Backpressure is the main reason for the seal of the adhesive to break and is therefore an important issue to address during speech therapy. High backpressure may be caused by hypertonicity of the neoglottis, but it might also be a result of the patient unconsciously attempting to speak too loud. In the latter case it is worthwhile to practice speaking at a softer tone and lower pitch. Usually auditory feedback and explanation to the patient is helpful. It can be helpful to use the valve as its own feedback mechanism. By adjusting the cough-relief valve to open at lower pressure, the cough relief valve will open when the patients is speaking with too much pressure. Also a manometer, monitoring the tracheal pressure during speaking, can be used to practice to speak with less pressure.