MSWA Bulletin Magazine Summer 2018

QUENCHING
YOUR THIRST
JAMAICA GRANTIS, MSWA SPEECH PATHOLOGIST
VOICE BANKING
LAURA RYAN, MSWA SPEECH THERAPY ASSISTANT
As we move into the warmer weather of summer, it is
increasingly important we are all mindful of staying well
hydrated. Maintaining adequate hydration can be challenging
if you are a person living with dysphagia (swallowing
difficulties), especially if your swallowing difficulties require
you to drink thickened drinks.
What are thickened drinks?
There are two kinds of thickened drinks; those considered
‘naturally thick’ (eg a milk shake or smoothie), and those we
prepare by mixing a thickening agent to a regular or thin drink,
so that it thickens artificially. Thickened drinks are usually
recommended by a Speech Pathologist if a person is shown
to be aspirating thin drinks; that is, thin fluid is entering the
lungs while drinking.
Aspiration can potentially lead to aspiration pneumonia.
Thickened fluids may help to reduce a person’s aspiration
risk by slowing down the flow of liquid, allowing a person
more time to organise and coordinate a safe swallow. There
are different levels of thickened fluids, ranging from slightly
and mildly thick, to moderate and extremely thick. Each level
can be tested to ensure it meets the right consistency, or
viscosity, for safe swallowing.
Did you know?
If you have been recommended to drink thickened drinks,
this usually means that all liquid you consume should be
thickened, including the broth in your soup, or the milk in your
cereal. It might also mean that you find it difficult to eat juicy
foods such as watermelon or oranges.
People who drink thickened drinks are at higher risk
of dehydration
Dehydration can lead to side effects such as headaches,
dizziness, dry skin, fatigue, cognitive difficulties, and other
more serious health concerns. There are many reasons why
it might be harder for someone who drinks thickened drinks
to meet their recommended daily fluid intake.
For example, thickened drinks:
• are ‘heavier’ and can leave you feeling fuller quicker, so you
tend to drink less
• take longer to flow through the mouth and throat before
being swallowed; they can also be harder to suck through a
straw and may need to be ‘drunk’ from a spoon – so it often
takes longer to finish a thickened drink
• may taste or feel different in the mouth – some thickened
drinks leave behind a mild coating in the mouth, and if not
prepared properly, could be a little lumpy, so some people
might find them unsatisfying to drink so they tend to drink less
• can sometimes be more expensive, leading some people to
only drink what they can afford
Thickened fluids aren’t always safer
Thickened fluids tend to leave behind some residue in the
mouth and throat after swallowing, and this residue can
sometimes be aspirated into the lungs after swallowing. It is
usually safer to aspirate thin/regular water than to aspirate a
drink mixed with a thickening agent.
The MSWA Speech Pathology team considers thickened
drinks a last resort
Our goal is to help MSWA Members swallow as safely,
efficiently and comfortably as possible, without modifying
or restricting usual eating and drinking habits. To do this we
explore all other options first, before going down the path
of trying thickened drinks. For example, do changes to a
person’s drinking posture help them to swallow with more
ease? Does the use of mindful swallowing strategies help
a person to swallow with more control? Are there adaptive
cups or straws we could try that help to better control the
delivery of fluid into the mouth, allowing a person to swallow
with greater safety? These and many other options should be
explored before recommending thickened fluids.
Thickened fluids aren’t always forever
Sometimes a Speech Pathologist might recommend a person
drink thickened drinks following a serious hospital procedure,
dental surgery, or a short-term exacerbation of MS symptoms.
Sometimes thickened fluids are recommended only during
times of extreme fatigue. The Speech Pathologist’s role is
to monitor and regularly review whether thickened fluids are
required long-term.
Thickened fluids aren’t all bad though
For most, thickened fluids help to improve swallow safety and
maintain hydration.
If you are having difficulty drinking thin or thickened
drinks, please contact the MSWA Speech Pathology
team on 9365 4888 for advice and support.
Similarly, if you would like to discuss whether thickened
drinks are appropriate (or possibly no longer appropriate)
for you, please contact the MSWA Speech Pathology team.
I have donated my voice. Not a sentence I thought I would
ever say.
Being a therapy assistant in the MSWA Speech Pathology
Department suits my personality perfectly. Every day I
am helping people, by implementing a therapy program
to help people with their communication devices. These
communication devices enable people, that might otherwise
be unable, to express their thoughts and emotions. They
empower people to share their opinion, initiate conversations,
tell jokes, instruct others and much, much more. Picture the
late Steven Hawking if you don’t know anyone who used one.
When setting up a communication device, you can often pick
from several pre-recorded voices, male or female etc. This is
great, however, they usually don’t sound anything like you. This
is where ‘voice banking’ comes in, not to be confused with
message banking, which is recording a sentence to be played
back exactly as it was recorded eg. “I love you sweetie.”
Voice banking is recording a sample of your voice to create
a unique synthetic voice that can then be used with these
communication devices. The quality of the finished synthetic
voice depends on the number of sentences and the quality of
the voice recorded. So, it’s crucial to complete the recordings
early on even if you think you might not need it.
Recording your voice can be a lengthy process, recording
anywhere between 400 – 3,200 sentences, the more you
record the more personal the synthetic voice will sound. It’s
advisable to complete the recordings over several sittings,
such as a few sentences at the same time each day so this
can take several weeks or months to complete depending on
your fatigue levels and other commitments. So, it’s strongly
recommended that you begin voice banking as early as
possible. Once you have completed the recordings you can
listen to your synthetic voice before deciding if you would like
to use it.
What if it’s too late? If you’re unable to record the sentences
but have a close relative who sounds like you, they might be
willing to do the recordings and ‘donate their voice’ for your
use. Because synthetic voices sound slightly robotic in nature
you won’t sound exactly the same as each other.
I recorded 3,155 sentences, which seemed never-ending
whilst recording them, however, I was intrigued to hear what
a synthetic me would sound like. I had a listen after 650
sentences and I was really impressed, it definitely sounded
like me. The more I recorded the better it got but I would have
been very happy using it at that level had I needed to! So,
my synthetic voice is now available for people to use on their
device, who knows one day I might bump into someone using
it, wouldn’t that be amazing! I might even need it myself or it
will never be used by anyone, but I will have had the experience
of recording it to assist others through the process.
Interesting fact: Stephen Hawking’s voice, ‘Perfect Paul’,
was derived from recordings of Dennis Klatt, an American
researcher in speech science and the pioneer of computerised
speech synthesis. Dennis recorded his own voice when
developing the software and this became the voice you heard
when listening to Stephen Hawking. Dennis Klatt later lost his
voice to cancer prior to his death in 1988.
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