He had tubes in his throat for the first ten days or so. Then they did the tracheotomy and put a tube into his stomach for feeding, so the tubes in his throat could be removed. Maybe to prevent infection or other complications?
Matt, first and foremost our love to you and your family from down-under in Oz.
It sounds like you are making some good signs of recovery.
My background is in neurology and esp spine but when I trained as a Rehabilitation Physician I was involved in the rehab of people with traumatic brain injuries also. Recovery is a very individual and variable thing depending on all the circumstances. It is clearly a difficult and frustrating time for Matt,family and friends but then again things can change when progress starts to be made. Every body is elated. I remember someone asking me in a job interview, "don't you find Rehabilitation Medicine depressing?" My answer, "only if you're doing it the wrong way !".
We used to regularly hold information conferences for people to explain what was happening. I hope the following does not sound too clinical, it is not meant to be.
Re Tracheostomy - is a hole made just below the "adam's apple" and into the trachea (the trachea is the main airway tube or "windpipe" to the lungs. The trachea then branches into smaller airway tubes like the bronchi etc.
A breathing tube (cannula) is inserted into the tracheostomy hole and a cuff around the cannula is blown up (like a bun around a [hollowed out] hot-dog). Thus the cuff closes the gap between the inside of the tracheal wall and the inserted cannula tube. This allows air to be pushed through the cannula, into the lungs, without it leaking back around the sides, and secondly prevents stuff going down the trachea into the lungs that shouldn’t be there eg excess mucus or food "going down the wrong way" ie aspiration/regurgitation of stomach contents coming up the oesophagus (swallowing tube) and back down the wrong way into the trachea . Stuff into the lungs that shouldn’t be there promotes infection.
The commonest reason to need a tracheostomy is to provide mechanical ventilation (breathing) and/or protect the airway from aspiration for more than a week or so . Lesser time periods of ventilation are provided by an "endotracheal tube" (the thing that goes through the mouth down into the lungs eg when you have a major Op and are anaesthetized and ventilated). It is impractical to have an endotracheal tube for medium or longer term.The tracheostomy also provides access for the nurses to suck out any secretions or material accumulating.
The tracheostomy/cannula bypasses the nose and mouth as the air entry points for breathing. The vocal cords in the larynx are also bypassed so very little speech can occur with insufficient air movement across the vocal cords. A few words might be said. If the cuff is deflated it allows the person to breathe on their own (sucking air around the sides of the cannula and via nose and mouth, and to test their ability to do so. It also makes it easier to move air across the vocal cords and therefore speak more easily.Blocking the opening with a finger will also allow the mechanical possibility of normal breathing and speech. If someone is breathing ok by themselves the tracheostomy can be closed over with a window allowing just suctioning secretions when needed.
Generally people are weaned off ventilators, trache cuffs left deflated for variable periods and speech, breathing and swallowing abilities tested under controlled conditions. Apart from any mechanical considerations explained above, speech communication starts to be tested at higher levels also ie degrees of language comprehension as well as language verbal expression, reading and writing. Motor and sensory capacities are also progressively tested, cognitive and perceptual abilities and visuospatial areas.
Matt, keep up the good work !
