Klaske van Sluis

General discussion 155 found between “pulmonary issues” and almost all other themes. Pulmonary issues might be partially responsible for other reported issues. Offering expiratory muscle strength training In further work on these pulmonary issues, a specific training is provided in the study presented in Chapter 7 . In this chapter we have investigated the feasi- bility and safety of expiratory muscle strength training in total laryngectomy patients. It was very promising to see that after the nescessary adaptions, this training device could be used with patients who had undergone total laryngec- tomy. This study was conducted as a pilot study in testing the feasibility, safety, and compliance of this training program. As the expiratory Muscle Strength Training device was developed for use by mouth, we had to make adaptions to it to make it suitable for use on a tracheostoma. The outcomes show high compliance to the training protocol. Performing EMST is feasible, although there are some challenging issues and one safety issue occurred. Encountered challenges included the need for an adapter, skills of the participants with plugging the voice prosthesis, placing the EMST150 with an adaptor on the tracheostoma, and creating an airtight seal. One safety issue occurred when a participant appeared without a voice prosthesis after a training session. Nevertheless, compliance to the training program was high (>95%). The results show a clear increase in Maximum Expiratory Pressure (MEP) over time in contrast to Peak Expiratory Flow (PEF) values in which no change was seen. The high baseline MEP values for the total laryngectomized participants were interesting when compared with reference values for healthy adults. The higher than expected MEP scores might be the effect of frequent coughing and forced expectoration which is present after total laryngectomy. None of the secondary outcome measures reached statistical significance, which is probably influenced by the low number of participants and the fact that we chose to include a sample of relatively fit participants. It would be valuable to continue research regarding pulmonary issues and investigate possibilities to improve the pulmonary condition. As seen in chapter 6, pulmonary issues correlate strongly with other issues such as participating in social activities. This points towards a correlation between the presence of pulmonary issues and problems with performing meaningful daily activities and social activities. It is important to detect patients who suffer from pulmonary issues and provide optimal medical aids and interventions to enhance their pulmonary functioning. Exploring rehabilitation needs In Chapter 8 we explored the impact of a total laryngectomy on women and investigated specific rehabilitation needs. This study further builds on previous qualitative work, which was predominantly carried out with male participants. Our study shows that the disease and its treatment formed a turning point in