ORTHOPHONIC REHABILITATION

Optimizing functional rehabilitation to improve quality of life

Speech therapy is an integral part of the care offered within the team of the Institute of the Ear, namely deafness , tubal dysfunction or the management of facial paralysis .

• Facing deafness (congenital or acquired with the wearing of hearing aids or a cochlear implant), speech therapy aims to allow the patient to find a pleasant social environment, to get out of his isolation and thus reducing the cognitive decline installed. A multidisciplinary approach is essential, through consultation with an ENT specialist and the expertise of hearing aid acousticians. Our work is multidisciplinary in direct link with the ORL, the treating doctor who identifies the complaint of the patient or the family and with the audioprosthetist who chooses, adapts and carries out the control of hearing aids. The speech therapist endeavors to assess the degree of perceptual loss as a function of phonemes, to organize hearing education, to find means of compensation (notably lip reading) and to initiate cognitive rehabilitation (reinforcement of skills under - related to memory and attention) and linguistic as well as to overcome psychological changes. The cognitive processes are trying, it requires real compensatory work to decode the message, which leads to chronic fatigue (more attention and alertness), a voluntary or unintentional restriction of social relationships.

• Improving facial paralysis

We objectify the grade of dysfunction (House and Brackmann classification), associated with the evaluation of the functions of the face and swallowing.

The rehabilitation of the paralyzed face follows a specific progression:

- Praxic work (lingual, labial, jugal, eyebrow, facial expressions, active / assisted mobilization of the eyelid ...) with emphasis on the orofacial sphere, mobilization of the phonatory organs, increase in tone. They will then be performed on the affected hemiface, carefully blocking the healthy hemiface.

- Guidance to inhibit attitudes causing even more marked distortions of the face.

- Articulatory and respiratory work.

- Intra-oral massage and facial massages.

- Thermotherapy.

In the event of synkinesia (involuntary and fortuitous contractions of a muscle group during a voluntary movement of another muscle group), work in close collaboration with ENT is invested. To inhibit synkinesia, one can limit the muscles that work in synchrony by performing an antagonistic movement. If these exercises of mobilizing the lips by imposing eye movements (looking upwards at the injured side) are unsuccessful, the use of botulinum toxin injections may be necessary.

Rehabilitative surgery of facial palsy or so-called palliative surgery is indicated when a paralysis is considered complete and final and the nerve cannot be repaired. The decision to consider such surgery is taken only at the end of a multidisciplinary decision-making process in close collaboration with the ORL.

• In case of tubal dysfunction

During the examination by tubomanometry carried out by the ENT, it is mentioned a bad velar contraction making the examination difficult. Speech therapy is offered beforehand before considering kinetube rehabilitation.

Speech therapy allows:

- Guidance on hygiene rules and self-insufflation maneuvers.

- Breathing work.

- Strengthening of the peri-tubular muscles and of the bicycle-pharyngeal sphincter (lingual, bicycle-pharyngeal, mandibular, lingual and mandibular-lingual exercises).

- Direct and discipline the mouth breath. Breathing exercises are used for this, which allow the patient to become aware of the possibility of blowing only through the mouth, and to train the breath in this direction. They promote better coordination of bicycle-pharyngeal movements.