Swallow the Gap
A pivotal podcast on a mission to improve medical intervention for patients with swallowing disorders (dysphagia). Primarily intended for medical speech-language pathologists (SLP) and also relevant for professionals and students involved in pulmonology, otolaryngology, gerontology, nutrition, rehabilitation sciences, and various other areas of healthcare. Join us as a force for change by inspiring critical thinking, facilitating discussion, and stimulating professional development for those involved in the evaluation and treatment of patients with aerodigestive disorders. For 2025, please keep your eyes peeled for monthly episode release!
https://www.swallowthegap.com (Gap Education, LLC)
Swallow the Gap
From Old Thinking to New Insights
With our dedication to our patients, we've gained a deeper understanding of the complexity of swallowing and dysphagia. How can we use these insights to advance SLP education and our own professional growth?
Guest: Nicole Wiksten, MS, CCC-SLP, BCS-S
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As a profession, we've made great strides in our understanding of normal and disordered swallowing. How can we then help to develop our profession into one that can help meet the demands intrinsic to this complexity? Find out more soon. Welcome to Swallow the Gap, the podcast that delves into the critical world of dysphagia care. I'm your host, dr Tim Stockdale, and I'm thrilled that you've come to join us for conversations aiming to bridge the gap in dysphagia education and practice. We value diversity in backgrounds and opinions, so our guests will not always reflect what we believe. Through critical reasoning and open minds, we serve as catalysts for advancement in medically focused speech-language pathology. Welcome back everybody. I have today with me Nicole Wigston. She's a clinical supervisor at Ohio State University in Ohio. It's lovely to see you again. We've chatted some in the past, but it's always been fun. It's good to have you on here with me today. Do you mind telling the people listening a little bit about yourself?
Speaker 2:Sure, it's good to see you again too. My name is Nicole Wickston and I am a clinical assistant professor at Ohio State, and I practice primarily in the area of swallowing and swallowing disorders. So I do some teaching, some clinical supervision. We have a swallow clinic in our academic clinic as well as working in acute care at our medical center.
Speaker 1:Very cool. Got a few things going on there.
Speaker 2:Just a few.
Speaker 1:Yeah, what do you think you like the most about your job?
Speaker 2:I really love inspiring speech pathology colleagues to be to love swallowing as much as I do, because I really find it very interesting, and even the ones that think they're not going to like it once they work with me and we do the thing. We see a few patients, I teach them a little bit. It's kind of catchy. So I love that when somebody finds their niche in this area.
Speaker 1:You're sharing your positive energy. You're passing it along. That's super cool.
Speaker 2:I can't help it.
Speaker 1:I love it. I love it. Well, one of the things we were going to discuss here today are some of the changes in speech pathology over the past 20 years you've been practicing and how we're adapting to those changes, how we're making things different. So question for you what do you think are some of the biggest things that have changed over dysphagia, at least within the past 20 years? 2025, let's shoot it back to 2005-ish.
Speaker 2:I know and I can't believe it's been 20 years that I've been practicing. But when I think back to the education that I received in grad school, to what we're doing now, it's just such a huge difference and the time flew by, but so much has changed. So one of the biggest differences I see is our clinical exam. So you know, when I learned to assess swallowing disorders, I was basically learning to count coughs right. Swallowing disorders I was basically learning to count coughs right. Like I'm just wondering if the patient is coughing, and if they are, then I'm going to try to make them not cough. So can I maybe have them try tucking their chin, try some thickened liquids? If that makes them not cough, great, I'm going to interpret that as I did something to help them feel better and I'm going to keep assessing whether or not they still use that chin tuck and whether or not it still makes them cough and again feel like maybe I'm helping them get better somehow, but really not having good direction about what exactly is wrong with their swallow, and so that has just changed so much.
Speaker 2:Now. What we know about swallowing and what we don't know at the bedside is such a big difference. So when I think about how I learned about modified barium swallows. Even then it was still assessing what the bolus is doing. So I remember learning that if there was residue in the molecular, that meant it could be a tongue-based retraction, and so that's what I should treat and not really watching the physiology. So that's just such a different way to have learned swallowing and what's actually happening with the physiology versus what's happening with the bullets.
Speaker 1:I'm glad you mentioned that. And man, I could go on off on that for a while. I was taught the same thing. I was taught there's residue in the molecular, it's base of tongue retraction. That's what it is. It's like a formula, a cookbook. You see this, you do that, that sort of a thing, Not necessarily thoroughly evidence-based, although a lot of times it is reduced base of tongue retraction. But it's like that's not the only thing it could be. So there's more nuance to it. As with counting coughs, the CSE, what's wrong with counting coughs? You're talking about dissonant counting coughs. Your people cough, I still count. I don't count coughs, but I pay attention to coughs in my clinical eval. What are some limitations of that?
Speaker 2:Yeah, so you know, initially, like as I was talking about, I would even try to think in my mind as an early clinician okay, well, if they were coughing on their thin liquids and I had them tuck their chin and that made them not cough anymore, I would hypothesize that maybe they have a delayed swallow, or maybe they have impaired bolus formation in their mouth and so they're aspirating before the swallow and so the chin tuck worked right. So I'm going to choose to maybe try to treat one of those things.
Speaker 2:I still don't exactly know why, and so cow cough really didn't tell me anything for sure.
Speaker 1:So would the rationale have been that, in your mind, the chin tuck is good for a delayed swallow and so because the chin tuck got rid of the cough, that their swallow might be delayed? Okay, I mean, there's definitely a string of logic there too. There's just again, the nuance. There's so much more nuance in what the chin tuck does or does not treat, what a cough may or may not mean, and that sort of thing. But it sounded like you're doing the best you could with what you had.
Speaker 2:Right, and now that you know instrumental evals are more available than they were back then, I could know for sure that I'm actually treating a dysphagia and not treating a cough that a patient has because they have a respiratory infection and they're just coughing in accordance with the moment after I gave them something to drink.
Speaker 1:Yeah, it's almost like there's some common recurrent laryngeal nerve innervation too in the cervical esophagus that might, in some patients, trigger a cough when they swallow. Who knows, who knows. Yeah, I've been very convinced, very convinced, and kind of looked silly in front of doctors because I was so sure that this patient with Parkinson's I mean, I can almost see their room still in my mind Sure that they were aspirating and whatever that meant to me at the time it was a pretty big deal. But I was wrong, it was very wrong, and sometimes we're wrong, sometimes we're right. Definitely a place for clinical evaluation. There's a lot that it can tell us, but there's a lot that it can't tell us.
Speaker 2:So a couple of big changes, a couple of big changes, yeah, and also even just knowing the difference between normal swallowing and abnormal swallowing. Right, that's not something I learned, or you know. We really included in our, in our education, but now we recognize that it's just as important to understand normal swallowing as it is to understand normal language development, for example and so that's a change that I think has happened over the past 20 years is we better understand what is normal and how that compares to what is abnormal or disordered.
Speaker 1:Yeah, no, that helps, that makes sense. One of the patterns that I see with what you're saying is the level of simplicity versus the level of complexity. When you learn a little, it's easy to go by rules of thumb and kind of oversimplify. So we got into working with patients with dysphagia. I mean we study that anatomy and so let's give it a go Right, and we learn more now that it's a lot more complex, and this is something that I've probably said a thousand times. So people are probably hitting stop. You know, next episode you're hearing me say that again. But we, you know, there's a lot more nuance, there's a lot more complexity than we realized originally, and to our credit. That's a good thing. That's a good thing. That means we're not staying where we were, it means we're getting better, we're pushing forward, we're pioneers in this field and we're really trying to get better, and so we're following the science. And the science is not as easy or not as simple as we thought it was before, and so I think it requires a greater level of complexity in what we're being taught and in what we're learning and so on. So I mean, as you're saying, with the clinical evaluation, like there's more to that than just counting coughs.
Speaker 1:With the modified barium swallow study. It's more than just a formula. You see residue in the piriform so it's reduced hyaluronidryl elevation. You see it in the vlecula. It's reduced base of tongue retraction. There's other stuff you got to look for If you're seeing residue in the piriform sinuses.
Speaker 1:What's the mechanism? So, normal swallowing you said normal swallowing. You need to learn about that, okay. So what's the mechanism? How does that happen?
Speaker 1:With normal swallowing, cranial nerves nine and 10, pharyngeal plexus get this signal and it's held the ues, which is tight at rest, to relax, settle down, which probably a lot of people are saying to me right now, to settle down. Way, way too enthusiastic about the freaking ues. But yeah, so you've got that. And then you've got the cricopharyngeal attacks. Attaches to the cricoid cartilage, goes around the pharynx and so when the larynx moves it helps to stretch that open and so, but then you have pressure from above that helps to move it through.
Speaker 1:So when you're looking at piriform sinus residue I mean there are just so many different things that are that can go through your mind Is it the duration of the opening of the UES? Is it the extent of it? Is it not getting enough pressure from above? And if it is any of those things, how do we get specific in being able to diagnose that? And that's just like one thing, one thing, and we don't get all of this in one dysphagia class. So what I think is cool is you're doing some things, you're making some changes within your sphere of influence. I'd love to hear more about that. What are you doing?
Speaker 2:Yeah. So as part of our curriculum we've really developed a robust program where we can help students learn more about these instrumental exams and how to diagnose dysphagia and how to make a more specific treatment plan, and so we've added a normal swallowing course, which has been a great addition to the dysphagia course that already existed, and then we're also adding some electives. So you know, our scope of practice is huge as an SLP program, but for those that really want to practice in this area, they have the opportunity to take some extra coursework that helps them develop the skills they need for going into their placements. So previously we send students to their placements and they don't have experience with modified barium swallows or fees, and so now they have some observation opportunities with fees in the hospital, being able to go and participate alongside a practicing SLP. They help set up, they help feed the patient, they help clean up, they learn all about the process and then when they go into their clinicals they can have some experience with this exam.
Speaker 2:We also have a course for modified barium swallow and endoscopy interpretation, and so the students have the opportunity to review some studies, some case studies, and they also have the opportunity to do some normal passes with their scopes and so that then when they go in their placement they have the opportunity to practice swallowing on abnormal patients if that's a possibility within the placement.
Speaker 2:So we're really trying to set them up to be more competent in the area of dysphagia assessment than previous. You know, previously we were getting them to the point where they could do a clinical bedside, but those skills of being able to do a fees or interpret a fees or do a modified or really interpret that thoroughly came later in the job during their CF. But now we're trying to get them that experience sooner, especially those that want to be in acute care. If you want an acute care job, those are skills that are absolutely necessary to be able to practice in that area. So the opportunity to learn more about the diagnostic process as well as utilize it for therapy planning, because certainly now we know which we didn't before how much we really need those exams to guide a good plan of care for a patient's treatment.
Speaker 1:Yeah, yeah, for real, because of the complexity of it, clinical eval or bedside eval isn't good enough most of the time. I mean, sometimes that's all you can get and clinicians would love to be able to have access to an instrumental and maybe they can't I realize there are lots of circumstances like that want to disparage them and thinking through, like what you're talking about. So I'm sure that there are a great number of listeners who work with students, but I also would suspect there are a great number of students who don't. So, in making this applicable to everybody, you think we're all trying to do better, we're all trying to learn more, and so I think it helps to kind of understand the layers of how we got to where we are right now, because that helps us to understand the influences of what we think right now, the biases that led to that, the things we may have mislearned or the things that are great and that we've learned and we need to continue passing along. And, from like an education perspective, if you are working with students, think of where do I want them to get and you reverse engineer that. So, with our learning in this, looking at the complexity of things, like you know, we're thinking we want the big picture, that we want to improve the swallow, right, but even beyond that, like, why do we want to improve the swallow? Well, nutrition, hydration, quality of life, we won't want them to get pneumonia, we don't want them to choke and asphyxiate, not be able to breathe.
Speaker 1:Those types of things are like the functional outcomes and then work backwards from there to the swallow.
Speaker 1:You know efficiency and safety, the physiological processes that are disordered or functional or dysfunctional, and that type of thing that are disordered or functional or dysfunctional and that type of thing, and then layering on top of that, I guess what, the innervation, like what I'm getting lost in my thoughts because there's a lot to it and I just get lost in my thoughts a lot, but anyway, but you're working backwards.
Speaker 1:You see the physiology, you know why does that happen, why is it important, and so, like, the normal is your baseline. So you, we see the value to understanding how to evaluate and treat swallowing and knowing what's typical or atypical, and so that necessitates that we we put more time into learning, that we put more time into understanding that, in addition to these mechanisms of assessment, like knowing how to pass a scope, practicing on many people like it's not. It's the mechanical skill too, or the technical skill of being able to pass the scope and manipulate the device and interpreting it, knowing kind of which trial to go to next, how to adapt which compensatory strategies to try, and so there's that, and there's just so much more, and I know there was a point to where I was going Maybe you were following my train of thought and you know it.
Speaker 1:What's my point?
Speaker 2:We considered making this applicable to everyone right Like thinking about those of us who maybe graduated at a time where we didn't, like I, didn't, learn about fees in graduate school. That's not something that was included in my, even in my class, like I did watch modified barium swallows on the computer screen, right, but I these, these wasn't a topic in my class and then even in my first job these was not an option. It wasn't available until my next job. So I was, you know, three years into my career before I even had the option to practice in fees and be able to be trained in that, and so it isn't available to everybody. But being able to understand what you're looking at or what you're reading when you receive the reports of an instrumental exam, you know, as I practice as an outpatient clinician right now, I don't have the opportunity to do fees and modifies on my outpatients and therefore I get the reports from the other modified barium swallows and fees and I need to be able to interpret them. So even as an outpatient clinician, if I'm not completing the exams, I need to use the information from those exams to guide my plan of care.
Speaker 2:But I do think for anybody who wants to be able to learn these skills that maybe didn't in grad school.
Speaker 2:You know there are opportunities growing out there to be able to learn it.
Speaker 2:So continuing education opportunities to be able to learn the skill to eventually either provide the exam or be able to interpret better, use that in your plan of care, whatever it might be.
Speaker 2:It's not as readily available just yet, but I think that could be coming and maybe that's even just kind of like had a little idea in my brain that maybe that would be something that, as we develop a course on the academic side where we're teaching graduate students how to do fees, why couldn't we teach, you know, a community SOP who wants to be able to learn this and grow a program at their facility? So I think this is something that we can eventually develop, just like we did for the clinical swallow valve and the AMBS and even things like the high resolution pharyngeal manometry. Right, that's really the only way that we can detect pressure in the pharynx, and so it would be great if I knew how to do that, but I don't, and I don't know anybody who's doing it. So when I need that information, that's not something that's readily available at my fingertips, but I have a feeling that if you were interviewing an SLP in 20 years.
Speaker 2:They're going to say I remember when we didn't have high resolution pharyngeal manometry available and it was really hard. But now we have it and I can do it and it's great. So in another 20 years our swallow practice is going to look a lot different than it does now, I'm sure.
Speaker 1:Yeah, yeah, I think it will.
Speaker 2:I think it will, I might've just gone off on my own tangent there, so hopefully no, I don't, I don't think so.
Speaker 1:I think that really was in line with what I was saying and, even if it was a tangent, it made sense, it was helpful. I mean the complexity, because we're pushing forward, we're learning more, we're doing better. We realize the complexity is higher. Therefore, the standard of learning is higher because we have to learn more, we have to learn about all these different things, and so the question becomes how do we get to this standard? And we know that it's not easy and it's not universal right now, or not? Well, it would be really hard to make universal changes in education to speech pathologists, and so, for everyone listening here, I think it comes back to us what can we do, what can we contribute? Whether it's developing a program for teaching, whether it's thinking specifically about the students that we get an externship in and where we want them to be, and how we reverse, engineer and help them to meet those expectations within our setting, or maybe it's in our personal development. There is a lot more that I need to know, and so, as I'm trying to figure this out, I'm looking for resources and opportunities to be able to do that. So, really, if we're talking about a problem, an issue, a gap. It's through the lens of like well, how do we help? How do we help and make it better? And so it sounds like you're doing some stuff and that's really cool. I'm wondering what person A, person B, whoever else is listening to this. I'm going to say some names and maybe people will be like that's me, no, anyway. But yeah, for us all to think about, like within our setting, within whatever our sphere of influence, how we can make this better, because it really is the purpose.
Speaker 1:Our patients deserve it. Think of the credibility that it lends when you can talk to a physician and provide a solid rationale, not just this person's aspirating and I need to make them stop aspirating but maybe this person's aspirating. They have recurrent pneumonia and readmissions costing the hospital thousands and thousands of dollars, and that's not the most important thing. Of course, the patient is the most important thing. That's just another consideration. And sometimes how we can leverage things to get what the patients need.
Speaker 1:But the patient is dependent on others for oral hygiene, they have a very weak cough and all of these different things, and I know that from you know. A while back they had a brainstem stroke and it affected cranial nerves nine and 10 or whatever, and so you can explain the rationale in a way that makes sense and it lends your credibility more likely to get patients. They're more likely to trust your recommendations, and I mean as providers, we want to be able to be out there and hold our own in conversation, not for the sake of looking cool but for the sake of like. It's a reflection of what's on the inside and it allows us the ability to better help our patients and in turn it gets us a lot of credibility. That's my soapbox again.
Speaker 2:Well, and I think you touched on something important, which is you know personally how we feel about our practice, and one of the things that can be hardest is change right, especially 20 years in.
Speaker 2:You know, I tell my students all the time, you're never going to know it all, especially when practicing in medicine.
Speaker 2:There's constant change happening, and so it's really important that the SLP keep up with the newest information, evidence-based practice.
Speaker 2:You know how the world is changing and that can be really hard, because you go from a place where you know things and you know as much as you can possibly know, and things change and you don't know as much as you could know, and so that's a constant battle. And it can be difficult to be the person who maybe doesn't know or learn, could know, and so that's a constant battle, and it can be difficult to be the person who maybe doesn't know or learn something new, and so we have to be willing to change with the field and with medicine as it's changing. So if I didn't learn fees, then I might not have another perspective that I can give my patient or a different opportunity to look at their deficit when the MBS doesn't give me the information I need, and vice versa. So if we only had one test, we would be very limited, but I have to be willing to change and learn and grow with that. So I just think that's really important to be open to change and recognizing that you will never know everything.
Speaker 1:Yeah, for sure, and one of the things I love is and I'm not putting you on the spot, don't take it this way- but, when people come on here who are like really well known and they'll talk about like, oh, listen to this stupid thing I did, because it shows the transparency that they're willing to give up. They're not willing to give up this pretense, this idea that, oh, this person's perfect. No, like, the one of the things that makes so many of these clinicians and researchers and and, and instructors, and whoever out there, great is their willingness to change, their willingness to learn, their willingness to reflect and say like, well, this is what I'm doing, great, this is what I want to improve and moving forward with it, and it's the direction that you're going. It's like so, so important, I think.
Speaker 1:Sometimes I lean on the side and then people have told me this I've had students get on my case because of it. I self-deprecate so much because I guess I don't take myself that seriously or seriously enough or something. And it's like you can learn some stuff and you can know some things, but you don't have to have an inflated ego, right? That's not what it's about. And so, different perspective, different perspective.
Speaker 2:For sure yeah.
Speaker 1:Cool. Well, is there anything else that's really sticking out? Any things that you've really seen clinicians in the community doing? Maybe some of the externship supervisors you work with, or just clinicians that you have seen that are doing a great job? Anything else out there you wanted to go into?
Speaker 2:Yeah, go into. Yeah, I think that when you know, part of my role is I send students out to their placements in the second year of the program, and there are certainly some preceptors that are very much interested in teaching the student as much as they can about all of the different modalities that are out there for assessment treatment, and so clinicians are having to push themselves not only to learn the new things but then to be able to teach the new things, and one thing we didn't learn in SLP school is how to be a teacher, and so I appreciate when a community SLP is willing to take the time to teach a graduate clinician the skills that they have encountered, or going along with them to learn the time to teach a graduate clinician the skills that they have encountered, or going along with them to learn the thing. So as, for example, maybe a facility is rolling out EMST and they are learning how to incorporate EMST into their dysphagia management program and they bring the student along and have them do projects related to that treatment modality and the student's able to learn along with the clinician, and vice versa, you know that the clinician is learning along with the student, and so, um, I find that really inspiring. And again, to have clinicians that are teaching students while they are learning at the same time is challenging but so absolutely rewarding, because that helps the clinician be able to understand what they're doing well enough to teach it, and so that's always promising.
Speaker 2:But being able to do things like you know let a student run your MBS or handle the scope on your patient is certainly a new area for clinician supervisors. To be able to allow the students that kind of independence in that area and not feel like but I own this patient and I feel very responsible for them. So being able to collaborate with your student is an amazing skill. And then also including them in, just like you said, being able to talk to physicians, talk to nurses, talk to other professionals about what we know is also helpful experience for students. To be able to let them have those conversations is beneficial for them as they go into their careers too. They can go in a little more confident than they were before, where their supervisor was the one to have all those conversations.
Speaker 1:You talked about learning while your students are learning, so like if you're attending a course, kind of inviting a student along and you're learning these things simultaneously. And one thing I really took away from that is you're modeling ongoing learning, You're modeling continuing learning, lifelong learning. You're not just teaching them with your words, You're setting an example of the things that they should do, and that's great, and that also because you're learning about the same things, it opens up conversation about those types of things too, which is great. There was one other thing. Oh yeah, so sometimes, if you're a supervisor, you know you're working at a community hospital or skilled nursing facility or wherever, and you have a student with you the difficulty in handing not handing over, but giving the students more independence, working with your patient.
Speaker 1:And I think the balance in that, too is we're thinking like. For me, I'm thinking, or I'm tempted to think I want to make sure this patient has the best care right. So on one hand, and in my mind, I'm thinking well, I'm probably, hopefully, better equipped than the student to do that. On the other hand, though, if you, if we hog it all to ourselves and don't give some liberty to the students, how are they going to learn, and so when we retire, who's going to take our place? So there has to be some growing pains. I think there has to be this a little more independence. You know, scaffold, teach, do what you need to do. But there has to be some sort of release of control within that, it seems.
Speaker 2:Yes, definitely. It's hard for me to sometimes let my students do it their way because you know I like my way. My way is the way I've done it for so long and I think it's the best way. And maybe the way the student does it is not wrong, just different. You know, not all SLPs do everything the same either. There are some things I recognize that we do, you know, that are very similar, but everybody has kind of their, their order, they like to do them in, but everybody eventually gets to the same. You know, we did all of these things. Everybody does a cranial nerve exam, for example, but we might all do it a little bit out of order, but we're all looking at the same thing. The way my student gives the instruction might not be the way that I do it, but as long as they come to the same realization I did, that's okay.
Speaker 1:I think that's a really good point and it's a point that I've disagreed with people on in the past is, well, if you're training a student or if you're working with somebody else, there is not necessarily only one right way to do it, and in certain cases there might be and I am not saying that there might be something that's clearly empirically better, based upon evidence and what we know about the patient population.
Speaker 1:But a lot of times there might be different options, and so if somebody a colleague or a student comes to a different conclusion, but there's a solid rationale there, like why does my way have to be the only way to do it? And in most cases it's not. And so I think it's really important that students and clinicians and everyone can critically think through these things and understand why they're doing, not just come to the same conclusion that you do or I do and I think that takes a lot of humility as well, too to admit like well, yeah, that's not maybe what I would have done, but that's a really strong rationale. I see what you're saying. Let's try it, see if it works.
Speaker 2:Yep, yep. And sometimes patients or students have the ability to experiment a little bit more because the way they're thinking about it isn't the way I do, and so they come up with a solution or an idea that maybe I didn't I didn't have, and so it's. It's really cool when that happens I'm like, hey, I didn't even think of that.
Speaker 1:That is really cool and that shows what students teach us and not just students teach us.
Speaker 1:Again, this is not just a conversation for SLPs or supervising students, but the importance of talking to other people, to talking to other clinicians, to getting insight from other individuals.
Speaker 1:It's not a reflection necessarily that you're not confident in what you do, but getting another perspective. There might be something you can refine, there might be something that can be better, and I think we get a lot of that from students. We get an outside perspective, Like if we've been doing the same thing 40 hours a week for 20 years. It can cause us sometimes to get stuck in a rut or one way of thinking, whereas just getting an outside perspective, even if somebody has a lot less experience, they're going to bring something new to it, and so I think that's important to remember that with our students, but also to remember that and the importance of collaborating with other therapists and physicians and whatnot, and with that, that actually is probably a good way to tie this up, because there unless sorry, is there anything else that is just burning that you really wanted to get out there, and if so, that is fine.
Speaker 2:You know there is, as I was thinking about, things that have changed over the course of, you know, my 20 years is that the other thing that we're doing is we are having patients swallow food, you know, for therapy, and back then it was kind of like, oh, they're aspirating, we need to, they should swallow nothing. And so I think we've learned a lot in 20 years about how much exercise actually swallowing is and that it's not really going to affect them in a negative way if we let them keep swallowing, that it's actually a more positive thing. So I feel like that is one big change I've seen in how we treat dysphagia.
Speaker 1:So I feel like that is one big change I've seen in how we, how we treat dysphagia. So as far as that goes like there, there are a couple of things that I that I'm getting, but I want to make sure that I'm understanding, like one, the specificity of treatment that it's important to continually for, for motor learning, for neuroplasticity, to keep swallowing. You know best, you've heard it said that the best exercise for swallowing is swallowing. You know best, you've heard it said that the best exercise for swallowing is swallowing. So it's important to swallow food, different textures, different weights, so that our body can kind of adapt and learn how to do that, learn how to respond to different bolus sizes and bolus weights, that type of thing. So I'm getting that from it. Is that, is that that part? That's part of what you're saying, right? Yes, okay. And the other part is it does it have to do with maybe not being quite as afraid of aspiration or other differences in swallowing than we used to be?
Speaker 2:Definitely Cause we are, you know, not as, not as afraid. We just aren't as afraid to let people swallow and to let people be uncomfortable, because we recognize that the more we learn about exercise science, for example, that it's it's in that exercise that you know patients are going to see the benefit, and so if we're afraid to let them try, they aren't going to see the benefit to their muscles if they're not actually using them. So yes, yeah, thank you for putting professional words to what I'm saying.
Speaker 1:No, no, I was, I was make. I wanted to make sure that I was getting the takeaway. That was intended, that was intended there, that was, that was part of it. Yeah, and there's. I mean, there's a big difference between being reckless and not being afraid, like if I did an MBS or a fees and I.
Speaker 1:This happened once I was doing a fees and this lady had dementia and I'm trying to think of what else we did prior to this point, but she swallowed a cracker and she swallowed a cracker. She didn't chew it very well, there was a big piece of cracker in her throat and I was a little scared, and I probably had reason to be scared too at that point. And so that's not to say like, yeah, give this lady all the crack. I mean, throw crackers at her, right, you know, give her all the crackers and that sort of thing too. But on the other side is patient aspirates some thin liquid and you know, yeah, good oral hygiene, their cough is strong. You consider these other variables and other parameters rather than just being deathly afraid of laryngeal penetration or all sorts of, you know, any kind of aspiration, that type of thing too. So, yeah, some middle ground there, I think is really predicated on what we've learned and how we've developed in our understanding of you know how these negative outcomes like pneumonia or asphyxiation develop.
Speaker 2:Right Learning how to challenge the system, but within limits of safety, for sure.
Speaker 1:Yes, yeah, yeah, very cool, very cool. Well, it was great to chat with you again. Some take home messages and if you think of anything else that you want to just put out there, let me know. But some take home messages for this, I think, the importance of we have a higher level of knowledge now, so we need to really raise our standards. So how do we do that?
Speaker 1:And that's going to depend on who you are, where you are, who you're working with your resources whether it's readings, articles, people, that type of a thing but reflect on what you know, even maybe keep track of it. Keep track of things that you've learned. It's kind of cliche and corny, as that sounds Like you know. These are some things I've learned this year. These are some ways I've changed in my thinking, so you can go back and look through that. But continue to reflect, continue learning. Share resources, like if you find courses that are good, if you find whatever types of resources that are good, like, share those with people. Spread the good news. Spread the information that's going to help your patients. Talk to people. Talk to students. Talk to other speech pathologists. Get their perspectives.
Speaker 1:Being part of a community, I think, is not just beneficial in knowledge sharing and maybe I'm an odd one out in this, but it gets me excited, like when I talk to other people, when I'm just by myself all the time. I mean, I'm not really classic introvert, so I'm kind of taking that into mind. My, you know how my brain works, yeah, but we there's a lot we can do to encourage each other too. Like if you're holding these conversations, you're not just learning or at least I'm not it just gets me excited to. It makes me want to do more, makes me want to do better and talk about ideas and that sort of thing too. So I think those are some take homes that that everybody you know can can walk away with, and definitely, definitely I will.
Speaker 2:Great Thank you. Thanks so much for the chat.
Speaker 1:Yeah, yeah, thank you for coming on, appreciate it and hopefully see you around. Thank you. Before you go, a quick reminder of two courses coming up soon. This Sunday, march 23rd, dr Kendrae Grand is doing a three-hour webinar teaching on cranial nerve exam for assessment of bulbar functioning, for the medical speech-language pathologist, the clinical specialty course. So that's this Sunday, march 23rd, with Dr Kendra Grant and on April 5th, saturday, respiratory muscle strength training foundations and evidence with Dr Chris Sapienza, the co-inventor of the EMST 150. The co-inventor of the EMST 150. As a thank you for being a listener, please use the code POD1, or P-O-D in all lowercase and the number one at checkout and that'll give you 10% off. To find these courses, go to swallowthegapcom slash livecourses or medslpgapcom slash livecourses.
