Auto actuatable switch, speech simulator and method for tracheotomized individuals

A method for simulating speech in a tracheotomized individual includes providing a source of compressed air, regulating the air pressure, and controlling the flow of air from the source between a condition in which airflow is stopped and a condition in which airflow is allowed in response to actuation by the individual. The air flow is supplied to a reed to vibrate it, and the resulting vibration-modulated air flow is introduced into the pharynx of the individual, permitting the individual to articulate audibly comprehensible speech. Apparatus for carrying out this method is also described.

BACKGROUND OF THE INVENTION 
The subject matter of the invention relates to a speech simulator, auto 
actuatable switch therefore, and a method for simulating speech in 
tracheotomized patients, including quadriplegics. 
The patient dependent on mechanical ventilation through a tracheostomy is 
unable to vocalize because of interrupted air flow to the larynx. An 
inability to communicate may compromise medical care and prove a source of 
extreme frustration and emotional stress to the patient. It is generally 
not feasible to disconnect the ventilator, deflate the cuff on the 
tracheostomy tube and occlude the tube to momentarily allow the patient to 
exhale around it for brief communication. Moreover, should the patient be 
a quadriplegic, written and gestural communications are impossible and lip 
reading or an elimination process of questioning both have their obvious 
limitations. 
Electronic artificial larynges have been developed to provide rudimentary 
communication for tracheotomized patients. The most common artificial 
larynx is generally a hand held, battery powered instrument which emits a 
continuous high frequency buzz. The buzzing sound is transmitted through 
the neck into the mouth where it is modified by mouth and throat movements 
to produce recognizable speech like sounds. Difficulty is often 
encountered however, in placing the instrument effectively and securely 
against the skin of the mandibular triangle and coordinating sound 
production with speech articulation. Importantly, the quadriplegic patient 
remains dependent on others to anticipate when he wants to speak and to 
operate the artificial larynx. 
Pneumatic artifical larynges have also been developed. The most common of 
these devices is the Tokyo artificial larynx which has a stoma cover 
connected to a mouth tube with a vibrator chamber therebetween. A modified 
version has a finger-controlled breathing port by the vibrator chamber. 
Both of these devices are hand-held and manually operable. 
The obvious limitations inherent in the use of the artificial larynx by a 
tracheotomized quadriplegic led to the development of an auto actuatable 
device comprising a headband with an adjustable sliding arm which actuates 
a tone generator, the output of which is tubed to a patient's mouth. A 
sliding contact switch mounted on the forehead is utilized to activate the 
tone generator to produce sound for speech by the simple wrinkling action 
of the patient's forehead. This device has a major limitation in that the 
headband must be adjusted snuggly enough to stay in place, but not so 
tight as to restrict circulation. This often necessitates the use of a 
cotton sweatband or a light weight cap to increase comfort and to decrease 
skin irritation and slipping on oily skin or hair. Moreover, the location 
of the tube within the patient's mouth interferes significantly with the 
patient's ability to articulate. The opening to the mouth tube frequently 
fouls with saliva thus impeding speech production. Additionally, speech 
produced by this device is electronic sounding and this artificial quality 
is frequently rejected by potential users. 
Alternative devices have also included the Pitt "Speaking Tracheostomy 
Tube" and the Portex "Trach Talk" which comprise tracheostomy tubes having 
a narrow gauge conduit incorporated into their convex surface that 
terminates at a fenestration slightly above the inflatable cuff. An 
external air flow can be delivered to the larynx through this conduit 
independent of the oxygen being supplied to the lungs by mechanical 
ventilation. This is accomplished manually by the patient occluding a "Y" 
connector attached between the narrow gauge conduit and a source of 
compressed air. In so doing, sufficient air flow is provided the patient 
such that an audible whisper might be produced. 
In practice, it has been found that the location of a fenestration through 
which compressed air is delivered to the larynx is situated too close to 
the tracheostomy, thereby allowing air to escape out and around the 
tracheostomy tube. This results in decreased air flow for speech and an 
annoying hissing noise at the neck. Furthermore, patients have frequently 
reported that air flow reaching the larynx tickles or gags them if for 
example, the flow is directed in too narrow a stream. It has been shown 
that patients on a ventilator frequently have laryngeal and 
supra-laryngeal tissue changes secondary to traumatic intubation. In many 
instances these tissue changes interfere with adequate air flow for voice 
production in patients with whom the "talking trach tubes" are tried. 
Finally, and most importantly, quadriplegic patients who can achieve 
audible speech with currently available speaking tracheostomy tubes still 
remain dependent on others to anticipate when they want to speak and to 
operate an external air flow. 
It would therefore be highly desirable to provide an improved speech 
simulator and a method for simulating speech for tracheotomized patients. 
It would also be highly desirable to provide an improved auto actuatable 
speech simulator and method which allows oral communication with, and 
readily intelligible speech by, a tracheotomized patient. 
It would also be highly desirable to provide an improved auto actuatable 
speech simulator and method which allows oral communication with, and 
readily intelligible speech by, a tracheotomized quadriplegic patient. 
It would be further highly desirable to provide an improved auto actuatable 
speech simulator and method which can be switched on and off by hand, if 
possible, or by an improved forehead mounted switch by quadriplegic 
patients. 
It would be further highly desirable to provide an improved speech 
simulator and method which provides for the introduction of air through a 
nasal catheter which does not bother the patient, interfere with the 
patient's speech or produce unwanted noises or physical sensations during 
use. 
It would be further highly desirable to provide an improved speech 
simulator and method which provides for a non-electronic, more natural 
sounding simulated speech by a tracheotomized patient. 
It would be further highly desirable to provide an improved speech 
simulator and method which provides a device which may be simply and 
inexpensively produced. 
It would be further highly desirable to provide an improved speech 
simulator and method which requires no assistance and, little, if any, 
instruction of the tracheotomized patient to operate. 
It would be still further highly desirable to provide an improved speech 
simulator and an auto actuatable switch therefore which can be used by a 
quadriplegic or even the most severely paralyzed patient. 
It still further highly desirable to provide an improved auto actuatable 
switch for use by a quadriplegic which has no moving parts and is 
comfortable to wear. 
It would finally be highly desirable to provide an improved auto actuatable 
switch for use by a quadriplegic which is simple to use, and may be 
utilized to operate any electrically actuatable device. 
SUMMARY OF THE INVENTION 
It is therefore a primary object of the invention to provide an improved 
speech simulator and method of simulating speech by a tracheotomized 
patient. 
It is another object of the invention to provide an improved auto 
actuatable speech simulator and method which allows oral communication 
with, and readily intelligible speech by, a tracheotomized patient. 
It is another object of the invention to provide an improved auto 
actuatable speech simulator and method which allows oral communication 
with, and readily intelligible speech by, a tracheotomized quadriplegic 
patient. 
It is another object of the invention to provide an improved auto 
actuatable speech simulator and method which can be switched on and off by 
hand, if possible, or by an improved forehead mounted switch by 
quadriplegic patients. 
It is another object of the invention to provide an improved speech 
simulator and method which provides for the introduction of air through a 
nasal catheter which does not bother the patient, interfere with the 
patient's speech, or produce unwanted noises or physical sensations during 
use. 
It is another object of the invention to provide an improved speech 
simulator and method which provides for a non-electronic, more natural 
sounding simulated speech by a tracheotomized patient. 
It is another object of the invention to provide an improved speech 
simulator and method which provides a device which may be simply and 
inexpensively produced. 
It is another object of the invention to provide an improved speech 
simulator and method which requires no assistance and, little, if any, 
instruction of the tracheotomized patient to operate. 
It is another object of the invention to provide an improved speech 
simulator and an auto actuatable switch therefore which can be used by a 
quadriplegic or even the most severely paralyzed patient. 
It is further an object of the invention to provide an improved auto 
actuatable switch for use by a quadriplegic which has no moving parts and 
is comfortable to wear. 
It is further an object of the invention to provide an improved auto 
actuatable switch for use by a quadriplegic which is simple to use, and 
may be utilized to operate any electrically actuatable device. 
Finally, it is an object of the invention to provide an improved speech 
simulator method and auto actuatable switch which meet all of the 
aforementioned objects, respectively. 
Briefly, what is provided is a speech simulator for tracheotomized 
individuals comprising a source of pressurized air, a regulator governing 
the pressure of the air, and a valve responsive to actuation by an 
individual interconnected between the air source and the regulator. The 
valve is operable between a first position thereof wherein the air from 
the source is stopped and a second position thereof wherein the air passes 
through the valve. A flexible tube ducts the air through the regulator to 
a reed device. The reed device vibrates audibly in response to the passage 
of the air through the valve and past the reed. A catheter having a 
proximal reed end and a distal pharyngeal end is introduced through a 
nostril into the pharynx of an individual. The catheter introduces air 
from the valve and reed into the pharynx of an individual, whereby the 
individual may articulate audibly comprehensible speech. A switch for 
actuation of the simulator by a individual comprises first and second 
adhesive pads for affixation to an epidermal area of a quadriplegic 
individual at a first displaced distance and movable towards each other to 
a relatively lesser second displaced distance by voluntary muscular action 
of the individual. A field producing device is secured to the first 
adhesive pad and a field responsive switch is secured to the second 
adhesive pad. The switch has an open condition thereof when the adhesive 
pads are at a first displaced distance and a closed condition thereof when 
the adhesive pads are at a second and more proximal displaced distance. A 
method for simulating speech in a tracheotomized individual comprising the 
steps of supplying a source of pressurized air, controlling the flow of 
the air between a first condition thereof wherein flow of the air is 
stopped and a second condition thereof wherein the air is allowed to flow 
by a switch responsive to actuation by an individual. The pressure of the 
air is governed by a regulator and the air is ducted from the switch to a 
reed and the reed is allowed to vibrate audibly in response to the passage 
of the air past the reed. The air past the reed is introduced into the 
pharynx of an individual through a catheter inserted through a nostril 
whereby the individual may articulate audibly comprehensible speech. A 
method for auto actuation of a switch by a quadriplegic individual 
comprising the steps of affixing first and second adhesive pads to an 
epidermal area of a quadriplegic individual at a first displaced distance. 
The first and second adhesive pads are moved to a relatively lesser 
displaced distance thereof by voluntary muscular action of the 
quadriplegic individual. A field producing device is secured to the first 
pad and a field responsive switch is attached to the second adhesive pad 
having an open condition thereof when the adhesive pads are first 
displaced distance and a closed position thereof when the adhesive pads 
are at the second and more proximal displaced distance.

DESCRIPTION OF A SPECIFIC EMBODIMENT 
Referring to the drawings, the improved auto actuable speech simulator 10 
of the invention is shown to comprise a compressed air source 12, an air 
valve 16 and an air pressure regulator 14. Air source 12 furnishes air 
under pressure through air valve 16 to regulator 14. Regulator 14 conducts 
air through tubing 18 into reed housing 20 and past reed 98 located in 
reed chamber 102 to produce vibrating air which is conducted out of the 
reed chamber 102 through catheter 22 into the pharynx of a tracheotomized 
patient having a trachostomy tube 8 to provide patient ventilation. 
Since vibrating air is delivered to the pharynx of a tracheotomized 
individual at a relatively low pressure, compressed air source 12 can be 
one of any number of commercially available compressed air sources. In 
most specific embodiments, however, the compressed air source 12 is either 
the readily available compressed air source in patient rooms as found in 
many hospitals and doctors offices or portable cylinders of compressed 
air. In specific embodiments, such air sources furnish air at pressures in 
the range of from about 40 psi to about 90 psi. As shown in FIG. 2, air 
source 12 is connected through valve 16 to regulator 14. Regulator 14, in 
specific embodiments, may be any commercially available air pressure 
regulator. When air source 12 is either in the form of available patient 
room air sources or portable compressed air cylinders, regulator 14 may be 
one of any of the commercially available air regulators used in 
conjunction with such compressed air sources for other patient purposes. 
In many specific embodiments, air source 12 and regulator 14 are 
associated therewith a humidifier (not shown) to humidify the air prior to 
its entry into air regulator 14. Moisturized air reduces the drying of the 
membranes in the pharynx by use of the invention. 
Tubing 18 can be any flexible tubing having a wall thickness sufficiently 
able to withstand the air pressure of air source 12 and to prevent kinking 
or sidewall collapse during use. Preferred tubing 18 suffers no collapse 
or kinking when bent into a radius as small as about one-half inch. In a 
specific embodiment, tubing 18 can be of metal reinforced elastomeric 
materials, i.e. silastic and latex materials. Tubing 18 must be long 
enough and flexible enough to provide for sufficient patient mobility. In 
a specific embodiment, tubing 18 is TYGON tubing having an one-eighth inch 
internal diameter such as normally used in hospital room in connection 
with patient room air sources. 
Referring to FIG. 5, reed housing 20, tubing 18 and catheter 22 are shown 
in detail. Housing 20 has opposite ends 99 and 100 and an interior chamber 
102. A pressurized air duct 104 is secured to housing 20 at end 100 and 
extends into chamber 102. Pressurized air duct 104 is attached to tubing 
18 as shown in FIG. 1. Adjacent to end 99 of reed housing 20 is an air 
outlet 112. A reed support 106 is secured to reed housing 20 at end 100 
and extends inwardly of chamber 102. Reed support 106 surrounds 
pressurized air outlet 112. Reed support 106 has reed supporting surfaces 
108 thereon which are spaced from both air pressurized duct 104 and air 
outlet 112. Reed supporting surfaces 108 face opposite reed chamber end 
100 and are spaced from both ends 99 and 100 of reed chamber 102. Air 
Outlet 112 is spaced from end 100 of reed housing 20 and reed supporting 
surfaces 108. Catheter 22 is attached to air outlet 112. 
Reed 98 is supported on reed supporting surfaces 108 and pressurized air 
flowing into reed chamber 20 through duct 104 flows past reed 98 and out 
outlet 112 causing reed 98 to vibrate. Supported in this manner, reed 98 
and reed support 106 define a reed space 114 therebetween. In the specific 
embodiment illustrated, reed 98 is of an elastomeric material. Reed 98 is 
positioned on reed supporting surfaces 108 and is stretched over reed 
supporting surfaces 108 and held in place by band 116. So held, reed 98 is 
in tension. The tension of reed 98 can be varied to vary the pitch of reed 
98 when vibrating. In all preferred embodiments, the vibration of reed 98 
should be adjustable from about 120 cycles per second to about 260 cycles 
per second. In other embodiments, reed 98 can take the form of a plastic 
or metal tongue which is secured to the reed supporting surfaces and 
suspended over outlet 112. 
Catheter 22 has a proximal reed end 94 and a distal pharyngeal end 96. 
Catheter 22 directs the audibly vibrating air from reed 98 into the 
pharynx of the user. Catheter 22 is inserted in the specific embodiment 
illustrated through a nostril of the patient into the region of the 
pharynx such that the patient is able by means of mouth movements to 
articulate audible speech. Catheter 22 has sidewalls of sufficient 
strength such that no wall collapse occurs in operation. In a specific 
embodiment, catheter 22 has sidewalls of sufficient strength such that no 
wall collapse occurs when the catheter is bent into a radius of about 
one-half inch, respectively. 
Catheter 22 between proximal end 94 and pharyngeal end 96 is from about 12 
inches to about 14 inches long. In addition to the opening 118 in 
pharyngeal end 96 of catheter 22, catheter 22 has a plurality of 
fenestrations 120. Fenestrations 120 are of a size and number to prevent 
pressures in excess of that causing individuals to gag when pharyngeal end 
96 is positioned within the pharynx of the user or reed 98 to stop 
vibrating to build up in catheter 22. In a specific embodiment, catheter 
22 has three fenestrations 120 in addition to opening 118 therein formed 
adjacent to pharyngeal end 96 of catheter 22. 
When catheter 22 is correctly positioned within the pharynx of the user, 
pharyngeal end 96 is positioned to about the level of the uvula. 
Positioning pharyngeal end 96 significantly below the uvula will cause the 
user to gag. Positioning pharyngeal end 96 above the uvula either results 
in no audibly articulate speech or speech which has preferably, end 96 
should be within about a centimeter of the uvula. 
Catheter 22 may be No. 8, 10, 12 or 14 French (Fr) catheters. In a specific 
embodiment, catheter 22 is of silastic or latex material. No. 8 French 
catheters are preferred. No. 14 french catheters can be used but are not 
as comfortable and may give the user a burning sensation when positioned 
in a nostril and pharynx of the user. Preferrably the catheter is 
positioned in a nostril. While catheter 22 can be also positioned in the 
mouth, catheter 22 may obstruct during speech articulation; and thus, the 
positioning of catheter 22 in the nostril is preferred. 
In all embodiments of the invention, regulator 14, tubing 18, reed housing 
20, and catheter 22 combine to deliver to reed 98 air at a sufficient 
pressure and flow rate to vibrate the reed from about 256 cycles per 
second to about 130 cycles per second. Regulator 14, tubing 18, reed 
chamber 20 and catheter 22 in combination also deliver to the distal 
pharyngeal end 96 of catheter 22 air at a sufficient air pressure and flow 
rate to enable the user to articulate audibly comprehensible speech when 
catheter 22 is positioned in the pharynx as afore mentioned, but at a flow 
rate and air pressure less than that causing the individual to gag or to 
stop reed 98 from vibrating. This is accomplished by providing pharyngeal 
end 96 with fenestrations of sufficient size and number and choosing the 
length and inside diameter of catheter 22 and tubing 18 and the inside 
dimensions of reed chamber appropriately to result in the proper pressure 
and flow rate at pharyngeal end 96 at a desired setting of regulator 14. 
The flow of air from compressed air source 12 to regulator 14 is controlled 
by means of air valve 16. Air valve 16 is an electro-mechanical valve 
operable in response to a power supply actuated by a patient operated 
electrical switch. In a specific embodiment, the patient operated switch 
32 is manually operable single pole single throw control switch such as 
the traditional kind of patient can switch used in most hospitals. 
Air valve 16 operates in response to power supply 24. Power is furnished to 
power supply 24 through grounded plug 26 which is connected to any 
conventional 117 volt 60 cycle AC source. Power from grounded plug 26 is 
conducted by line cord 28 to power supply 24 and is fused on one lead 
thereof by means of fuse 30. Single pole single throw switch 32 controls 
the application of power through fuse 30 to stepdown transformer 36 which 
in the embodiment shown has a secondary output of approximately 24 volts 
AC. Secondary output of stepdown transformer 36 is applied to full waive 
rectifier bridge 38 comprising diodes 40, 42, 44 and 46. Alternately, a 
battery pack can be utilized in lieu of the AC source and stepdown 
transformer 36 for portable use. 
The rectified output of full wave rectifier bridge 38 is applied to a 
voltage divider network comprising resistor 48 and resistor 50. The power 
on indicator 56 is connected in parallel with resistor 50 to indicate the 
closure of single pole single throw switch 32 through the application of 
power to stepdown transformer 36. 
The second voltage divider network comprising series connected resistor 52 
and resistor 54 is connected in parallel to the voltage divider network 
comprising resistor 48 and resistor 50 through switch jack 60. Switch jack 
60 allows the application of power to the series connected resistors 52 
and 54 by means of the closure of the single pole single throw switch 32. 
When electrical contact is made across the terminals of switch jack 60, 
the output of full wave rectifier bridge 38 is applied across resistor 52 
and resistor 54 thereby illuminating valve open indicator 58 and 
energizing relay coil 62. When energized, relay coil 62 causes the closing 
of relay contacts 34 in the primary circuit of stepdown transformer 36. 
When a switch connected to switch jack 60 is in the closed position, relay 
contacts 34 close and power is applied to solenoid coil 64 thereby opening 
air valve 16 and allowing air to pass from compressed air source 12 to 
regulator 14. When not energized, solenoid coil 64 allows air valve 16 to 
close thereby stopping the flow of air from compressed air source 12 to 
regulator 14. 
Upon the opening and closing of air valve 16, air is supplied to regulator 
14 and air moves through tubing 18, reed chamber 102 and catheter 22. When 
catheter 22 positioned in the pharynx of an individual as above-described, 
a sudden surge of air upon the opening of air valve 16 will cause the 
patient to gag as the flow of air through catheter 22 is at a flow rate or 
pressure higher than after flow has been maintained for some time. To 
minimize such sudden surges of air through catheter 22, reed chamber 102 
is provided in such a size in relationship to the diameter of tubing 18 
and catheter 22 so as to cause air to expand into the reed chamber 102 
before passing reed 98 and into the catheter 22 thereby eliminating 
gagging. Reed chambers 102 larger than necessary to avoid any "sudden 
surge" which will cause gagging are useful with the invention; however, 
the delivery of audibly vibrating air to the pharynx will be delayed such 
that the user must anticipate speech and accordingly close switch 32. 
Referring now to FIGS. 3 and 4, another embodiment 70 of switch 32 to be 
used with the invention is shown. Switch 70 is designed for actuation 
without the use of hands. Switch 70 can be used with quadriplegic patients 
unable to utilize manually operated switches without assistance. Switch 70 
comprises an upper pad 72 and a lower pad 74. Upper pad 72 presents a 
front surface 76 and an adhesively coated back surface 78. Similarly, 
lower pad 74 presents a front surface 80 and an adhesively coated back 
surface 82. In use, upper pad 72 and lower pad 74 are affixed to a portion 
of the users anatomy over which he has voluntary muscle control by 
adhesively securing back surface 78 and back surface 82 to the patient. In 
a specific embodiment, since a quadriplegic patient or even the most 
severe paralyzed individuals are still able to wrinkle the forehead, upper 
pad 72 may be positioned over a crease line on the patients forehead with 
lower pad 74 positioned subjacently. Affixed to either upper pad 72 or 
lower 74 at the front surface 76 or 80, respectively, may be affixed a 
permanent magnetic 84 or other field producing device. Opposite to 
permanent magnet 84 on either of the counterpart lower pad 74 or upper pad 
72 on the front surface 80 or 76 respectively is affixed a magnetic reed 
switch 86 or a corresponding field responsive switch. The output of 
magnetic reed switch 86 is conducted via switch leads 88 to switch jack 60 
for operation of the power supply 24. 
In use, upper pad 72 and lower pad 74 so positioned so that when the 
quadriplegic maintains his forehead in an unwrinkled condition, the 
magnetic reed switch 86 is unaffected by permanent magnet 84 and hence 
remains in an open position. Subsequently, should the quadriplegic patient 
wish to activate the auto actuable speech simulator 10 of the invention, 
the wrinkling of the forehead causes the field permanent magnet 84 to 
actuate magnetic switch 86 thereby closing the contact between the switch 
sleeves 88 and presenting a shorted condition across switch jack 60. This 
action introduces a vibrating air column to the tracheomized 
quadriplegic's pharynx and allows the quadriplegic to articulate audibly 
comprehensible speech. 
The invention above described provides an improved speech simulator and a 
method for simulating speech for tracheotomized patients. The invention 
provides an improved auto actuable switch, speech simulator and method 
which allows oral communication with and readily intelligible speech by a 
tracheotomized patient, and even a tracheotomized quadriplegic patient. 
The improved speech simulator can be actuated by a hand switch if possible 
or by an improved forehead mounted switch by a quadriplegic and other 
incapacitated patients not able to use a hand switch. The improved speech 
simulator 10 and method of the invention provides the introduction of air 
through a nasal catheter and does not interfere with the patients speech, 
or produce unwanted noises or physical sensations during use. Speech is 
non-electronic and quasi natural sounding. The speech simulator and method 
of the invention provides a device which has few moving parts, may be 
simply and inexpensively produced and which requires no assistance and 
little, if any, instruction for use by a tracheotomized patient. The 
speech simulator of the invention can be used by a quadriplegic patient or 
even the most severely paralyzed patients and is both convenient and 
comfortable to use. 
While there have been described above the principles of this invention in 
connection with specific apparatus, it is to be clearly understood that 
this description is made only by way of example and not as a limitation to 
the scope of the invention.