Incidences psychologiques de la laryngectomie et rehabilitation vocale. Analyse et perspectives therapeutiques
Institution:
Université Louis Pasteur (Strasbourg) (1971-2008)Disciplines:
Directors:
Abstract EN:
The process of vocal rehabilitation is a crucial step in the social reinsertion of the cancer patient who has been subjected to a laryngectomy or a pharyngolaryngectomy. Individual differences are evident as patients cope with their illness, the side effects of their medical treatment, and with the challenges of their social rehabilitation. Forty laryngectomy patients were selected in the order of their arrival at the centre andre allimann in colmar and followed during their vocal rehabilitation. On the basis of the qualitative and quantitative longitudinal data gathered, the thesis focuses on the impact of psychological and psychosocial factors on vocal rehabilitation, including the use of the oesophagagal voice in everyday life. The thesis also explores the psychological impact of the loss of the voice, as well as the effects of the surgical mutilations and the relationship between the voice and the body. Two case studies are used to illustrate how an appreciation of individual differences can be important in the process of vocal rehabilitation and its outcome, against the background of the relationship between the speech language pathologist and the laryngectomy patient. The study's results also suggest that certain psychological and social factors play a predominant role in determining the quality of the patient's oesophageal voice.
Abstract FR:
La rehabilitation vocale est une des etapes cruciales de la reinsertion du patient qui, suite a un cancer de la sphere orl, doit subir une laryngectomie totale ou une pharyngolaryngectomie. Or, on observe de grandes divergences au niveau des ressources individuelles mises en oeuvre pour faire face a la maladie, aux traitements et a la rehabilitation proprement dite. Quarante laryngectomises ont ete suivis, selectiones dans l'ordre d'arrivee, au cours de leurs stages de rehabilitation vocale au centre andre allimann des hospices civils de colmar. A partir de l'analyse des donnees quantitatives et qualitatives recueillies de facon longitudinale, la presente recherche etudie l'impact des facteurs psychologiques et psychosociaux sur l'acquisition de la voix oesophagienne et sur son appropriation dans la vie courante et elle explore la problematique de la voix dans son ancrage corporel et dans son retentissement subjectif. Deux exemples plus detailles permetent egalement d'eclairer les effets de la prise en compte des facteur personnels sur le deroulement et l'issue de la rehabilitation vocale dans le cadre de la dynamique de la relation orthophoniste-laryngectomise. Les resultats suggerent aussi que certains des facteurs psychologiques et sociaux jouent un role preponderant sur la qualite de l'acquisition de la voix oesophagienne.