonic I PAT PAL (see Figure 1).

Figure 1: Instructional Method for Teaching Use of an Artificial Larynx

I = Information:  The patient is informed on benefits of artificial larynges and selection
of the proper device.  Influential factors: purchase price and upkeep, availability, possible
modifications, expediency, post-operative complications, patient preferences.

P = Placement: Placement of the device to achieve.  For example, with certain artificial
larynges, the "sweet spot" is the place in at the best clarity of sound and resonance is
achieved. With intra-oral devices appropriate placement of the intra-oral tubing is
discussed.

A = Articulation: Shaping sounds into speech using the articulators for precise sound
production.  Overarticulation or exaggerated movements of the articulators is often
recommended to increase speech intelligibility level.  Placement of the artificial larynx
should favor lip reading.

T = Timing: "On-Off" timing consistent with syllable initiating and releasing positions of
phonemes in words and phrases results in optimum sound production and greater speech
intelligibility level.

PAL = Pitch and Loudness: Modify pitch to more closely resemble gender appropriate
pitch level.  Loudness - volume should be adequate for the communications setting.
Changes in one will usually show changes in the other.

(S. J. Salmon, Ph.D., 1983)

Instruction on the use of a neck-type artificial larynx using the ?I PAT PAL? method:

I = Information.  The patient is informed on benefits of the transcervical artificial larynx as well as other artificial larynges.  This discussion should include:  device costs, availability, model options, design differences between models and purchasing information.  The purpose of the artificial larynx must be discussed. Is this device to serve as the patient's primary mode of communication, or will it be a "back-up" device for use when esophageal voice or tracheoesophageal voice are not optimal.  The Speech Pathologist ideally will have an assortment of devices available for demonstration, trial and purchase. Once a model has been decided upon and dispensed specific care and use instructions should be provided.

P = Placement.  Optimal and consistent positioning of the device is necessary for appropriate sound transmission.  Correct placement varies with individual users and may vary over time and treatment.  Optimal placement is determined by examination of the patient's neck and oral structures and direct experimentation.  If the neck is edematous or fibrotic sound waves will not be adequately transmitted through the tissue.  Alternatively, neck-type artificial larynges may be placed on the apple of the cheek, at the midline junction between the neck and floor of mouth or the anterolateral aspect of the neck (Keith, 1994).  The point of optimal sound transmission is termed the ?sweet spot?.  It is paramount that the entire circumference of the vibrating head be placed firmly and directly on the sweet spot. Incomplete contact of the vibrating head will generate a distracting buzz, which results in a poor signal-to-noise-ratio and reduces speech intelligibility.  If placed too firmly against the tissue, sound transmission may be dampened (Graham, 1997).  If the unit is placed correctly the sound will be perceived by the listener as emanating from the mouth.  Some clinicians find it useful to mark the "sweet spot" with a piece of tape or skin marker. This allows the patient to locate the sweet spot easily while practicing optimal placement in front of a mirror. Practice should continue until consistent placement has been established. (Graham,1997).  Ideally, the laryngectomee would hold his artificial larynx in his non-dominant hand, while placing the unit on the ipsilateral side of the neck. This frees the dominant for writing, gesturing, hand shaking or holding a telephone receiver.  Non-dominant hand use cannot, always be achieved without compromising patient comfort. Arthritis or upper extremity weakness may make use of the non-dominant hand impractical.   If the laryngectomee has a unilateral hearing aid, it is recommended that the patient place the artificial larynx on the contralateral side of the neck. This placement increases the distance between the artificial larynx and the hearing aid which reduces ambient noise, generated by the electrolarynx, from entering the aided ear. Improved signal-to-noise ratio in the aided ear may help the laryngectomee monitor his voice out-put.    

A = Articulation.    The lips, teeth and tongue and mandible position are responsible for shaping the tone produced by the artificial larynx.  An oral-peripheral examination it is recommended prior to embarking upon direct treatment of articulation skills.  This examination should identify fit of dentures, movement of oral structures and strength. If problems are noted, an oral-motor treatment program should be instituted. The oral-peripheral examination should be repeated periodically if the laryngectomee patient is undergoing radiation therapy, as changes in oral and neck tissue status, such as mucositis and lymphedema may restrict oral movement or transmission of sound waves through the soft tissue of the neck. This may result in changes to the sweet spot. Unlike intra-oral or pneumatic devices, transcervical artificial larynges do not have tubing that might obstruct movement.  However, slight exaggeration of lingual and labial contacts is often necessary to improve speech intelligibility for all patients using electromechanical speech. A natural or slightly reduced rate of speech should be encouraged. Firm articulatory contacts increase intraoral-pharyngeal air pressure, which may contribute to accurate production of voiceless consonants (Graham, 1997). Voiceless consonants are the most difficult phoneme class for electrolarynx users to produce. Electrolarynges transmit sound, or voice, continuously if the tone button is depressed.  Laryngeal speakers start and stop voicing intermittently throughout words depending upon the phonemes in that word. For example, the vocal folds vibrate, for the voiced phoneme /g/ but not for the voiceless phoneme /k/. Electrolarynges transmit sound, or voice, continuously if the tone button is depressed.   Therefore, voiced phonemes will be substituted for voiceless sounds (e.g. /g/ for /k/). Voiceless phonemes with no voiced cognate, such as /h/ cannot be produced by an electrolarynx.  To produce a voiceless phoneme such as a /k/ in the word car, the speaker must articulate the /k/ a split second prior to turning to activating the electrolarynx. It is important to educate the laryngectomee and his family about articulation problems relating to voiced- voiceless sound substitutions and to teach compensation strategies for these errors as soon as possible. Simple, short-term solutions may include, spelling out words that are not understood by family and staff or using alternative words.   

T = Timing.  Once the "sweet spot" has been established the patient's next voicing goal will be to obtain consistent, coordinated on and off timing. All transcervical electrolarynges currently available are battery-operated and switch activated.  Sound is generated when the switch is depressed and ceases when it is released. Individuals new to artificial larynges may activate the on-control prior to speaking or conversely start moving the articulators before turning on the device. Others may release the button before they have finished speaking. Frequently, laryngectomees new to the artificial larynx may fail to turn the device off immediately after speaking. This adds a schwa at the end of each mistimed utterance. For example, instead of "one",   "one-/ә/" is produced.  Other timing problems include: turning the unit off between every syllable within a word, creating a distracting, staccato-like effect or conversely, not turning the unit off between phrases, creating run-on utterances.  The patient should be encouraged to mentally think of his sentences in phrase units and pause slightly (off voicing) between those phrases and to refrain from deactivating the unit after every word or syllable. For example, the sentence "We speak in thought units, not in parts of speech" is best understood by the listener if delivered with a slight pause at the comma, dividing the two phrases.

Timing errors, whether in the on or off aspect, can impact intelligibility as much as poor articulation. Fortunately, these timing errors are easily corrected with guided practice. Timing errors often become clear to the patient if the speech pathologist demonstrates both the error and the correct target in succession. The first goal of timing instruction and practice is coordination of external sound source activation/deactivation with purposeful speech movements.  Advanced timing skills facilitate articulation of voiceless consonants. For example, articulating voiceless consonants just prior to activating the on control. Natural pausing and speech phrasing should be reinforced, from the start of electrolarynx training.

PAL = Pitch and loudness. The pitch of the electrolarynx is set by the speech pathologist during the initial artificial larynx treatment session. Pitch should be adjusted to a level that is appropriate to patient's age and gender. Volume should be set so that the patient can hear himself clearly.  After the patient establishes proficiency with the elements of placement, articulation, and timing, they can be taught to modulate pitch for more natural intonation patterns by manipulating the pitch buttons on the external device.  The laryngectomee should be instructed on basic volume adjustments specific to his or her device within the first few treatment sessions.

Distracting Behaviors- Distracting non-verbal behaviors are not part of the standard I PAT PAL pneumonic. However, Archer (2002) suggests that nonverbal communication is more powerful in message decoding than words alone.  Therefore, nonverbal behaviors must be considered a fundamental skill, no less important than placement or articulation, for effective communication. Distracting behaviors may appear within the first treatment session. Behaviors, such as stoma blast, facial grimaces, & head contortion, call attention to communication delivery at the expense of content.  Prolonged exhalation naturally occurs during laryngeal voice production. To project the voice, the laryngeal speaker forces air over the vocal folds. Electromechanical voicing allows for continuous voicing at any point, regardless of inhalation-exhalation cycle (Graham, 1997). Forced exhalation will not create a volume gain in the laryngectomee. Strong exhalatory force creates turbulence at the stoma which produces an audible sound referred to as "stoma blast".  Stoma blast calls attention to its self, is distracting to listeners, and if forceful enough may mask or override the signals of speech with noise.  Negative practice, contrasting controlled exhalation with forceful exhalation is useful in eliminating stoma blast, and improving intelligibility. Facial grimaces or atypical head and arm postures often resolve once the patient?s attention has been called to them. Videotaping or practicing conversational skills at a laryngectomy patient group may also be useful in eliminating these unwanted behaviors.  

Historical Perspective of the Transcervical Artificial Larynx

In 1942, Wright introduced the first electrolarynx, the Sonovox (Keith, 1994).  This unit was produced by Aurex in 1945, and set the design foundation of the modern transcervical artificial larynx. In 1959, the transistorized Electrolarynx was developed by Bell Laboratories (Keith, 1994). The Bell or Western Electric was produced in two models 5A and 5B, which incorporated internal preset frequency ranges for males and females respectively. This preset pitch range could be adjusted to meet individual preference.  The laryngectomee could additionally modify the pitch with an external tone activation switch.  The Western Electric 5A and 5B do not have an external intensity or volume adjustment.  The Western Electric was powered by a carbon-zinc battery. However, physical adjustments to the battery compartment as reported by Eric Blom in 1978, allowed the unit to accommodate standard 9-Volt battery (Keith, 1994). The patient and clinician were advised to exercise care during these adjustments, because damage incurred during this change nullified the manufacturer?s warranty.


Figure 2:  The Western Electric Electrolarynx
Reprinted w/ permission of AT&T

In an attempt to reduce need for repair or replacement of the 5A and 5B units, Bell introduced an updated model of the Western Electric electrolarynx, the 5C, in 1985.  Improvements to the 5C included: transducer head changes, elimination of pitch-gender assignment, and elimination of external variable-pitch control.  Pitch adjustments to the 5C were made solely by turning the single, internally placed, screw. Volume adjustments were made by turning the collar around the vibrating head of the unit.   The 5C utilized a standard alkaline 9-Volt battery.    

In the early 1990s, AT&T began phasing out the 5C, replacing it with the 5E.  Unlike its predecessors, whose casing was beige, the case of the 5E was matte grey. The 5E incorporated a three-frequency control switch to allow basic pitch adjustment during conversational speech.  The middle position of the pitch control indicates fundamental frequency.  Sliding the switch up elevated the pitch by one-half octave. Sliding it down, lowered the pitch one-half octave from the fundamental frequency. Like the 5C, the fundamental frequency of the 5E could be altered by rotating an interior screw.  The 5-series dominated the artificial larynx market for several decades. However, Western Electric or AT&T artificial larynges are rarely seen in the twenty first century.  A small number of units are available through the National Special Needs Center in Parsippany, NJ.

 Perhaps the most commonly used model of transcervical artificial larynx is the Siemens Servox Inton. The Servox Inton generates a tone as a piston strikes a fixed diaphragm in the head of the unit (Keith, 1994).  Volume is easily adjusted by the user by moving the volume wheel on the exterior of the unit. Fundamental frequency is adjusted both internally via screw and the speaker may choose from two frequency control buttons. The upper button generates a fundamental frequency, while the lower button generates a fundamental tone that is one-half octave lower.  This two-button system was designed to improve inflection in electromechanically generated speech.  The Servox Inton is powered by a rechargeable NiMH battery.  The Servox battery can be recharged without removing the battery from the casing.  The cost of the Servox Inton is approximately $515.00.

In 2002, Siemens introduced the Digital Servox. The Digital Servox is similar in appearance to its predecessor.  The plastic portion of the Digital Servox casing is blue in lieu of the Inton?s light grey.  Like the Inton, the Digital Servox uses a rechargeable NiMH battery.  Pitch is set internally and the user may use one of two buttons externally to select pitch or to create inflection.  Volume is adjusted by depressing one of the pitch buttons and moving a rocker switch. Volume settings may be set, so that one button may produce a louder tone than the other. The Digital Servox is similar in cost to the Inton.


Figure 3: The Servox Inton
Reprinted w/ permission of Siemens Medical


In 1997 Griffin Laboratories introduced the TruTone electrolarynx.  The TruTone generates its sound through a vibrating membrane housed in a black plastic casing. The TruTone is powered by either a 9-volt alkaline or 8.4 Volt rechargeable batteries. Volume is adjusted by moving an externally visible dial on the side of the casing. Pitch adjustments are made both internally and externally. Internally, the pitch range can be set from high to low. Low settings limit the pitch variation to one or two tones. Externally, pitch is controlled by increasing or decreasing pressure placed on a single button- the greater the pressure, the higher the pitch. Pressure controlled pitch adjustment allows for rapid pitch changes and more natural inflection.  The TruTone is the only electrolarynx with this feature on the market. While pressure controlled pitch is an asset for many speakers, those new to using electromechanical speech may find it distracting. The speech pathologist can help the laryngectomee accommodate to pressure controlled pitch by increasing the internal pitch range gradually and comfort and proficiency with this feature increase. The TruTone costs approximately $510.00.


Figure 4: The TruTone
Reprinted w/ permission of Griffin Labs

Advantages and Disadvantages of Transcervical Artificial Larynges

The advantages of transcervical devices are as follows:

*
 Durable

*  Relatively easy to learn

No negative impact upon articulation

Provides communication during periods of high stress and tension when other methods of speech such as standard esophageal voicing and tracheoesophageal voicing may be compromised by heightened tension at the level of the esophageal opening during periods of high stress (Peters & Dichtel, 1995).

*  Relatively inexpensive compared with other voice rehabilitation options

*  Readily available power sources (9-Volt battery)

Most models may allow of intra-oral adaptation

The disadvantages of transcervical devices are:

highly visible

An initial period of practice is required to learn avoid articulation error associated with electromechanical voice.

*  patient must hold the device while speaking

*  can have a mechanical, robotic sound quality.

Rechargeable, device specific, batteries are required for certain models.  These may be more expensive than a standard 9-volt battery and must be routinely charged.

Conclusion

Whether back-up method of voicing or primary mode of communication, every laryngectomee should have an artificial larynx and be able to use it proficiently.  Of all the models discussed in this series, transcervical electrolarynges are by far, the most common type artificial larynx dispensed. Throughout the years neck-type units have proven to be reliable, durable and easy to use. Transcervical devices are unique in that they may be modified for intra-oral or cheek use if neck-placement is not obtainable.  Innumerable electro-technological gains were made during later half of the 20th century. This has translated to improvements in pitch and volume control in the modern electrolarynx.    

**********************
References:

Archer, http://nonverbal.ucsu.edu   Retrieved November 25 2004
Blom, E. D. (1978) The Artificial Larynx:  Past and Present.  In Salmon, S. J. &Goldstein, L.P. (Ed.)     The Artificial Larynx Handbook.  New York, New York.  Grune & Stratton.
Farrell, S, Dietrich Burns, K. & Messing, B.P.  (2004, November) Foundation Skills for the Artificial Larynx-Part II:  Intraoral Artificial Larynx.  VoicePoints: Web Whispers Journal.
Graham, M.S. (1997).  The Clinician?s Guide to Alaryngeal Speech Therapy, Newton, MA, Butterworth-Heinemann.
Keith, R., Darley, L., Frederic. L., (Eds.). (1994).  Laryngectomee Rehabilitation.  Austin, Texas. Pro-Ed, 3rd ed.
Messing, B.P., Dietrich Burns, K., & Farrell, S. (2004, October) Foundation Skills for the Artificial Larynx-Part I:  Pneumatic Artificial Larynx.  VoicePoints: Web Whispers Journal.
Peters, P.M. & Dichtel, W. J. (1995).  The Source for Laryngectomy.  East Moline, Illinois. Linguisystems, Inc.
Salmon, S. J.  (1983). Using the Artificial Larynx:  A Presentation on Instruction. In R. E. Stone & K. A. Stone (Ed.), Post-Laryngectomy Rehabilitation. Help Employ Laryngectomized Persons:  H.E.L.P., Unit 7, Indiana University School of Medicine, Medical Educational Resources Program.
Salmon, S. J. (1997). Using an Artificial Larynx.  In Lauder, E. (Ed.). (1997). Self Help for the Laryngectomee.  Chap. 3.



                          Dutch's Bits, Buts, & Bytes
 
AN EMAILER?S ABBREVIATION - ACRONYM GLOSSARY

 
Acronyms have always been an integral part of computer culture and now they are popular on the Internet to represent common phrases that people say to one another.  Part of the reason they are used so much is because it's quicker and easier to type out a few letters, rather than typing out the full expression. They're also fun, but some can be naughty so watch out!

BTW: 99% of these terms below are not acronyms, just shorthand. The younger generation is learning
that abbreviations and shorthand are in fact called acronyms - but this is NOT true! SONAR, RADAR,
and AIDS are acronyms for example, whereas RTFM and BTW are not. The difference between
acronyms and shorthand is that with acronyms, you pronounce the letters as a word (such as FUBAR,
SWAG, ASAP), whereas with shorthand, you say the letters and do not pronounce it as a word.
GOT IT?

VERSION ONE:  By the way, among the frequently asked questions that I get is what these commonly used acronyms mean when included in Emails on the Internet.  Below is, in my opinion, at least a starters list for your edification.  There are many more out there in use and more are added each day, but, for what it's worth, the below are likely the most common. In any event, hope this helps, and see you next time!

VERSION TWO:  BTW, among the FAQ's that I get is what these CUA's mean when included in Emails on the Internet.  Below is, IMO, at least a "starters list" for your edification.  There are many more out there in use and more are added each day, but FWIW the below are likely the most common.  IAE, HTH, and SYNT!

 
BFN        bye for now
BTSOOM     beats the stuffing out of me
BTW        by the way
CUA        commonly used acronym(s) OR common user access
FAQ        frequently asked question
FU          fouled up
FUBAR      fouled up beyond all recognition
FUD        (spreading) fear, uncertainty, and disinformation
FWIW       for what it's worth
FYI        for your information
GR&D       grinning, running, & ducking
HTH        hope this helps
IAE        in any event
IANAL      I am not a lawyer
IANAD      I am not a doctor
IMCO       in my considered opinion
IMHO       in my humble opinion
IMNSHO     in my NOT so humble opinion
IMO        in my opinion
IOW        in other words
LOL        lots of luck or laughing out loud
LARY      laryngectomee
MHOTY      my hat's off to you
NRN        no reply necessary
OIC        oh, I see!
OOTB       out of the box (brand new)
OTOH       on the other hand
OTTH       on the third hand
PITA       pain in the [...]
PMFJI      pardon me for jumping in
ROTFL      roll(ing) on the floor laughing (also, ROF,L, ROFL)
RSN        real soon now (which may be a long time coming)
RTM       read the manual (or message)
SITD       still in the dark
SNAFU      situation normal, all fouled up
SYNT       see you next time
TANSTAAFL  there ain't no such thing as a free lunch
TIA                thanks in advance
TIC                tongue in cheek
TLA               three-letter acronym (such as this)
TTFN             ta ta for now
TTYL             talk to you later
TYVM            thank you very much
WYSIWYG    what you see is what you get
YHGTBKM    you have got to be kidding me

 

   ListServ "Flame Warriors"   


                                                                               
Terms of Importance
flame

1. n.   A hostile, often unprovoked, message directed at a participant of an internet discussion forum.  The content of the message typically disparages the intelligence, sanity, behavior,  knowledge, character, or ancestry of the recipient.
2. v.   The act of sending a hostile message on the internet.

flame warrior
1. n.   One who actively flames, or willingly participates in a flame war ... (Another Example Below) ...

The Archivist

Archivist saves and squirrels away each and every discussion
forum message.  Do you remember having a bad day back in 1999
when in one of your messages you may have said a few things that
were...well, perhaps a little...hasty?  Don't worry, Archivist still has it
and will post it to the forum if you begin to get the upper hand in
battle.  Archivist can be a very effective and fearsome Warrior.

Above courtesy of Mike Reed
See more of his work at: http://www.winternet.com/~mikelr/flame1.html 
 
 

   Welcome To Our New Members:

I would like to welcome all new laryngectomees, caregivers and professionals to WebWhispers! There is much information to be gained from the site and from suggestions submitted by our members on the Email lists.  If you have any questions or constructive criticism please contact Pat or Dutch at Editor@WebWhispers.org.

Take care and stay well!
Murray Allan, WW President

     We welcome the 22 new members who joined us during November 2004:
 

Adel Al Rehani
San Jose, CA
Malcolm Babb
Chesterfield, UK
Carol Blackmann - Vendor (InHealth)
Carpinteria, CA
Linda Cahen
South Euclid, OH
Denzil Cowen
Sanctuary Cove, Qld., Australia
Charles Donachie
Scranton, PA
Bob Gill
Clearwater, FL
Owen Jaeger - Caregiver
Earlysville, VA
Ruthy Large - Caregiver
Greensburg, IN
Dennis Leo
Kurri Kurri, NSW, Australia
Dennis Mason
Nanticoke, PA
Susan Massey
Dayton, TX
Ben McKenzie
Roswell, GA
Alan Miller
Bruce Mines, Ont. Canada
Helen Morgan - Caregiver
Schenectady, NY
Bill Nelson
Vancouver, WA
Bena Riddle - SLP
Balmoral, Qld, Australia
Elinor Ripley
Monument Beach, MA
David Ross
Edgewater, FL
Patty Smith - Caregiver
Jacksonville, FL
Mimi Tolbert
Leavenworth, KS
 
Caroline Wright - SLP Student
Sedgefield, Durham, UK
 



 
WebWhispers is an Internet-based laryngectomee support group.
  It is a member of the International Association of Laryngectomees.        
  The current officers are:
  Murray Allan..............................President
  Pat Sanders............V.P.-Web Information
  Terry Duga.........V.P.-Finance and Admin.
  Libby Fitzgerald.....V.P.-Member Services
  Dutch Helms...........................Webmaster
      

  WebWhispers welcomes all those diagnosed with cancer of the
  larynx or who have lost their voices for other reasons, their
  caregivers, friends and medical personnel.  For complete information
  on membership or for questions about this publication, contact
  Dutch Helms at: webmaster@webwhispers.org   

 

Disclaimer:
The information offered via the WebWhispers Nu-Voice Club and in
http://www.webwhispers.org is not intended as a substitute for professional
medical help or advice but is to be used only as an aid in
  understanding current medical knowledge.  A physician should always be   
consulted for any health problem or medical condition.



As a charitable organization, as described in IRS § 501(c)(3), the WebWhispers Nu-Voice Club
is eligible to receive tax-deductible contributions in accordance with IRS § 170.



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