Mask Communications Voice Care

Background:

These are unprecedented times, and almost without exception, each one of us has altered the way we work. In healthcare, this has meant wearing PPE face masks for some or all of the time; for others, it has resulted in increased voice use over the telephone and video-calls.

Both of these changes in work practice have increased the demands made on your voice because they are unusual speaking situations. Along with the increased demand on your voice, there is likey to be increased stress due to the anxiety around treating patients with Covid-19, as well as increased anxiety about the health of yourself, your family, friends and colleagues. It is worthwhile noting that stress can be a significant contributing factor to voice problems.

How does your voice work?

Voice is produced as air passes through the voice box (larynx), causing the vocal cords inside, to draw together and vibrate rapidly.

The volume for voice is generated by the airflow passing through the vocal cords and not by the larynx simply vibrating of its own accord. It can be tempting to increase your volume by pushing your larynx to work harder. However, when the larynx is strained in this way, it creates tension in the structures and muscles in and around the larynx. In turn, the straining actually hinders volume and voice quality.

Why is talking with a mask or over video so hard?

Understanding another person’s speech relies heavily on lip-reading and facial expression; these aspects are lost when wearing a mask. On video calls, there might be time delays which make matching facial expression and lip movement to the audible speech difficult.

It is easy to see then, how wearing a mask or communicating via video which creates both a perceived and actual need to alter how we talk, can translate into increasing our vocal volume.

On top of all of this, there may be a lot of tension and fatigue around patient care in the current climate, which could also impact on healthy voice production. We carry a lot of tension in our necks and shoulders, which in turn further hinder healthy functioning of the larynx. Our voice reflects our inner feelings, so it is easy to see how feeling stressed could translate as strain on your voice. Your response might be to strain the voice further so you can be understood more easily, especially if our client has additional difficulties such as a hearing loss or dementia.

However, straining your voice is not the answer!

The good news is that there are lots of strategies to help you communicate more efficiently with clients while looking after your voice 😊

1. Voice Production

The muscles of respiration are bigger and stronger than those of the larynx, so make sure you use your   breath  to speak. Before speaking, breath in; try to breathe gently into your lower ribs rather than gasping for air high up in your upper chest.
Speak as you breath out, using the air from your lungs to generate the volume of your voice.

• Try not to force the volume or speech from your voice or neck.
• Keep sentences short, using everyday words that are more likely to be understood by your listener.
• Keep drinking plenty of water when safe and possible to do so.
• For video calls, have a drink to hand to sip throughout the meeting.
• Speak more slowly.
• Pause between sentences to allow people to process what you have said; this will also give your voice a rest, and a chance for you to take in another breath.
• On video calls, consider using a head-set microphone so your voice is transmitted more efficiently.

2. Relaxation

• Before speaking, take a second to check that your shoulders are relaxed. If necessary, consciously let your shoulders go. Notice if they drop down.
• Make sure your jaw is not clamped together and that your tongue is resting on the floor of your mouth. If your tongue is pushed up hard against the roof of your mouth or pulled hard against your teeth, it is tense and needs to relax.
• Before and after work, or during breaks, and when in a clean, infection-free environment, take some deep, relaxing breaths into your ribs. Drop your shoulders down in the direction of your hips, then let go to help release the tension here. Check again that your tongue and jaw are relaxed.
• Try doing some rolling of the shoulders and gently moving your head from side to side to further release tension in the neck.

3. Alternative Forms of Communication

If your patient is struggling to understand you, consider using pictures to communicate with your patients. If   you have access to a speech and language therapist, ask him or her what pictures they have.*

Use an alphabet board to spell out any words that are hard to pronounce/be understood.

Make use of hand gestures, even simple thumbs up/down for yes/no.

Encourage patients to try these strategies if they are struggling to speak whilst wearing a mask.

When using video calls, consider sending out information beforehand to reduce the amount of talking required during the call.

4. Other Considerations

Some of the tips below might be hard to control in a hospital environment, but if you are aware of them, you might be able to change some to help you and your patient.

• Try to reduce any background noise if possible, for example, turn off radios, ask others to be considerate about the noises they are making, e.g. if they are looking for something and knocking things. Is it possible to choose a time when there might be less distractions to have a conversation with the patient? Obviously, this is challenging in a hospital situation.
• Make sure the person is wearing their hearing aid and glasses if feasible.
• Make sure the hearing aid has batteries in, is switched on and is working.
• Try to communicate at eye level to the patient and maintain good eye-contact.Make sure you have their attention before speaking. Give them a moment to focus on you and the fact you are talking to them before explaining or asking something, especially if it is going to be important.

Note: If you have voice problems for more than three weeks, you might benefit from asking your GP to refer you to ENT and speech and language therapy.

If you would like further advice, please speak with your GP, your local speech and language therapist or contact us at Speakmore. You can also find more information on the British Voice Association website (listed below).

References and Further Information:

https://www.britishvoiceassociation.org.uk/
https://www.rcslt.org/speech-and-language-therapy/clinical-information/voice
Berry, C. ‘Your Voice and How to Use it successfully’, 1987. Harrap Publishers.

* Picture resources for use medical and care settings kindly shared by Kathy Cann, Speech and Language Therapist.

* A-Z directory of flashcards designed to Improve communication through the PPE barrier https://www.cardmedic.com/

Disclaimer: The information in this leaflet is for general guidance. If you have any concerns about yours, or somebody else’s voice or communication skills, please seek specific advice from an HCPC registered speech and language therapist.

For a free summary poster-infographic or PDF copy of this sheet, please email us: hello@speakmore.co.uk