Klaske van Sluis

158 References functional problems in communication, swallowing and smell function. When patients did report problems in these domains the SLP would schedule follow- up appointments. Therefore, structured follow-up assessments during the first year post-laryngectomy are recommended to facilitate these evaluations. 9.4.2 Offering speech rehabilitation This thesis shows that tracheoesophageal speech offers the most natural speech rehabilitation method after total laryngectomy and, when successful, provides a stable long-term verbal communication method. When possible, patients de- serve tracheoesophageal speech rehabilitation in the early stage post-surgery to allow them to regain verbal speech as to enhance QoL as quickly as possible. Worldwide there are still differences in offered speech rehabilitation meth- ods. In some countries caretakers are reluctant to offer tracheoesophageal speech, since they associate this with a higher complication rate. Not all healthcare sys- tems cover the costs of tracheoesophageal speech, leading to reimbursement is- sues. This is problematic in a patient group in which individuals are often from a lower socio-economic background. In some cases, patients prefer a speech rehabilitation method which makes them less dependent on the hospital. In tracheoesophageal speech, regular hospital visits are needed for voice prosthe- sis changes. With the advances in oncological treatment, these patients deserve the best available rehabilitation options for speech and general functioning to optimize their daily life after surgery. Healthcare professionals should offer guidance and interventions to help total laryngectomized individuals cope with their condi- tion. To assure that the best rehabilitation is offered, clinicians and researchers have to make ongoing efforts to map treatment outcomes, work out reimburse- ment issues, and implement new developments in the clinical trajectory. References [1] P. H. Dejonckere, M. B. J. Moerman, J. P. Martens, J. Schoentgen, and C. Manfredi, “Voicing quantification is more relevant than period pertur- bation in substitution voices: an advanced acoustical study,” European Archives of Oto-Rhino-Laryngology , vol. 269, pp. 1205–1212, Apr. 2012. [2] C. J. van As-Brooks, F. J. Koopmans-van Beinum, L. C. Pols, and F. J. Hilgers, “Acoustic Signal Typing for Evaluation of Voice Quality in Tra- cheoesophageal Speech,” Journal of Voice , vol. 20, pp. 355–368, Sept. 2006. [3] M. S. De Bodt, F. L. Wuyts, P. H. Van de Heyning, and C. Croux, “Test- retest study of the grbas scale: influence of experience and professional background on perceptual rating of voice quality,” Journal of Voice , vol. 11, no. 1, pp. 74–80, 1997.