Intra-Oral Prosthetics

Taylor Harris

&

Brittany Janowski

What are intra-oral prosthetics?

• Artificial substitutes for missing, altered, or deformed oral structures

• Placed in vocal tract

• Primarily used to improve speech & swallowing

Population

• Head & Neck Cancer

• Cleft palate

• Progressive neurologic diseases

• Traumatic injuries

Multidisciplinary Team

• Maxillofacial prosthodontist *• Speech-Language Pathologist• Oral & Maxillofacial Surgeons• Plastic Surgeons• Head & Neck Surgeons• ENT doctors• Occupational therapist• Physiotherapists• Oncologists• Physical Therapists

Role & Responsibilities of the SLP

• Determine specific needs• Actively participate in design of

appliance• Assess effectiveness• Provide direction for modifications

• i.e. size, shape• Provide follow-up treatment & monitor

• Swallowing, speech, voice, resonance

• Teach patient about care & cleaning

Types

Palatal Lift• Designed to augment or replace

hard and soft palate tissue defects

• Aids in restoration of soft palate functions

• Improves velopharyngeal closure

• Commonly used for dysarthria; velopharyngeal incompetence

Palatal Obturator

• Closes or occludes opening caused by cleft or fistula

• Used to facilitate separation of oral & nasal cavities for speech, feeding, & swallowing• hypernasality• suckling ability in babies

• Not to be confused with palatal lift

The Latham Device

Nasoalveolar Obturator

Obturator Categories

• Modification Obturator Short term

• Interim Obturator Post surgery

• Definitive Obturator Long term

Speech Bulb

• Occludes nasopharynx when the velum is short (velopharygeal indufficiency)

• Aids in velopharyngeal closure

• Contains pharyngeal section, goes behind soft palate

• Can be combined with an obturator

Tongue Prosthetic

• Sometimes used following total glossectomy

• Steel clasps attach to lower teeth

• Facilitates speech & swallowing

Tongue for Speech

Limitations of Prosthetic Devices

• Require insertion and removal• Have to redo periodically due to

growth• Can be lost or damaged• May be very uncomfortable • Compliance is often poor• Don’t permanently correct the

problem• Many centers use only if surgery is

not possible

Assessment

• Prosthetic assessment is provided to:• evaluate, select, and/or dispense a

prosthetic device to improve functional communication

• including associated activities and participation

Who Can Assess

• Prosthetic assessments are conducted by appropriately credentialed and trained SLPs

• SLPs perform assessments as members of collaborative teams that include • Individual• family/caregivers• Educators• medical personnel

Why Assess?

To identify:• underlying strengths and weaknesses

related to the use of prosthetic as it affects communication and swallowing

• effects of prosthetic on activities such as capacity and performance in everyday communication and participation

• factors that serve as barriers or facilitators for successful communication/swallowing

What Process Includes

• Review of status • Case history info • Standardized and/or

nonstandardized methods• Follow-up services• Cost considerations & safety

and health implications• Dispensing practices

Setting of Assessment

• Clinical, educational or other natural environment setting conducive to eliciting a representative sample of the client's communication using a prosthetic device.

• Identifying the influence of related factors on functioning (activity and participation) requires assessment data from multiple settings.

Documentation of Assessment

• Results, interpretation, prognosis, and recommendations.

• Provide a rationale for the preferred prosthetic; a description of device; procedures involved in the assessment of the device; counseling provided to the patient; and the patient‘s response.

Prosthetic Intervention

Intervention services are conducted to assist

individuals to understand, use, adjust, and restore their

customized prosthetic device.

Who Provides Intervention Services?

• conducted by appropriately credentialed and trained SLPs, possibly supported by SLP assistants under appropriate supervision.

• SLPs as members of interdisciplinary teams

Expected Outcomes of Treatment

• Strengths & weaknesses related to communication /swallowing

• Acquire new skills and strategies using the device

• Aid for successful communication/swallowing• Provide appropriate accommodations and

train how to use them• Improve abilities, functioning, participation,

and contextual facilitators• May result in recommendations for

reassessment or follow-up, or referral for other services

Goal(s) Associated With Prosthetics

• Painless, efficient swallowing of secretions• Unrestricted head movement• Elimination or reduction of nasal emission• Decrease respiratory effort/long breath

groups• Increased subglottal pressures; increased

loudness• Improved articulatory precision• improved speech intelligibility• normalized nasality

Clinical Process

Depending on assessment results, intervention addresses the following:

• Provide info, course of intervention and duration, effective communication/swallowing

• Education and maintenance, info about safety and instrument warranty

• How repair, maintain, and modify• Intervention accomplishes objectives• Meets the abilities, needs, and wants of

patient and who they communicates with, considering the environment it will be used

Setting of Treatment

• clinical or educational settings

• other natural environments that are selected on the basis of intervention goals and in consideration for the social, academic, and/or vocational activities that are relevant to the individual.

sEMG

• As muscles contract, microvolt level electrical signals are created within the muscle that may be measured from the surface of the body. A procedure that measures muscle activity from the skin is referred to as surface electromyography (SEMG).

One Researcher’s Results

• ‘Eighty-seven percent (39/45) of all patients increased their functional oral intake of food/liquid including 92% of stroke patients and 80% of head/neck cancer patients.’

Cultural/Ethical Considerations

It is important to be culturally sensitive in

assessment and treatment of

individuals needing dysphagia

management.

Things to Consider about Diversity

• Foods to use in dysphagia assessment and treatment

• Who is it appropriate to talk with about therapy?

• Choosing assessments that are culturally considerate

Counseling

• Counseling is important for individuals pre and post surgery

• Being a part of society and communicating with others is something humans need, and the need for prosthetics can alter this from happening.

References

• American Speech-Language-Hearing Association. (2001). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report [Technical Report]. Retrieved from www.asha.org/policy. doi:10.1044/policy.TR2001-00150

• American Speech-Language-Hearing Association. (2004). Preferred Practice Patterns for the Profession of Speech-Language Pathology [Preferred Practice Patterns]. Available from www.asha.org/policy

.• Crary, M. A., Carnaby, G. D., Groher, M. E., & Helseth, E. (2004). Functional benefits of dysphagia therapy

using adjunctive sEMG biofeedback [Abstract]. Dysphagia, 19, 160-164.doi:10.1007/s00455-004- 0003-8

• Grames, L.M., Jones, D.L., Kummer, A.W., Kurnell, M.P., Ruscello, D. (2006). Response to “Velopharyngeal dysfunction:Speech characteristics, variable etiologies, evaluation techniques, and differential

treatments” by Dworkin, Marunick, & Krouse. Language, Speech, and Hearing Services in

Schools. 36, 236-238. • Light. J. (1995). A review of oral and oropharyngeal prosthesis to faciliatate speech and swallowing. American

Journal of Speech-Language Pathology, 4, 15-21.• Likes, C. P., McCarthy, E. S., Zwilling, C., Dingman, C. A coordinated, multidisciplinary approach to caring for

the patient with head and neck cancer [PPT document]. Retrieved from South Carolina Speech Language Hearing Association Web site: http://www.scsha.com/handouts/session42.pdf