Lámh

Article by Imogen Hawes, Lámh Tutor

Tracheostomy & Lámh

Annie is a 2 ½ year old sociable, bright little girl. Annie is learning to spell her name and knows all her animals. Annie has Nemaline Myopathy.  This is a rare muscle weakness condition and she has a tracheostomy due to her respiratory difficulties. Annie communicates using spoken word attempts and LAMH signs. She can combine up to 3 signs.

Emma is 9 months old. She waves bye, claps her hands and smiles at everyone. Emma has a Cystic Hygroma and vascular malformation of the tongue.  These obstruct her airway and she requires a tracheostomy for respiration. Emma is unable to make any vocal sounds and her cries are silent. Emma’s parents and brother are starting to use LAMH with her.

There are approximately 50 children in Ireland at present with tracheostomy tubes.  Many of these children are under 3 years of age. They therefore have the tracheostomy during this key stage of early language development.

A tracheostomy is an external opening into the trachea (windpipe). Children require tracheostomies for a variety of reasons including obstruction of the upper airway and the need for long term ventilation.  The children undergo surgery that involves making an incision into trachea the below the level of the larynx (voice box).  A tracheostomy tube is then inserted to maintain the airway. These children frequently spend long periods in hospital and require additional nursing care at home.

Many children with tracheostomies are silent. This is because air does not travel through the larynx to the mouth and nose. These children do not get the same opportunities to babble, and develop spoken first words and sentences. Some children are able to use speaking valves.  Speaking valves can re-direct some air through the larynx to the mouth and nose enabling the child to vocalize and speak. A Tracheostomy is usually a temporary measure and children will normally go on to develop speech.

LAMH Sign language is the preferred means of augmentative communication for young children with Tracheostomies in Ireland. LAMH can be the main method of communication for a child who is unable to vocalise. LAMH is used to augment any sounds or words a child can produce. In the Children’s University Hospital, Temple Street we are trying to promote the use of LAMH with children with tracheostomies. LAMH courses have been run for parents and staff.

Feedback following the LAMH Module One courses has been positive and there has been increased awareness of the need for augmentative communication not only for children with tracheostomies attending the hospital but also for other children with communication difficulties.  We plan to continue to run training for new families and staff within the Children's University Hospital, Temple Street.

Promoting the use of LAMH with children with tracheostomy has gone “Nationwide”!  A presentation on “Communication with Children with a Tracheostomy” was given to parents attending a TAG (Tracheostomy Advocacy Group) family day at Dublin Zoo in May 2007. This day was featured on RTE One’s “Nationwide” Programme!

Imogen Hawes,
Lámh Tutor

January 2009