1 00:00:02,639 --> 00:00:05,139 On this episode of the Swallia pride podcast, 2 00:00:05,279 --> 00:00:08,160 we have an awesome research team, which I 3 00:00:08,160 --> 00:00:10,179 am so, so happy to have them on. 4 00:00:10,639 --> 00:00:12,719 We have Connor Daughtridge. She's the one that 5 00:00:12,719 --> 00:00:14,240 wrote in to be on the podcast, and 6 00:00:14,240 --> 00:00:17,035 I had the fortunate opportunity to meet Connor 7 00:00:17,035 --> 00:00:18,554 at ASHA, and I and I really, really 8 00:00:18,554 --> 00:00:19,855 enjoyed talking with her. 9 00:00:20,155 --> 00:00:22,714 She is a research SLP employed by Atrium 10 00:00:22,714 --> 00:00:24,175 Health in Charlotte, North Carolina, 11 00:00:24,554 --> 00:00:27,275 partnering with the CARD Lab at UNC Chapel 12 00:00:27,275 --> 00:00:29,570 Hill working on the speech profiles and cue 13 00:00:29,570 --> 00:00:32,309 responsiveness after left hemisphere stroke study. 14 00:00:32,689 --> 00:00:34,689 She holds a master's degree in speech pathology 15 00:00:34,689 --> 00:00:37,329 from UNC at Chapel Hill. Her primary clinical 16 00:00:37,329 --> 00:00:39,729 and research interests are aphasia and apraxia of 17 00:00:39,729 --> 00:00:42,545 speech. Previously, she worked at inpatient rehab at 18 00:00:42,545 --> 00:00:45,184 Novant Health New Hanover Regional Medical Center in 19 00:00:45,184 --> 00:00:47,125 inpatient rehab and acute care. 20 00:00:47,585 --> 00:00:51,045 And she is joined by doctor Katerina Haley. 21 00:00:51,184 --> 00:00:53,184 Katerina is a professor in the division of 22 00:00:53,184 --> 00:00:54,990 speech and hearing sciences. She specializes in the 23 00:00:55,149 --> 00:00:56,990 in the assessment and treatment of adults with 24 00:00:56,990 --> 00:00:58,770 left hemisphere brain injury. 25 00:00:59,230 --> 00:01:01,410 Her greatest areas of interest include the perceptual, 26 00:01:01,550 --> 00:01:04,510 motor, and language mechanisms that influence speech production 27 00:01:04,510 --> 00:01:07,310 in aphasia and apraxia of speech, the development 28 00:01:07,310 --> 00:01:10,450 of quantitative speech assessment procedures for clinical applications, 29 00:01:10,965 --> 00:01:13,125 and the development of procedures and materials to 30 00:01:13,125 --> 00:01:15,625 support self determination in people with aphasia. 31 00:01:16,164 --> 00:01:18,504 She received her training in speech language pathology 32 00:01:18,564 --> 00:01:19,465 at the Karolinska 33 00:01:19,765 --> 00:01:22,405 Institute in Stockholm and her graduate training at 34 00:01:22,405 --> 00:01:25,819 Vanderbilt University. She teaches courses in aphasia, neurologic 35 00:01:25,879 --> 00:01:28,140 communication disorders, and research design. 36 00:01:29,000 --> 00:01:31,879 And we are also joined by doctor Adam 37 00:01:31,879 --> 00:01:34,040 Jacks. Adam is an associate professor in the 38 00:01:34,040 --> 00:01:35,739 division of speech and hearing sciences. 39 00:01:36,364 --> 00:01:39,025 He teaches courses in speech science and neuromotor 40 00:01:39,165 --> 00:01:39,905 speech disorders. 41 00:01:40,284 --> 00:01:42,765 His research focuses on understanding the link between 42 00:01:42,765 --> 00:01:43,265 neuropathology 43 00:01:43,644 --> 00:01:47,024 and behavioral manifestations of neurological speech disorders, 44 00:01:47,564 --> 00:01:50,064 investigating novel interventions for people with aphasia, 45 00:01:50,390 --> 00:01:53,030 and identifying factors associated with improved quality of 46 00:01:53,030 --> 00:01:54,090 life with aphasia. 47 00:01:54,549 --> 00:01:57,189 After receiving his master's and PhD degrees in 48 00:01:57,189 --> 00:01:59,670 communication sciences and disorders at the University of 49 00:01:59,670 --> 00:02:02,950 Texas at Austin, he completed a postdoctoral fellowship 50 00:02:02,950 --> 00:02:04,170 in behavioral neuroimaging 51 00:02:04,469 --> 00:02:07,055 at the Research Imaging Institute at the University 52 00:02:07,055 --> 00:02:09,794 of Texas Health Sciences Center at San Antonio. 53 00:02:10,094 --> 00:02:11,694 Hope and I hope you all love this 54 00:02:11,694 --> 00:02:13,614 episode. I just really enjoyed talking to this 55 00:02:13,614 --> 00:02:15,534 team. They're doing really, really, really cool work, 56 00:02:15,534 --> 00:02:17,694 and I super appreciate them wanting to come 57 00:02:17,694 --> 00:02:18,514 on the podcast. 58 00:02:31,129 --> 00:02:33,530 Welcome to the Swall Your Pride podcast. I'm 59 00:02:33,530 --> 00:02:35,324 your host, Teresa Richard. Richard. I'm a board 60 00:02:35,324 --> 00:02:38,444 certified specialist in swallowing and swallowing disorders, a 61 00:02:38,444 --> 00:02:40,764 mobile thieves business owner, and founder of the 62 00:02:40,764 --> 00:02:41,985 MedSLP Collective. 63 00:02:42,444 --> 00:02:44,525 This podcast is all about delivering the latest 64 00:02:44,525 --> 00:02:47,264 evidence based practice to medical SLPs everywhere. 65 00:02:47,564 --> 00:02:49,909 Whether you're a new clinician seeking tangible tools 66 00:02:49,909 --> 00:02:52,069 for treatment or a seasoned vet stuck in 67 00:02:52,069 --> 00:02:53,990 a rut, my goal is to help ditch 68 00:02:53,990 --> 00:02:55,670 the old school ways of the past that 69 00:02:55,670 --> 00:02:57,909 no longer serve you or your patients, to 70 00:02:57,909 --> 00:03:00,230 reinvigorate your passion for our field, to broaden 71 00:03:00,230 --> 00:03:02,294 your knowledge about our scope of practice, and 72 00:03:02,294 --> 00:03:04,134 to inspire you to practice at the top 73 00:03:04,134 --> 00:03:04,875 of your license. 74 00:03:05,175 --> 00:03:07,094 So if you're listening, I encourage you to 75 00:03:07,094 --> 00:03:09,175 swallow your pride, be open and willing to 76 00:03:09,175 --> 00:03:11,735 learn because let's face it, your patients deserve 77 00:03:11,735 --> 00:03:14,375 that kind of care. With that, let's dive 78 00:03:14,375 --> 00:03:15,114 right in. 79 00:03:15,655 --> 00:03:17,800 Just a quick disclaimer that all statements and 80 00:03:17,800 --> 00:03:20,360 opinions expressed in this episode do not reflect 81 00:03:20,360 --> 00:03:23,159 on the organizations associated with the speakers and 82 00:03:23,159 --> 00:03:25,319 are their own opinions solely. Thank you all 83 00:03:25,319 --> 00:03:26,920 for joining me. We've got a packed house 84 00:03:26,920 --> 00:03:29,305 today, which is exciting. I I love episodes 85 00:03:29,305 --> 00:03:31,224 where we've got lots of voices coming together 86 00:03:31,224 --> 00:03:33,165 to to chime in on a topic. So, 87 00:03:33,625 --> 00:03:35,305 welcome, welcome. Thank you all for joining me. 88 00:03:35,305 --> 00:03:36,824 I'd love for each of you to tell 89 00:03:36,824 --> 00:03:38,425 the people a little bit about yourself. So, 90 00:03:38,425 --> 00:03:39,885 Connor, we'll start with you. 91 00:03:40,264 --> 00:03:41,724 Perfect. I can get started. 92 00:03:42,300 --> 00:03:44,460 And I'll start by introducing myself and the 93 00:03:44,460 --> 00:03:46,080 Grander team a little bit. 94 00:03:46,379 --> 00:03:48,939 So all three of us on today are 95 00:03:48,939 --> 00:03:51,180 part of the research team working on the 96 00:03:51,180 --> 00:03:53,760 study speech profiles and cue responsiveness 97 00:03:54,140 --> 00:03:55,760 after left hemisphere stroke, 98 00:03:56,115 --> 00:03:58,914 which is an NIH funded study that has 99 00:03:58,914 --> 00:04:00,294 several aims. But 100 00:04:00,675 --> 00:04:03,495 simply put, we are working to better define 101 00:04:03,555 --> 00:04:05,974 and differentially diagnose between dysarthria, 102 00:04:06,435 --> 00:04:09,254 apraxia, and aphasia with phonemic paraphasia. 103 00:04:09,879 --> 00:04:12,840 And doctor Haley will get into the details 104 00:04:12,840 --> 00:04:14,199 on that a little bit more in a 105 00:04:14,199 --> 00:04:14,860 few minutes. 106 00:04:15,799 --> 00:04:18,379 The study does have two main sites, UNC 107 00:04:18,439 --> 00:04:20,939 hospitals in the Chapel Hill area 108 00:04:21,319 --> 00:04:23,979 and then Atrium Health in the Charlotte area, 109 00:04:24,324 --> 00:04:25,625 both in North Carolina. 110 00:04:26,085 --> 00:04:28,485 And I am one of the research speech 111 00:04:28,485 --> 00:04:31,205 therapists at Atrium Health, and my main role 112 00:04:31,205 --> 00:04:34,485 is to screen, contact, consent, and then test 113 00:04:34,485 --> 00:04:35,145 the eligible, 114 00:04:36,085 --> 00:04:36,985 stroke participants. 115 00:04:37,920 --> 00:04:40,080 And we'll get more into what testing looks 116 00:04:40,080 --> 00:04:41,300 like shortly as well. 117 00:04:41,759 --> 00:04:44,639 Connor, is your only role research Research SLP, 118 00:04:44,639 --> 00:04:46,240 or do you do you treat as well? 119 00:04:46,240 --> 00:04:48,319 You just do research? Only research right now. 120 00:04:48,319 --> 00:04:48,819 Yep. 121 00:04:49,199 --> 00:04:50,639 I've I've heard of a few more, you 122 00:04:50,639 --> 00:04:52,214 know, like, a few more roles that are 123 00:04:52,214 --> 00:04:53,895 popping up like that. I'm like, you literally 124 00:04:53,895 --> 00:04:56,214 just do research. That's so cool. So that's 125 00:04:56,214 --> 00:04:57,895 awesome. Thank you for sharing that with us. 126 00:04:57,895 --> 00:05:00,375 My name is Adam Jacks, and I'm co 127 00:05:00,375 --> 00:05:00,875 investigator 128 00:05:01,175 --> 00:05:02,154 on this project. 129 00:05:03,254 --> 00:05:04,955 And and my role on this project 130 00:05:05,310 --> 00:05:07,810 focuses primarily on, test 131 00:05:08,270 --> 00:05:09,490 stimulus development 132 00:05:10,110 --> 00:05:11,330 and acoustic analysis, 133 00:05:11,870 --> 00:05:14,930 procedure development, and generally supporting the team. 134 00:05:15,629 --> 00:05:18,675 Katarina is the principal investigator, but we we 135 00:05:18,675 --> 00:05:22,435 work very closely together on developing analyses, working 136 00:05:22,435 --> 00:05:24,194 with the team, getting the rest of the 137 00:05:24,194 --> 00:05:25,574 team coordinated, and, 138 00:05:26,115 --> 00:05:28,375 also in disseminating what we've learned. 139 00:05:29,074 --> 00:05:30,214 Outside of this project, 140 00:05:30,595 --> 00:05:31,574 I also teach 141 00:05:31,949 --> 00:05:33,169 graduate and undergraduate 142 00:05:33,550 --> 00:05:35,949 students at UNC Chapel Hill. So I teach 143 00:05:35,949 --> 00:05:36,689 the undergrad 144 00:05:37,149 --> 00:05:39,709 speech science course since I'm really interested in 145 00:05:39,709 --> 00:05:40,449 speech acoustics. 146 00:05:41,550 --> 00:05:43,789 And then I also teach the graduate motor 147 00:05:43,789 --> 00:05:45,569 speech disorders class. 148 00:05:46,044 --> 00:05:47,024 I'm Katarina 149 00:05:47,485 --> 00:05:47,985 Haley. 150 00:05:49,245 --> 00:05:50,464 Theresa, I really appreciated 151 00:05:51,164 --> 00:05:52,845 how you said about, like, it's so cool 152 00:05:52,845 --> 00:05:54,144 that you can work on research. 153 00:05:54,685 --> 00:05:57,425 We we have a team here that is 154 00:05:57,724 --> 00:05:58,224 very, 155 00:05:59,129 --> 00:06:01,930 it's very mixed. So they're clinical researchers, and 156 00:06:01,930 --> 00:06:03,770 I'm one of those Adam is another one 157 00:06:03,770 --> 00:06:06,430 of those. And then we have several practitioners 158 00:06:06,650 --> 00:06:07,310 that are 159 00:06:07,850 --> 00:06:08,350 clinicians, 160 00:06:08,810 --> 00:06:10,889 and we really value that because we're working 161 00:06:10,889 --> 00:06:12,910 together to solve some problems. 162 00:06:13,975 --> 00:06:15,254 And I think that's really one of the 163 00:06:15,254 --> 00:06:17,415 strengths of our pro of our project. So 164 00:06:17,415 --> 00:06:19,735 even though Connor is doing research, it's it's, 165 00:06:19,735 --> 00:06:22,535 like, very applied research. It's research with, you 166 00:06:22,535 --> 00:06:24,634 know, real patients that have had real strokes 167 00:06:24,775 --> 00:06:25,275 and, 168 00:06:26,694 --> 00:06:29,040 and all of that stuff. So yeah, so 169 00:06:29,040 --> 00:06:30,579 I'm the principal investigator 170 00:06:32,000 --> 00:06:34,079 on this project. And that means that it's 171 00:06:34,079 --> 00:06:36,500 my job to take care of the team 172 00:06:36,720 --> 00:06:38,800 to make sure we're all working together and 173 00:06:38,800 --> 00:06:41,074 that we're achieving the goals that we 174 00:06:41,535 --> 00:06:41,855 have. 175 00:06:42,495 --> 00:06:45,694 And because we're at the same time trying 176 00:06:45,694 --> 00:06:49,154 to improve practice for speech language pathologists, 177 00:06:50,415 --> 00:06:51,634 and also advance, 178 00:06:52,095 --> 00:06:52,915 our understanding 179 00:06:53,455 --> 00:06:55,259 of how the brain works, how the left 180 00:06:55,259 --> 00:06:56,319 hemisphere works, 181 00:06:57,180 --> 00:06:59,500 and how it reacts to stroke, we, 182 00:07:00,379 --> 00:07:02,459 we have to work together. And it's really, 183 00:07:02,459 --> 00:07:05,680 really essential that we're addressing both practical questions 184 00:07:05,740 --> 00:07:07,600 and also at the same time innovation 185 00:07:08,300 --> 00:07:09,040 and discovery, 186 00:07:09,644 --> 00:07:10,144 and, 187 00:07:11,644 --> 00:07:13,485 to have an openness that there may be 188 00:07:13,485 --> 00:07:16,064 different conclusions from what we had, like, anticipated 189 00:07:16,444 --> 00:07:18,524 at first. And so that's that's my role. 190 00:07:18,524 --> 00:07:19,024 I 191 00:07:19,564 --> 00:07:21,104 besides supporting the team 192 00:07:22,139 --> 00:07:23,839 and making sure everybody feels comfortable. 193 00:07:24,620 --> 00:07:25,120 I 194 00:07:25,580 --> 00:07:27,279 help with various types of analysis, 195 00:07:27,580 --> 00:07:29,680 administrative work and interpretation. 196 00:07:30,139 --> 00:07:33,019 And then, of course, writing articles and doing 197 00:07:33,019 --> 00:07:34,000 conference presentations 198 00:07:34,459 --> 00:07:34,959 and 199 00:07:35,420 --> 00:07:37,439 writing grants and things like that. 200 00:07:37,875 --> 00:07:40,675 And also sharing the resources that we're developing, 201 00:07:40,675 --> 00:07:43,095 which we'll touch on a little bit later. 202 00:07:43,634 --> 00:07:45,475 Awesome. Awesome. Well, welcome all of you. So 203 00:07:45,475 --> 00:07:46,995 nice to meet all of you. Thank you 204 00:07:46,995 --> 00:07:49,555 for being here. Alright. So so let's dive 205 00:07:49,555 --> 00:07:51,634 in. Where where should we start? Connor, do 206 00:07:51,634 --> 00:07:53,175 you wanna give us a an overview? 207 00:07:53,769 --> 00:07:55,149 Yeah. I can get us started. 208 00:07:55,689 --> 00:07:57,610 So I'll just kinda begin with why we 209 00:07:57,610 --> 00:07:59,789 wanted to come on the podcast in general. 210 00:08:00,089 --> 00:08:01,689 As we said, a large part of the 211 00:08:01,689 --> 00:08:04,329 study is to better define apraxia of speech 212 00:08:04,329 --> 00:08:07,209 and to create some more objective measures that 213 00:08:07,209 --> 00:08:09,389 clinicians can use to take the guesswork 214 00:08:09,824 --> 00:08:11,365 out of diagnosing AOS. 215 00:08:12,464 --> 00:08:14,944 And we've been updating the speech therapists at 216 00:08:14,944 --> 00:08:17,185 our sites that we recruit from, but we 217 00:08:17,185 --> 00:08:19,745 just thought why not reach more SLPs through 218 00:08:19,745 --> 00:08:20,485 this platform. 219 00:08:20,865 --> 00:08:22,564 So that's kind of why we're here. 220 00:08:23,104 --> 00:08:24,625 And how we have it set up a 221 00:08:24,625 --> 00:08:27,250 little bit is we'll move through the continuum 222 00:08:27,389 --> 00:08:30,029 of care as a stroke survivor would and 223 00:08:30,029 --> 00:08:32,429 kind of explain the challenges throughout, and then 224 00:08:32,429 --> 00:08:34,910 we'll get more into the details on the 225 00:08:34,910 --> 00:08:37,754 study and the definitions and wrap up with 226 00:08:38,154 --> 00:08:41,215 the acoustic and perceptual analysis that we're using 227 00:08:41,674 --> 00:08:44,394 and, have developed so far, and then kind 228 00:08:44,394 --> 00:08:47,754 of the future direction for upcoming research ideas 229 00:08:47,754 --> 00:08:50,730 and and resources that we are aiming to 230 00:08:50,809 --> 00:08:52,509 share with the SLP community. 231 00:08:53,129 --> 00:08:53,629 Beautiful. 232 00:08:54,009 --> 00:08:56,329 And I just wanted to just chime in 233 00:08:56,329 --> 00:08:58,250 here and say that one of the things 234 00:08:58,250 --> 00:09:01,049 that we decided early on was that we 235 00:09:01,049 --> 00:09:02,429 were going to do this, 236 00:09:03,289 --> 00:09:03,789 project, 237 00:09:04,855 --> 00:09:07,174 about this dilemma of how do you diagnose 238 00:09:07,174 --> 00:09:09,434 apraxia of speech, which is, like, a long, 239 00:09:10,535 --> 00:09:11,035 recognized, 240 00:09:12,134 --> 00:09:13,835 dilemma. Like, it's not easy. 241 00:09:14,295 --> 00:09:16,375 But we decided early on that we were 242 00:09:16,375 --> 00:09:17,434 going to focus 243 00:09:17,990 --> 00:09:20,789 our study on the first few months after 244 00:09:20,789 --> 00:09:21,289 stroke, 245 00:09:22,789 --> 00:09:25,190 because this is when speech language pathologists are 246 00:09:25,190 --> 00:09:25,690 seeing, 247 00:09:26,070 --> 00:09:27,370 these patients, evaluating, 248 00:09:27,750 --> 00:09:28,970 diagnosing, and treating. 249 00:09:30,634 --> 00:09:31,134 And, 250 00:09:31,674 --> 00:09:34,254 we wanted our participants to be representative 251 00:09:34,634 --> 00:09:36,975 of actual patients that speech pathologists 252 00:09:37,434 --> 00:09:39,754 seen see. And this is this is different 253 00:09:39,754 --> 00:09:43,230 from most other treatment or, most other assessment 254 00:09:43,450 --> 00:09:46,110 studies rather on apraxia of speech in that 255 00:09:46,570 --> 00:09:47,309 they typically 256 00:09:47,690 --> 00:09:50,009 look at people who are at least six 257 00:09:50,009 --> 00:09:51,070 months post onset, 258 00:09:51,610 --> 00:09:52,509 and we're looking 259 00:09:52,970 --> 00:09:55,789 at zero months to six months post onset. 260 00:09:56,169 --> 00:09:58,110 So we'll begin with acute care. 261 00:09:58,455 --> 00:10:00,855 There is when a patient comes into the 262 00:10:00,855 --> 00:10:02,934 hospital with a stroke, there's kind of just 263 00:10:02,934 --> 00:10:03,995 a flurry of 264 00:10:04,375 --> 00:10:07,434 evaluations and a revolving door of medical professionals 265 00:10:07,495 --> 00:10:10,315 trying to see them. And any speech therapist 266 00:10:10,455 --> 00:10:12,375 who has worked in acute care knows that 267 00:10:12,375 --> 00:10:15,070 dysphagia is the primary concern at that time. 268 00:10:15,289 --> 00:10:17,449 Everyone wants to know, can they eat? Can 269 00:10:17,449 --> 00:10:19,629 they drink? Can they take their medications? 270 00:10:20,169 --> 00:10:23,149 So there's a lot of extraneous factors that 271 00:10:23,449 --> 00:10:25,370 really influence and play a role in what 272 00:10:25,370 --> 00:10:26,509 you're able to do. 273 00:10:27,284 --> 00:10:29,284 And the patients have just gone through a 274 00:10:29,284 --> 00:10:32,485 traumatic and life altering medical event, so they're 275 00:10:32,485 --> 00:10:36,105 emotional, fatigued, and they might have limited endurance. 276 00:10:36,565 --> 00:10:38,245 So you really have a limited amount of 277 00:10:38,245 --> 00:10:40,245 time with them overall where you're trying to 278 00:10:40,245 --> 00:10:42,345 gather as much information as possible. 279 00:10:43,420 --> 00:10:46,300 And not to mention, they're also in pain 280 00:10:46,300 --> 00:10:48,460 and on many medications at that time too, 281 00:10:48,460 --> 00:10:50,879 which can impact alertness and attention. 282 00:10:51,660 --> 00:10:53,660 So it is kind of messy when they 283 00:10:53,660 --> 00:10:55,754 first come in. But the goal at this 284 00:10:55,754 --> 00:10:58,554 stage is to set a positive tone for 285 00:10:58,554 --> 00:11:00,414 speech therapy from the get go 286 00:11:00,875 --> 00:11:03,754 and help the patient communicate with their families 287 00:11:03,754 --> 00:11:04,654 and care team 288 00:11:05,034 --> 00:11:08,334 and really start instilling confidence in the communication 289 00:11:08,634 --> 00:11:10,575 modalities that they do have. 290 00:11:11,139 --> 00:11:13,940 And so even though we're not suggesting a 291 00:11:13,940 --> 00:11:16,740 formal diagnosis at this time for someone with 292 00:11:16,740 --> 00:11:17,959 apraxia of speech, 293 00:11:18,419 --> 00:11:20,100 we do wanna talk a little bit about 294 00:11:20,100 --> 00:11:22,600 what informal assessment might look like. 295 00:11:24,065 --> 00:11:26,225 So every speech therapist knows who works in 296 00:11:26,225 --> 00:11:27,985 acute care. You're gonna start with that chart 297 00:11:27,985 --> 00:11:29,684 review, reviewing their, 298 00:11:30,465 --> 00:11:33,665 medical history that is pertinent and then reviewing 299 00:11:33,665 --> 00:11:36,725 those scans, so the MRI or CT scans. 300 00:11:36,940 --> 00:11:38,940 And that's really gonna help you predict what 301 00:11:38,940 --> 00:11:41,420 their deficits may be and kind of tailor 302 00:11:41,420 --> 00:11:43,660 your assessment a little bit based off of 303 00:11:43,660 --> 00:11:45,740 that. Yeah. And I'll say a little bit 304 00:11:45,740 --> 00:11:48,560 more here too. At this point, we don't 305 00:11:49,115 --> 00:11:50,875 necessarily think that, okay, if we look at 306 00:11:50,875 --> 00:11:53,434 the brain scan, the MRI, or the CT, 307 00:11:53,434 --> 00:11:55,914 that we're gonna be able to know exactly 308 00:11:55,914 --> 00:11:57,834 what a person is going to be able 309 00:11:57,834 --> 00:11:58,495 to do. 310 00:11:58,954 --> 00:12:00,975 But we think it's important that SLPs 311 00:12:01,440 --> 00:12:04,100 feel confident that they can take some clues 312 00:12:04,160 --> 00:12:05,940 and say and start to make some 313 00:12:06,480 --> 00:12:08,639 maybe some predictions about, well, what do I 314 00:12:08,639 --> 00:12:10,340 think I might see in in 315 00:12:11,040 --> 00:12:13,600 do I hear what I expect that I'm 316 00:12:13,600 --> 00:12:15,759 going to hear when I look at the 317 00:12:15,759 --> 00:12:16,419 the scans? 318 00:12:16,764 --> 00:12:18,445 And we look we're talking only about the 319 00:12:18,445 --> 00:12:20,845 left hemisphere in this study, and so it's 320 00:12:21,004 --> 00:12:22,845 you know, we we expect generally that a 321 00:12:22,845 --> 00:12:24,464 lot of people are gonna have aphasia. 322 00:12:25,245 --> 00:12:26,464 They may have some difficulty 323 00:12:26,845 --> 00:12:27,345 with, 324 00:12:28,125 --> 00:12:31,050 formulating what they wanna say, coming up with, 325 00:12:31,529 --> 00:12:33,070 with words, word finding. 326 00:12:33,850 --> 00:12:35,370 But, yeah, we have some ideas. Okay. If 327 00:12:35,370 --> 00:12:37,210 it's a frontal lesion, then maybe we're going 328 00:12:37,210 --> 00:12:39,070 to expect to experience 329 00:12:39,690 --> 00:12:42,410 apraxia of speech or maybe a nonfluent ephasia. 330 00:12:42,410 --> 00:12:43,309 If there's something 331 00:12:43,804 --> 00:12:46,284 that is more posterior, we might expect something 332 00:12:46,284 --> 00:12:48,684 that's a little bit more fluent. But, really, 333 00:12:48,684 --> 00:12:50,444 everybody's a little bit different, and they they 334 00:12:50,444 --> 00:12:52,304 give us different profiles. And 335 00:12:52,764 --> 00:12:53,504 when I, 336 00:12:54,125 --> 00:12:56,125 you know, I draw the the side of 337 00:12:56,125 --> 00:12:57,899 the brain for my students. I'm I'm doing 338 00:12:57,899 --> 00:12:59,179 it in the air here. I know we're 339 00:12:59,179 --> 00:13:01,820 on audio here. But there's there's this big 340 00:13:01,820 --> 00:13:02,960 section in the middle, 341 00:13:03,340 --> 00:13:03,840 where 342 00:13:04,220 --> 00:13:06,940 middle cerebral artery strokes are what we see 343 00:13:06,940 --> 00:13:09,419 most of the time, and they overlap in 344 00:13:09,419 --> 00:13:11,679 all these different areas. And so, 345 00:13:12,524 --> 00:13:14,524 you know, we might expect some motor planning 346 00:13:14,524 --> 00:13:18,285 difficulties. We might expect some neuromuscular weakness, maybe 347 00:13:18,285 --> 00:13:21,105 some dysarthria, and we might also expect aphasia. 348 00:13:21,485 --> 00:13:23,085 And ever since Katerina and I have been 349 00:13:23,085 --> 00:13:25,805 working together, we we were just sort of, 350 00:13:25,805 --> 00:13:27,184 like, looking at, 351 00:13:27,529 --> 00:13:29,290 like, what's being done in the field, and 352 00:13:29,290 --> 00:13:31,129 a lot of the field was trying to 353 00:13:31,129 --> 00:13:32,750 pick a pow pick apart 354 00:13:34,490 --> 00:13:37,049 mild isolated disorders, and we were really interested 355 00:13:37,049 --> 00:13:39,230 in, like, well, what do people look like, 356 00:13:40,615 --> 00:13:43,254 reality and in in recognizing the messy reality 357 00:13:43,254 --> 00:13:45,754 that we have a lot of overlap in, 358 00:13:46,215 --> 00:13:48,075 in conditions, different 359 00:13:49,095 --> 00:13:50,934 multiple things are going to exist in the 360 00:13:50,934 --> 00:13:52,315 same person. So, 361 00:13:54,339 --> 00:13:55,620 anyway, I just wanted to talk a little 362 00:13:55,620 --> 00:13:57,220 bit about that and things that we we 363 00:13:57,220 --> 00:13:58,659 we can start to see, like, well, what 364 00:13:58,659 --> 00:13:58,899 do we 365 00:14:00,100 --> 00:14:00,600 if 366 00:14:00,980 --> 00:14:02,919 if we think that we're going to, 367 00:14:03,700 --> 00:14:06,100 see small if we see small vessel disease, 368 00:14:06,100 --> 00:14:07,779 a lot of tiny little strokes, we might 369 00:14:07,779 --> 00:14:09,884 start to wonder, hey. Should we be looking 370 00:14:09,884 --> 00:14:11,585 at cognition a little bit more? 371 00:14:12,125 --> 00:14:15,345 But that happens alongside with dysarthria and apraxia 372 00:14:15,485 --> 00:14:16,144 and aphasia. 373 00:14:17,004 --> 00:14:18,524 Thank you for saying that, Adam. I I 374 00:14:18,524 --> 00:14:20,524 struggled a bit in acute care, you know, 375 00:14:20,524 --> 00:14:22,924 with with reading these MRIs and reading where 376 00:14:22,924 --> 00:14:24,250 the stroke happened in the brain. And I'm 377 00:14:24,250 --> 00:14:26,169 like, shouldn't this be more clear cut? You 378 00:14:26,169 --> 00:14:29,129 know? Shouldn't if x happens, then they present 379 00:14:29,129 --> 00:14:31,289 with y. You know? And and anybody that 380 00:14:31,289 --> 00:14:33,210 that works clinically knows that is not the 381 00:14:33,210 --> 00:14:35,289 way. But I do feel like there could 382 00:14:35,289 --> 00:14:35,950 be more 383 00:14:36,475 --> 00:14:39,274 guidelines or guardrails. You know? So so thank 384 00:14:39,274 --> 00:14:41,195 you for saying that because I think those 385 00:14:41,195 --> 00:14:42,575 of us that have worked clinically 386 00:14:42,955 --> 00:14:45,115 feel like there should be some some better 387 00:14:45,115 --> 00:14:47,274 guardrails. So thank you for doing this work. 388 00:14:47,274 --> 00:14:49,535 I think that this is something that is 389 00:14:49,730 --> 00:14:51,809 happening now. Like, it's not just our team. 390 00:14:51,809 --> 00:14:53,250 There are other teams as well that are 391 00:14:53,250 --> 00:14:55,330 looking at it. And the thing that has 392 00:14:55,330 --> 00:14:58,050 been missing in the past is that there 393 00:14:58,050 --> 00:14:59,750 haven't been any large studies, 394 00:15:00,210 --> 00:15:02,210 you know, because when you're looking for patterns 395 00:15:02,210 --> 00:15:05,404 like that, you wanna, like, have probabilities of 396 00:15:05,404 --> 00:15:07,745 what causes what. And, like, in general, 397 00:15:08,605 --> 00:15:10,225 you need large sample sizes. 398 00:15:10,684 --> 00:15:12,524 Well, how many I might be skipping ahead 399 00:15:12,524 --> 00:15:14,284 here, but how many patients are you guys 400 00:15:14,284 --> 00:15:15,825 hoping to include in the study? 401 00:15:16,620 --> 00:15:19,660 Several 100. So far, we have four about 402 00:15:19,660 --> 00:15:22,139 four hundred and fifty people, who are stroke 403 00:15:22,139 --> 00:15:22,639 survivors. 404 00:15:23,019 --> 00:15:24,700 Yeah. Well, thank you for adding that. 405 00:15:25,420 --> 00:15:27,580 And I do agree from the clinical perspective, 406 00:15:27,580 --> 00:15:29,200 it is very needed. 407 00:15:29,740 --> 00:15:32,115 And like you said, Theresa, the guardrails would 408 00:15:32,115 --> 00:15:33,955 be very nice to have a little bit 409 00:15:33,955 --> 00:15:35,095 more guidance on. 410 00:15:36,355 --> 00:15:38,754 But yeah. So as you are gathering that 411 00:15:38,754 --> 00:15:41,235 information, you do kind of start to gather 412 00:15:41,235 --> 00:15:43,394 a hypothesis on what what I might be 413 00:15:43,394 --> 00:15:46,269 looking for walking into the patient's room. And 414 00:15:46,269 --> 00:15:47,789 so as soon as you meet them, you 415 00:15:47,789 --> 00:15:50,370 know, you start observing their informal conversation. 416 00:15:51,230 --> 00:15:53,230 Are they responding to me? Are they trying 417 00:15:53,230 --> 00:15:54,589 to greet me when I walk in the 418 00:15:54,589 --> 00:15:55,089 room? 419 00:15:55,470 --> 00:15:57,710 Even if they can't verbalize, are they trying 420 00:15:57,710 --> 00:16:00,370 to gesture and point to communicate with me? 421 00:16:00,985 --> 00:16:02,285 If they are verbalizing, 422 00:16:02,665 --> 00:16:05,625 do they have effortful speech? Is it labored 423 00:16:05,625 --> 00:16:07,085 breath, imprecise articulation? 424 00:16:08,425 --> 00:16:11,304 How intelligible are they? Are there any motor 425 00:16:11,304 --> 00:16:13,945 issues? Any hemiparesis? These questions are just kind 426 00:16:13,945 --> 00:16:16,490 of going in the back of your mind 427 00:16:16,490 --> 00:16:18,649 as you're talking with the patient and working 428 00:16:18,649 --> 00:16:21,149 with them because you're trying to gather information 429 00:16:21,370 --> 00:16:23,289 as or you're trying to gather as much 430 00:16:23,289 --> 00:16:25,769 information as you can on their language and 431 00:16:25,769 --> 00:16:27,230 motor speech function, 432 00:16:28,325 --> 00:16:30,644 in an informal way in case you don't 433 00:16:30,644 --> 00:16:32,884 have time to do it more formally in 434 00:16:32,884 --> 00:16:34,804 that setting, and likely you won't. 435 00:16:35,684 --> 00:16:37,284 And that's you know, you're just kind of 436 00:16:37,284 --> 00:16:41,384 assessing informally for aphasia, dysarthria, voice, and apraxia 437 00:16:41,524 --> 00:16:42,904 of speech as you go. 438 00:16:45,050 --> 00:16:45,450 And, 439 00:16:45,930 --> 00:16:47,769 I'll jump in here too to say a 440 00:16:47,769 --> 00:16:49,790 little bit. When we were first conceptualizing 441 00:16:50,410 --> 00:16:52,490 this study, this kinda goes to what I 442 00:16:52,490 --> 00:16:55,290 was saying about the we expect to see, 443 00:16:56,665 --> 00:16:57,165 overlapping 444 00:16:57,865 --> 00:16:58,365 difficulties 445 00:16:58,745 --> 00:17:02,285 in language and speech programming and speech execution. 446 00:17:02,504 --> 00:17:04,684 So we we try to be really intentional 447 00:17:04,904 --> 00:17:05,404 about 448 00:17:05,785 --> 00:17:07,945 what are the things that we're asking people 449 00:17:07,945 --> 00:17:09,565 to do so that we can 450 00:17:10,660 --> 00:17:11,480 really identify 451 00:17:12,019 --> 00:17:13,000 those distinct 452 00:17:13,460 --> 00:17:15,559 problems in in the same people. 453 00:17:16,900 --> 00:17:18,980 Because it's a research study, we're doing a 454 00:17:18,980 --> 00:17:21,700 lot more in an early stage than most 455 00:17:21,700 --> 00:17:23,779 people would do. So typically, one of our 456 00:17:23,779 --> 00:17:24,279 evaluations 457 00:17:24,660 --> 00:17:26,200 might last a couple of hours, 458 00:17:27,595 --> 00:17:28,335 all in. 459 00:17:29,674 --> 00:17:32,075 But we're not saying that that's what should 460 00:17:32,075 --> 00:17:35,115 typically happen in the in the acute stage. 461 00:17:35,115 --> 00:17:36,875 But but we are trying to figure out, 462 00:17:36,875 --> 00:17:38,734 okay, like, from this larger sample, 463 00:17:39,515 --> 00:17:40,255 what are 464 00:17:40,630 --> 00:17:42,809 procedures that we think will be more useful 465 00:17:42,950 --> 00:17:44,789 to clinicians when they only have a few 466 00:17:44,789 --> 00:17:45,289 minutes, 467 00:17:45,669 --> 00:17:47,049 you know, to check-in in 468 00:17:47,349 --> 00:17:48,089 every day? 469 00:17:48,710 --> 00:17:50,309 And so we yeah. We're looking to make 470 00:17:50,309 --> 00:17:51,769 sure that we sample from 471 00:17:52,150 --> 00:17:54,329 language, speech motor planning, execution. 472 00:17:56,575 --> 00:17:59,475 And we tend to find we've been curious 473 00:17:59,615 --> 00:18:01,934 and suspicious for a long time that we're 474 00:18:01,934 --> 00:18:04,255 really we are really interested in apraxia of 475 00:18:04,255 --> 00:18:06,174 speech, but we start to listen to people 476 00:18:06,174 --> 00:18:07,855 when we say, do I have a little 477 00:18:07,855 --> 00:18:09,315 bit of dysarthria there? 478 00:18:09,730 --> 00:18:12,049 Am I am I hearing some some differences 479 00:18:12,049 --> 00:18:13,809 in the voice? Am I hearing some differences 480 00:18:13,809 --> 00:18:14,549 in resonance? 481 00:18:14,849 --> 00:18:16,529 And so we've we've made sure that we've 482 00:18:16,529 --> 00:18:17,669 included some, 483 00:18:18,849 --> 00:18:21,649 tasks and some analysis procedures where we can 484 00:18:21,649 --> 00:18:23,474 figure that out. And, of course, also the 485 00:18:23,474 --> 00:18:25,894 same thing. We're we're sampling language as well. 486 00:18:26,115 --> 00:18:27,894 And then kind of last thing on 487 00:18:28,275 --> 00:18:31,154 on the evaluation portion in acute care, you 488 00:18:31,154 --> 00:18:32,674 just wanna make sure that you're doing that 489 00:18:32,674 --> 00:18:35,394 oral MEC exam, and that is typically included 490 00:18:35,394 --> 00:18:37,740 in the clinical swallow assessment, which you have 491 00:18:37,740 --> 00:18:38,639 to do absolutely, 492 00:18:39,179 --> 00:18:40,859 for patients who have come in with a 493 00:18:40,859 --> 00:18:42,700 stroke. But it can also provide a lot 494 00:18:42,700 --> 00:18:45,019 of insight on, you know, if the patient 495 00:18:45,019 --> 00:18:45,759 has dysarthria 496 00:18:46,139 --> 00:18:47,039 or dysphagia. 497 00:18:48,059 --> 00:18:50,644 Because, again, from our point of view, when 498 00:18:50,644 --> 00:18:51,144 diagnosing 499 00:18:51,765 --> 00:18:55,065 apraxia of speech, we really aren't interested in 500 00:18:55,444 --> 00:18:57,765 or we don't think it's very practical always 501 00:18:57,765 --> 00:18:59,384 in the acute setting because 502 00:19:00,085 --> 00:19:02,424 the patient is just changing so rapidly, 503 00:19:03,269 --> 00:19:05,109 and your time is so precious with the 504 00:19:05,109 --> 00:19:07,529 patient at that time. And as the SLP, 505 00:19:07,590 --> 00:19:10,789 you wanna provide counseling and communication access, and 506 00:19:10,789 --> 00:19:13,690 then that formal diagnosis is better to come, 507 00:19:14,470 --> 00:19:16,710 later on down the road once they've been 508 00:19:16,710 --> 00:19:18,904 given some time to adjust and, 509 00:19:19,384 --> 00:19:21,085 have become a little bit more stable. 510 00:19:21,384 --> 00:19:23,304 Connor, I want to just add to that 511 00:19:23,304 --> 00:19:26,025 the how precious the time is because I 512 00:19:26,025 --> 00:19:26,845 think that 513 00:19:27,224 --> 00:19:28,984 that's an area where a lot of times 514 00:19:28,984 --> 00:19:30,684 we can do better work, 515 00:19:31,384 --> 00:19:32,044 in that, 516 00:19:32,659 --> 00:19:34,819 you know, we may feel like our job 517 00:19:34,819 --> 00:19:36,659 is to evaluate and try to figure what's 518 00:19:36,659 --> 00:19:38,740 going on and how it's changing rapidly during 519 00:19:38,740 --> 00:19:40,759 the first few days post stroke. 520 00:19:41,700 --> 00:19:43,779 But that's also a time where, 521 00:19:44,099 --> 00:19:47,079 patients are in extreme need of reassurance, 522 00:19:48,194 --> 00:19:51,954 and communication access and just information for for 523 00:19:51,954 --> 00:19:53,654 family for them to, 524 00:19:55,075 --> 00:19:57,734 just get in a space where they're ready 525 00:19:57,794 --> 00:19:59,494 to move forward in their rehabilitation. 526 00:20:00,115 --> 00:20:01,554 And this is one of the things we 527 00:20:01,554 --> 00:20:03,609 hear later on that people feel like they 528 00:20:03,609 --> 00:20:05,069 didn't get the right counseling. 529 00:20:05,450 --> 00:20:07,450 They didn't they didn't get reassured. They were 530 00:20:07,450 --> 00:20:09,549 really worried. They had, like, misconceptions 531 00:20:09,929 --> 00:20:12,190 about what was gonna happen later on. So, 532 00:20:13,369 --> 00:20:16,509 it's really, really, really important that speech pathologists 533 00:20:16,889 --> 00:20:18,269 focus on the person, 534 00:20:19,355 --> 00:20:21,855 in the acute care and the family and 535 00:20:22,315 --> 00:20:23,535 provide them with, 536 00:20:23,914 --> 00:20:26,494 with communication access and information 537 00:20:26,955 --> 00:20:27,775 at that point. 538 00:20:28,475 --> 00:20:28,975 So 539 00:20:29,674 --> 00:20:32,255 when it comes to diagnosing speech specifically, 540 00:20:33,990 --> 00:20:36,170 sometimes we can do it just by intuition. 541 00:20:36,470 --> 00:20:39,509 Like, an experienced clinician that has seen hundreds 542 00:20:39,509 --> 00:20:40,250 and thousands 543 00:20:40,789 --> 00:20:42,490 of cases, they we have 544 00:20:43,029 --> 00:20:45,509 a picture of, like, what the whole profile 545 00:20:45,509 --> 00:20:48,325 looks like, and we can identify this just 546 00:20:48,325 --> 00:20:49,765 so I can hear that this is a 547 00:20:49,765 --> 00:20:50,825 praxiom speech, 548 00:20:52,325 --> 00:20:55,464 or it's a praxiom speech with coexisting dysarthria, 549 00:20:55,525 --> 00:20:56,265 for example. 550 00:20:56,805 --> 00:20:58,884 But the truth of it, and this is 551 00:20:58,884 --> 00:21:01,279 something that's new in this in our research 552 00:21:01,279 --> 00:21:03,380 is that sometimes it's not clear. 553 00:21:03,839 --> 00:21:05,759 Sometimes it's not clear what it is, and 554 00:21:05,759 --> 00:21:07,299 it's not a textbook case. 555 00:21:09,039 --> 00:21:10,900 And it can also change, 556 00:21:11,519 --> 00:21:13,619 as Connor mentioned, like, rapidly. 557 00:21:15,144 --> 00:21:17,484 But in those cases, what we are, 558 00:21:18,184 --> 00:21:19,644 wanting to say is that 559 00:21:20,984 --> 00:21:21,964 this is normal 560 00:21:22,904 --> 00:21:25,565 and it's okay to not have a confirmed 561 00:21:25,705 --> 00:21:26,205 diagnosis. 562 00:21:27,809 --> 00:21:30,049 And it's okay for that picture to become 563 00:21:30,049 --> 00:21:31,110 clearer and clearer 564 00:21:31,490 --> 00:21:34,529 certainly in acute care. But also after that, 565 00:21:34,529 --> 00:21:37,090 like, it's it's okay for it to kind 566 00:21:37,090 --> 00:21:38,309 of evolve. So, 567 00:21:40,904 --> 00:21:42,664 we'll get into that more. But once you 568 00:21:42,664 --> 00:21:45,065 get into later stages of recovery, then you 569 00:21:45,065 --> 00:21:45,805 can become, 570 00:21:46,825 --> 00:21:49,305 more analytical if it isn't, you know, yet 571 00:21:49,305 --> 00:21:50,525 clear and, like, 572 00:21:50,904 --> 00:21:52,605 just really look at the features 573 00:21:52,984 --> 00:21:54,779 and see how the features features come together 574 00:21:54,920 --> 00:21:56,380 and then use reasoning 575 00:21:57,000 --> 00:22:00,039 to, to arrive at a diagnosis. But that's 576 00:22:00,039 --> 00:22:02,039 not what you would do in an acute 577 00:22:02,039 --> 00:22:04,599 care setting. It would be more intuition and 578 00:22:04,599 --> 00:22:07,980 just information gathering and okay. Just say, 579 00:22:08,515 --> 00:22:11,335 yep. We suspect this, but we don't know. 580 00:22:11,714 --> 00:22:14,194 So, Katerina, you mentioned that timing was is 581 00:22:14,194 --> 00:22:15,734 very crucial for this study. 582 00:22:16,115 --> 00:22:18,194 Are you willing to share when did you 583 00:22:18,194 --> 00:22:20,214 evaluate these patients? How soon 584 00:22:20,515 --> 00:22:22,434 post stroke and were there multiple points of 585 00:22:22,434 --> 00:22:23,394 measurement or just 586 00:22:24,049 --> 00:22:24,549 yeah. 587 00:22:24,849 --> 00:22:27,009 Yeah. So we we this is a study 588 00:22:27,009 --> 00:22:28,849 that's just done in at one point in 589 00:22:28,849 --> 00:22:31,809 time. So we're asking people for two hours 590 00:22:31,809 --> 00:22:32,710 of their time. 591 00:22:33,809 --> 00:22:34,309 And, 592 00:22:35,650 --> 00:22:36,630 it's a lot. 593 00:22:37,144 --> 00:22:37,644 So 594 00:22:37,944 --> 00:22:40,204 we are we're open to, 595 00:22:41,144 --> 00:22:42,365 to see them anywhere, 596 00:22:43,224 --> 00:22:45,625 typically within the first six months. We've extended 597 00:22:45,625 --> 00:22:47,304 it so we do see some people who 598 00:22:47,304 --> 00:22:49,144 are more chronic as well. But the vast 599 00:22:49,144 --> 00:22:51,704 majority of them are seen before the six 600 00:22:51,704 --> 00:22:52,680 month mark. 601 00:22:53,000 --> 00:22:53,660 Some are 602 00:22:54,119 --> 00:22:55,500 seen day two after stroke, 603 00:22:55,799 --> 00:22:57,100 and then some are seen, 604 00:22:57,480 --> 00:22:59,340 you know, six months after. 605 00:23:00,119 --> 00:23:03,240 We make contact with them early on while 606 00:23:03,240 --> 00:23:04,220 they're in the hospital. 607 00:23:05,000 --> 00:23:07,500 We we talk to them and establish, 608 00:23:08,404 --> 00:23:09,464 you know, a relationship. 609 00:23:10,325 --> 00:23:12,164 And then it's up to them when they 610 00:23:12,164 --> 00:23:13,704 feel comfortable to be assessed. 611 00:23:14,565 --> 00:23:17,845 Are are you noticing any big difference between 612 00:23:17,845 --> 00:23:19,865 maybe two days post stroke verse 613 00:23:20,244 --> 00:23:22,005 six months post stroke as far as the 614 00:23:22,005 --> 00:23:24,829 data that you're collecting? Yep. Yeah. We 615 00:23:25,130 --> 00:23:26,410 well, so there's the, 616 00:23:26,890 --> 00:23:29,130 there's the variable of of, 617 00:23:29,769 --> 00:23:33,529 severity. Like, so what we don't have the 618 00:23:33,529 --> 00:23:35,849 answers to this yet, and this is something 619 00:23:35,849 --> 00:23:37,789 we want to pursue in further research 620 00:23:38,294 --> 00:23:39,754 is the the trajectories, 621 00:23:41,095 --> 00:23:42,954 because you're gonna see different trajectories. 622 00:23:43,414 --> 00:23:46,214 Right? So there's some people who end up 623 00:23:46,214 --> 00:23:48,954 with, let's say, chronic apraxia of speech 624 00:23:49,335 --> 00:23:51,335 for the rest of their lives. Often they're 625 00:23:51,335 --> 00:23:51,690 very 626 00:23:52,569 --> 00:23:54,269 severe, after the stroke, 627 00:23:54,889 --> 00:23:55,389 and, 628 00:23:56,329 --> 00:23:59,529 they typically don't want to be tested. They're 629 00:23:59,529 --> 00:24:01,149 sometimes they're not even testable, 630 00:24:02,250 --> 00:24:03,309 because they have 631 00:24:04,184 --> 00:24:06,044 their they have very little output. 632 00:24:06,585 --> 00:24:07,065 And they're 633 00:24:08,024 --> 00:24:11,144 then we try to scale schedule them later 634 00:24:11,144 --> 00:24:11,644 on, 635 00:24:13,224 --> 00:24:15,005 when they have recovered a bit. 636 00:24:15,944 --> 00:24:18,524 And then there's some people who have some 637 00:24:20,890 --> 00:24:23,769 milder speech issues that they may not even 638 00:24:23,769 --> 00:24:24,269 recognize, 639 00:24:24,730 --> 00:24:26,890 you know, as such, because there's so many 640 00:24:26,890 --> 00:24:29,549 other things happening and they might get discharged, 641 00:24:30,570 --> 00:24:31,070 quickly 642 00:24:31,690 --> 00:24:33,549 and then maybe like lost 643 00:24:33,875 --> 00:24:36,674 to to follow-up. And so we're interested in 644 00:24:36,674 --> 00:24:38,434 both of those, and I I don't know 645 00:24:38,434 --> 00:24:40,434 if I'm answering your questions here, but for 646 00:24:40,434 --> 00:24:41,894 sure people are evolving. 647 00:24:42,434 --> 00:24:44,775 And in this study, we're not able to 648 00:24:45,075 --> 00:24:47,795 track that Yeah. Because we're letting them choose 649 00:24:47,795 --> 00:24:49,869 when we see them, and we're looking at 650 00:24:50,090 --> 00:24:52,430 just the whole picture of different profiles. 651 00:24:52,730 --> 00:24:53,230 Yep. 652 00:24:53,930 --> 00:24:54,750 Makes sense. 653 00:24:56,809 --> 00:24:58,910 We do have a little bit of 654 00:24:59,450 --> 00:25:01,390 we we can look at their medical 655 00:25:01,765 --> 00:25:03,765 chart to see, you know, what the speech 656 00:25:03,765 --> 00:25:06,804 therapist was saying initially and then when at 657 00:25:06,804 --> 00:25:08,644 the time of testing, if they've improved a 658 00:25:08,644 --> 00:25:11,464 lot. So we look at that I mean, 659 00:25:11,605 --> 00:25:13,285 it's not a main focus of the study, 660 00:25:13,285 --> 00:25:15,044 I would say, but we you can look 661 00:25:15,044 --> 00:25:16,105 at it a little bit. 662 00:25:16,404 --> 00:25:16,904 Yeah. 663 00:25:20,700 --> 00:25:22,859 Alright. Well, I will just kinda jump back 664 00:25:22,859 --> 00:25:25,339 in with where we left off if that's 665 00:25:25,339 --> 00:25:28,539 okay. Yep. So after the patient moves on 666 00:25:28,539 --> 00:25:30,079 from acute care and they 667 00:25:30,464 --> 00:25:33,025 begin to get more medically stable, they're gonna 668 00:25:33,025 --> 00:25:35,184 leave the hospital and either go home and 669 00:25:35,184 --> 00:25:37,285 maybe receive home help or outpatient, 670 00:25:37,904 --> 00:25:40,065 or if they have more physical needs, they 671 00:25:40,065 --> 00:25:42,005 will go to inpatient rehab. 672 00:25:42,400 --> 00:25:44,400 And in this setting, we do think it's 673 00:25:44,400 --> 00:25:47,200 a bit easier and more necessary to provide 674 00:25:47,200 --> 00:25:48,660 that more formal diagnosis, 675 00:25:49,679 --> 00:25:52,559 because overall, they are improving, and that's when 676 00:25:52,559 --> 00:25:53,700 the therapy really 677 00:25:54,000 --> 00:25:54,500 starts, 678 00:25:55,515 --> 00:25:58,234 going. So their medications are being sorted out 679 00:25:58,234 --> 00:25:59,215 and better refined. 680 00:26:00,234 --> 00:26:02,394 The people are they're getting dressed at that 681 00:26:02,394 --> 00:26:05,375 time, and that really improves identity and motivation 682 00:26:05,515 --> 00:26:06,174 and positivity. 683 00:26:07,349 --> 00:26:09,529 Their schedule is a little bit more regular, 684 00:26:09,670 --> 00:26:13,269 and so their endurance is improving and fatigue 685 00:26:13,269 --> 00:26:14,490 is less of a factor. 686 00:26:15,029 --> 00:26:17,509 And then as the speech therapist who's working 687 00:26:17,509 --> 00:26:19,690 with them, you're able to really 688 00:26:20,615 --> 00:26:23,255 build that sense of rapport and trust with 689 00:26:23,255 --> 00:26:23,755 them. 690 00:26:24,455 --> 00:26:25,195 And so, 691 00:26:26,375 --> 00:26:27,894 you know, it's a bit easier and you 692 00:26:27,894 --> 00:26:29,975 have a little bit more time to devote 693 00:26:29,975 --> 00:26:30,475 to 694 00:26:30,855 --> 00:26:33,275 really giving them a more formal diagnosis 695 00:26:33,575 --> 00:26:34,715 and treatment plan. 696 00:26:35,570 --> 00:26:38,289 But despite all of these positive changes, we 697 00:26:38,289 --> 00:26:40,769 definitely recognize that it's still really hard, and 698 00:26:40,769 --> 00:26:42,710 that's why we're doing this project. 699 00:26:43,410 --> 00:26:46,049 It's hard to differentiate between those motor speech 700 00:26:46,049 --> 00:26:49,214 and language deficits. And Adam kinda touched on 701 00:26:49,214 --> 00:26:52,355 this before, but someone can have aphasia, apraxia, 702 00:26:52,494 --> 00:26:54,654 and dysarthria all at the same time. They 703 00:26:54,654 --> 00:26:55,394 can coexist. 704 00:26:56,095 --> 00:26:58,835 And when that happens, it is difficult to 705 00:26:59,214 --> 00:26:59,714 decipher 706 00:27:00,015 --> 00:27:00,515 which 707 00:27:00,839 --> 00:27:03,579 speech characteristics or symptoms of which disorder. 708 00:27:04,279 --> 00:27:06,359 And sometimes it just involves a process of 709 00:27:06,359 --> 00:27:06,859 elimination. 710 00:27:08,039 --> 00:27:11,160 But in evaluation reports, what we kind of 711 00:27:11,160 --> 00:27:13,660 recommend and we do see often is, 712 00:27:14,184 --> 00:27:17,144 speech therapists will write suspected apraxia of speech 713 00:27:17,144 --> 00:27:19,465 if it's something that, you know, they think 714 00:27:19,465 --> 00:27:22,025 is going is what's going on, but they're 715 00:27:22,025 --> 00:27:22,765 not positive. 716 00:27:23,545 --> 00:27:26,285 And then they kinda list the speech behaviors, 717 00:27:27,384 --> 00:27:29,809 that are observed that align with that diagnosis. 718 00:27:30,349 --> 00:27:32,509 And some of those characteristics might be a 719 00:27:32,509 --> 00:27:35,089 combination of distortion and substitution 720 00:27:35,549 --> 00:27:36,049 errors, 721 00:27:36,509 --> 00:27:38,289 and then abnormal prosody. 722 00:27:38,990 --> 00:27:41,575 And in our experience, a lot of speech 723 00:27:41,575 --> 00:27:42,195 therapists don't 724 00:27:42,734 --> 00:27:43,234 typically, 725 00:27:44,414 --> 00:27:47,075 use prosody as a main defining characteristic, 726 00:27:47,535 --> 00:27:49,455 but we found that that is one of 727 00:27:49,455 --> 00:27:50,115 the main, 728 00:27:50,975 --> 00:27:52,835 defining characteristics of apraxia. 729 00:27:53,690 --> 00:27:55,849 And so with that, you might see a 730 00:27:55,849 --> 00:27:56,349 patient 731 00:27:56,890 --> 00:27:59,529 produce longer words, one syllable at a time 732 00:27:59,529 --> 00:28:01,309 and really segment the syllables, 733 00:28:01,849 --> 00:28:04,170 or they may have long pauses in between 734 00:28:04,170 --> 00:28:04,670 words. 735 00:28:05,794 --> 00:28:08,454 But there are, of course, overlapping characteristics 736 00:28:08,914 --> 00:28:10,134 kinda like I said before. 737 00:28:10,835 --> 00:28:13,875 So for example, you can have distortions in 738 00:28:13,875 --> 00:28:16,294 apraxia of speech and also in dysarthria. 739 00:28:16,835 --> 00:28:19,714 They might be for different reasons, but they 740 00:28:19,714 --> 00:28:20,934 might sound very 741 00:28:21,329 --> 00:28:23,669 similar and that's why this is so hard. 742 00:28:25,089 --> 00:28:28,789 So we rely right now on subjective analysis 743 00:28:28,929 --> 00:28:30,869 without those quantitative tools 744 00:28:31,409 --> 00:28:32,210 to make 745 00:28:32,929 --> 00:28:36,325 or excuse me, to make confident judgments to 746 00:28:36,325 --> 00:28:38,664 differentiate between apraxia, dysarthria, 747 00:28:39,045 --> 00:28:40,904 and aphasia with phonemic paraplegia. 748 00:28:42,164 --> 00:28:44,644 And that's really why we're in need of 749 00:28:44,644 --> 00:28:46,184 some refined definitions 750 00:28:46,920 --> 00:28:49,480 and quantitative assessment tools that help us to 751 00:28:49,480 --> 00:28:50,700 make more confident 752 00:28:51,160 --> 00:28:52,299 diagnostic decisions. 753 00:28:53,080 --> 00:28:56,519 And, ultimately, those those diagnostic decisions are gonna 754 00:28:56,519 --> 00:28:59,640 drive treatment and outcomes for the patients and, 755 00:28:59,640 --> 00:29:01,964 you know, that's what we're so focused on. 756 00:29:02,684 --> 00:29:04,525 And that's kind of where the profile study 757 00:29:04,525 --> 00:29:07,325 really comes in. So, Katerina, you can take 758 00:29:07,325 --> 00:29:09,884 over from here. So the difference in our 759 00:29:09,884 --> 00:29:13,585 approach is we're operating from the assumption that 760 00:29:14,599 --> 00:29:16,140 it's a lot more complex 761 00:29:16,519 --> 00:29:16,759 about, 762 00:29:18,519 --> 00:29:21,420 how how speech is affected after stroke than 763 00:29:21,960 --> 00:29:23,980 these buckets of AOS, 764 00:29:24,279 --> 00:29:26,059 aphasia, with anemic paraphasia, 765 00:29:26,519 --> 00:29:27,494 or dysarthria. 766 00:29:27,954 --> 00:29:31,234 Right? Every patient is different and even within 767 00:29:31,234 --> 00:29:33,634 the syndrome, so, like, say, apraxia of speech, 768 00:29:33,634 --> 00:29:34,294 for example, 769 00:29:34,595 --> 00:29:36,694 they don't all sound the same. There there's 770 00:29:36,914 --> 00:29:39,154 a a lot of qualitative as well as 771 00:29:39,154 --> 00:29:39,654 quantitative 772 00:29:39,954 --> 00:29:40,454 difference. 773 00:29:41,075 --> 00:29:43,690 And we're not looking to develop one single 774 00:29:43,690 --> 00:29:45,470 checklist that you're just gonna 775 00:29:45,930 --> 00:29:46,430 use, 776 00:29:47,370 --> 00:29:48,509 and then identify 777 00:29:49,210 --> 00:29:50,110 one specific 778 00:29:50,570 --> 00:29:52,029 disorder versus another. 779 00:29:52,410 --> 00:29:54,330 We're instead looking at, like, what are the 780 00:29:54,330 --> 00:29:56,615 features that are common after stroke? 781 00:29:57,075 --> 00:29:58,695 What are the things that we're seeing? 782 00:29:59,234 --> 00:30:01,394 And then based on that, we can, 783 00:30:02,674 --> 00:30:05,234 make decisions about clinical care. And one of 784 00:30:05,234 --> 00:30:07,734 the things that we make decisions about potentially 785 00:30:07,955 --> 00:30:10,775 is whether they fit a specific profile, 786 00:30:11,529 --> 00:30:13,930 but they may not. You know? And the 787 00:30:13,930 --> 00:30:16,650 analogy that I like to use is, like, 788 00:30:16,650 --> 00:30:18,589 when we look at aphasia syndromes, 789 00:30:19,130 --> 00:30:21,289 we're all comfortable with the fact that there 790 00:30:21,289 --> 00:30:22,970 are a lot of people that can't be 791 00:30:22,970 --> 00:30:26,589 neatly classified as having one syndrome versus another. 792 00:30:26,794 --> 00:30:27,294 Like, 793 00:30:28,634 --> 00:30:30,575 and we feel like it's the same, 794 00:30:31,275 --> 00:30:34,315 with how speech is affected after stroke. There's 795 00:30:34,315 --> 00:30:36,714 some prototypical cases and then there's some that 796 00:30:36,714 --> 00:30:39,355 are not. So our approach is to measure 797 00:30:39,355 --> 00:30:41,519 the things that make, that are important, 798 00:30:43,339 --> 00:30:45,740 and then look at the patterns that we're 799 00:30:45,740 --> 00:30:46,240 getting, 800 00:30:47,099 --> 00:30:47,839 and then, 801 00:30:48,539 --> 00:30:51,920 use reasoning to differential di lead diagnose 802 00:30:52,299 --> 00:30:54,220 and also to, like, start to think about, 803 00:30:54,220 --> 00:30:56,644 like, what matters for treatment planning. Right? 804 00:30:58,305 --> 00:31:01,424 So we've been at it since 2020 805 00:31:01,424 --> 00:31:04,144 on this project. Oh my goodness. Yeah. It's 806 00:31:04,224 --> 00:31:06,384 it was we got funded right when the 807 00:31:06,384 --> 00:31:07,285 COVID pandemic 808 00:31:08,065 --> 00:31:10,625 started, and we were testing stroke survivors in 809 00:31:10,625 --> 00:31:11,765 hospitals with 810 00:31:12,309 --> 00:31:14,070 face to face. So it was a bit 811 00:31:14,070 --> 00:31:14,809 of a challenge. 812 00:31:15,430 --> 00:31:17,849 But, as I mentioned, we've we've seen, 813 00:31:18,470 --> 00:31:19,910 about 450 814 00:31:19,910 --> 00:31:20,970 people so far. 815 00:31:21,509 --> 00:31:23,210 We've seen 200 816 00:31:23,750 --> 00:31:26,795 matched neuro typical controls as well. So one 817 00:31:26,795 --> 00:31:28,475 of the things we're working on is to 818 00:31:28,475 --> 00:31:30,174 develop norms also 819 00:31:30,475 --> 00:31:31,115 so that, 820 00:31:31,595 --> 00:31:33,674 the the things that we're measuring can be 821 00:31:33,674 --> 00:31:34,894 used by speech pathologists 822 00:31:35,195 --> 00:31:36,174 in their settings. 823 00:31:38,130 --> 00:31:40,210 And we are at a point in this, 824 00:31:40,769 --> 00:31:42,470 project where we have enough 825 00:31:42,769 --> 00:31:45,570 data now that we're starting to disseminate a 826 00:31:45,570 --> 00:31:46,070 lot. 827 00:31:46,529 --> 00:31:49,329 So we have different mechanisms of doing that. 828 00:31:49,329 --> 00:31:51,970 We'll be writing articles. We'll be presenting. We 829 00:31:51,970 --> 00:31:54,035 are going to ASHA next week to do 830 00:31:54,035 --> 00:31:54,535 a, 831 00:31:55,474 --> 00:31:57,255 seminar on on this, 832 00:31:58,035 --> 00:31:58,535 project. 833 00:31:59,555 --> 00:32:01,815 We also have a website that we'll be 834 00:32:01,875 --> 00:32:04,454 sharing tools for, and I think, 835 00:32:04,835 --> 00:32:06,595 we'll talk about that a little bit later. 836 00:32:06,595 --> 00:32:07,095 But 837 00:32:07,970 --> 00:32:10,609 it's really about sharing with the community and 838 00:32:10,609 --> 00:32:12,549 getting feedback from them as well. 839 00:32:12,930 --> 00:32:15,509 Our long term goal is to 840 00:32:16,529 --> 00:32:17,830 really improve intervention. 841 00:32:18,529 --> 00:32:21,190 Okay. It's not to diagnose, just to diagnose. 842 00:32:21,330 --> 00:32:22,630 So we're 843 00:32:23,444 --> 00:32:24,184 very interested 844 00:32:24,565 --> 00:32:25,544 in having, 845 00:32:27,444 --> 00:32:27,944 presentation 846 00:32:28,244 --> 00:32:30,085 profiles that are going to tell us about 847 00:32:30,085 --> 00:32:30,825 the prognosis 848 00:32:31,125 --> 00:32:32,724 and that are going to tell us about 849 00:32:32,724 --> 00:32:34,585 how people might respond to a treatment. 850 00:32:34,884 --> 00:32:35,865 And we are 851 00:32:36,390 --> 00:32:39,029 honestly expecting there to be like a different 852 00:32:39,029 --> 00:32:39,529 classification 853 00:32:39,830 --> 00:32:42,650 system that we're gonna use that's more complex 854 00:32:42,789 --> 00:32:44,250 than the one that's existing 855 00:32:44,630 --> 00:32:44,869 today. 856 00:32:47,029 --> 00:32:49,954 We're already seeing that. And also another, 857 00:32:50,654 --> 00:32:51,954 surprise to us, 858 00:32:52,815 --> 00:32:54,194 honestly was that 859 00:32:54,654 --> 00:32:57,775 because we opened our minds to dysarthria and 860 00:32:57,775 --> 00:33:00,974 like mild dysarthria potentially coexisting, we're finding that 861 00:33:00,974 --> 00:33:03,554 it's quite common in the first few months. 862 00:33:03,859 --> 00:33:06,019 In a grant, you have aims. We have 863 00:33:06,019 --> 00:33:08,900 three aims. The first aim is that we 864 00:33:08,900 --> 00:33:10,440 want to develop a new assessment. 865 00:33:11,700 --> 00:33:14,039 Okay. Because there's not really a good assessment 866 00:33:14,099 --> 00:33:16,980 for speech, after stroke that's doing the things 867 00:33:16,980 --> 00:33:18,200 we want it to do. 868 00:33:18,980 --> 00:33:20,484 So we're developing 869 00:33:20,865 --> 00:33:23,765 speech measures that can capture the features that 870 00:33:24,144 --> 00:33:26,465 commonly occur after stroke and that we can 871 00:33:26,465 --> 00:33:27,605 we can check off. 872 00:33:29,105 --> 00:33:32,565 We're also developing methods where we can assess, 873 00:33:33,759 --> 00:33:34,259 severity 874 00:33:34,640 --> 00:33:35,779 so that we can, 875 00:33:36,960 --> 00:33:37,460 track, 876 00:33:37,759 --> 00:33:40,079 you know, recovery and so that we can 877 00:33:40,079 --> 00:33:42,500 probably link that to intervention methods. 878 00:33:43,599 --> 00:33:45,359 And we wanna do it in a way 879 00:33:45,359 --> 00:33:46,179 that is, 880 00:33:46,799 --> 00:33:47,299 efficient. 881 00:33:47,759 --> 00:33:48,419 You know? 882 00:33:49,345 --> 00:33:50,404 We have people 883 00:33:50,784 --> 00:33:54,325 with speech difficulties after stroke that range from 884 00:33:54,784 --> 00:33:55,605 very severe 885 00:33:55,984 --> 00:33:58,625 to really, really mild, and it doesn't make 886 00:33:58,625 --> 00:34:00,964 any sense to give everybody the same test. 887 00:34:02,065 --> 00:34:03,284 So we're working, 888 00:34:03,744 --> 00:34:05,659 to develop adaptive testing, 889 00:34:06,519 --> 00:34:07,339 where we, 890 00:34:08,119 --> 00:34:09,099 vary the complexity 891 00:34:09,400 --> 00:34:11,019 of words that we present, 892 00:34:12,440 --> 00:34:14,839 and we customize it to the person to 893 00:34:14,839 --> 00:34:16,679 where we can find a level that, 894 00:34:17,000 --> 00:34:18,539 where the person breaks down, 895 00:34:18,905 --> 00:34:21,385 the individual breaks down. And so that's just 896 00:34:21,385 --> 00:34:23,885 a much more efficient way to assess, 897 00:34:24,425 --> 00:34:27,224 severity. And it's also more precise because we 898 00:34:27,224 --> 00:34:29,864 can we can hover around where they're having 899 00:34:29,864 --> 00:34:30,364 difficulties, 900 00:34:30,744 --> 00:34:33,550 and then we can, you know, evaluate how 901 00:34:33,550 --> 00:34:35,550 they're responding to different kinds of cues and 902 00:34:35,550 --> 00:34:37,710 that kind of stuff at that sweet spot, 903 00:34:37,710 --> 00:34:38,609 so to speak. 904 00:34:40,429 --> 00:34:42,609 And then we're also developing several 905 00:34:43,309 --> 00:34:44,864 automated or semiautomated 906 00:34:45,244 --> 00:34:48,704 measures. So in this world now with, 907 00:34:49,644 --> 00:34:50,945 technology and acoustics 908 00:34:51,244 --> 00:34:51,985 and digital, 909 00:34:52,844 --> 00:34:55,344 supports, there's so much that we can do 910 00:34:55,485 --> 00:34:57,389 that we had to do with pen paper 911 00:34:57,389 --> 00:35:00,049 and pencils and just our impressions before. 912 00:35:01,869 --> 00:35:03,789 And Adam will talk more about that. But 913 00:35:03,789 --> 00:35:06,670 our ultimate goal is for these tools to 914 00:35:06,670 --> 00:35:07,170 become 915 00:35:07,789 --> 00:35:09,089 available to everybody. 916 00:35:11,184 --> 00:35:13,905 And right now, we are, we're able to 917 00:35:13,905 --> 00:35:16,144 share some things for research purposes and a 918 00:35:16,144 --> 00:35:18,224 few things for clinicians too, and Adam will 919 00:35:18,224 --> 00:35:19,525 talk about them some more. 920 00:35:19,824 --> 00:35:22,405 But basically, our our whole goal is to, 921 00:35:23,184 --> 00:35:24,630 provide tools that are gonna 922 00:35:25,429 --> 00:35:27,750 be okay for clinicians. So there'll be HIPAA 923 00:35:27,750 --> 00:35:29,130 okay, and there'll be, 924 00:35:30,230 --> 00:35:30,730 also, 925 00:35:31,190 --> 00:35:32,809 very efficient for clinicians 926 00:35:33,190 --> 00:35:35,750 to use to get measures. And so they 927 00:35:35,750 --> 00:35:37,929 don't just have to, like, rely on their 928 00:35:38,324 --> 00:35:40,905 perception and their own judgment immediately. 929 00:35:41,364 --> 00:35:43,045 They can measure things and then look at 930 00:35:43,045 --> 00:35:44,905 what they measured and analyze it. 931 00:35:46,164 --> 00:35:48,405 So that was aim aim one, to develop 932 00:35:48,405 --> 00:35:50,244 a new assessment. It's not gonna be a 933 00:35:50,244 --> 00:35:52,664 paper and pencil assessment. It's gonna be, 934 00:35:53,349 --> 00:35:56,630 a digital one. Like Awesome. Computer based. Probably 935 00:35:56,630 --> 00:35:58,469 web based. Yeah. I I think the tough 936 00:35:58,469 --> 00:36:00,309 part about where we are now is, you 937 00:36:00,309 --> 00:36:02,309 know, we have clinicians that have gone from 938 00:36:02,309 --> 00:36:04,650 paper and pencil to now this fast moving 939 00:36:04,789 --> 00:36:07,929 AI life, and people want instant answers and 940 00:36:08,204 --> 00:36:10,045 put in a speech sample and get this 941 00:36:10,045 --> 00:36:12,385 whole long thing told to them. So 942 00:36:13,244 --> 00:36:15,265 kudos to you guys for trying to 943 00:36:15,644 --> 00:36:17,085 to bridge that gap because I know it's 944 00:36:17,085 --> 00:36:18,224 not an easy one. 945 00:36:18,605 --> 00:36:20,765 We've said yes. So then the main aim 946 00:36:20,765 --> 00:36:23,164 here was to or the first aim anyway 947 00:36:23,164 --> 00:36:24,440 was to develop 948 00:36:25,300 --> 00:36:26,359 a a new assessment. 949 00:36:28,900 --> 00:36:31,559 And we've been using for for years 950 00:36:32,339 --> 00:36:34,900 in using a motor speech exam that had 951 00:36:34,900 --> 00:36:37,159 a number of different words. And usually, 952 00:36:37,954 --> 00:36:40,434 they have some very simple words and some 953 00:36:40,434 --> 00:36:42,934 very difficult words, but there were some shortcomings 954 00:36:43,155 --> 00:36:45,554 in some of the previous lists. And we 955 00:36:45,554 --> 00:36:46,454 wanted to do, 956 00:36:47,394 --> 00:36:49,655 something where we're starting from scratch, really. 957 00:36:50,170 --> 00:36:52,329 And as we developed what we call the 958 00:36:52,329 --> 00:36:54,989 MSE 99, so motor speech exam, 959 00:36:55,369 --> 00:36:57,210 99 for 99 words. 960 00:36:57,530 --> 00:37:00,650 So we were very intentional about including words 961 00:37:00,650 --> 00:37:01,389 that had 962 00:37:01,769 --> 00:37:02,750 a more comprehensive 963 00:37:03,050 --> 00:37:03,550 distribution 964 00:37:04,010 --> 00:37:07,265 of phonetic complexity. So in addition to very 965 00:37:07,265 --> 00:37:10,385 easy and very hard, we have a good 966 00:37:10,385 --> 00:37:12,545 bunch of words in the middle, and that 967 00:37:12,545 --> 00:37:13,985 makes it to where we think that we 968 00:37:13,985 --> 00:37:14,805 can sample, 969 00:37:15,905 --> 00:37:17,664 people a little bit better and and get 970 00:37:17,664 --> 00:37:20,644 a real truer idea of of how 971 00:37:22,199 --> 00:37:24,119 how their speech skill is at a given 972 00:37:24,119 --> 00:37:24,619 time. 973 00:37:25,239 --> 00:37:26,920 So other things that we we we were 974 00:37:26,920 --> 00:37:28,139 very careful about, 975 00:37:29,000 --> 00:37:32,199 sampling phonetic complexity, but we also controlled for 976 00:37:32,199 --> 00:37:33,099 word frequency. 977 00:37:33,559 --> 00:37:35,179 So we're not using obscure 978 00:37:35,480 --> 00:37:37,244 or really uncommon words, 979 00:37:37,805 --> 00:37:40,045 as I've found to be the case in 980 00:37:40,045 --> 00:37:41,485 a lot of previous things. We also try 981 00:37:41,485 --> 00:37:44,545 to exclude words with negative emotional valence. 982 00:37:45,565 --> 00:37:47,325 So while we're doing this, we don't have 983 00:37:47,325 --> 00:37:48,545 to talk about weapons 984 00:37:48,925 --> 00:37:50,845 or anything, like use words with those in 985 00:37:50,845 --> 00:37:51,345 there. 986 00:37:51,730 --> 00:37:53,650 But we originally had a 100 words, and 987 00:37:53,650 --> 00:37:56,050 then we decided to take one off. So 988 00:37:56,050 --> 00:37:58,849 we've got three sets of 33 989 00:37:58,849 --> 00:37:59,349 words. 990 00:37:59,809 --> 00:38:01,910 And right now, essentially, when we 991 00:38:02,849 --> 00:38:05,164 when we get our participants to say the 992 00:38:05,164 --> 00:38:07,824 words, we do them in batches of 33. 993 00:38:08,684 --> 00:38:10,844 And in some of our initial work in 994 00:38:10,844 --> 00:38:13,644 our initial analysis, we're finding that the the 995 00:38:13,644 --> 00:38:14,864 three different subtests, 996 00:38:15,485 --> 00:38:17,265 because they're really well matched, 997 00:38:17,760 --> 00:38:20,400 they look like they're gonna be useful for 998 00:38:20,400 --> 00:38:22,260 parallel forms. So if some person 999 00:38:22,960 --> 00:38:25,300 is given one version one time, 1000 00:38:25,599 --> 00:38:27,360 they can get another one the next time 1001 00:38:27,360 --> 00:38:30,320 without being concerned about whether there's learning going 1002 00:38:30,320 --> 00:38:30,480 on. 1003 00:38:31,304 --> 00:38:33,864 So they're matched for complexity and frequency and 1004 00:38:33,864 --> 00:38:35,405 even in image ability 1005 00:38:36,105 --> 00:38:37,484 of how easily 1006 00:38:37,864 --> 00:38:38,364 visualizable 1007 00:38:38,824 --> 00:38:39,964 our words are. 1008 00:38:41,304 --> 00:38:42,125 But in 1009 00:38:42,425 --> 00:38:44,159 the next stage is one of the things 1010 00:38:44,319 --> 00:38:47,039 that we're looking at doing and Katharina touched 1011 00:38:47,039 --> 00:38:49,059 on this is we want to develop this 1012 00:38:49,440 --> 00:38:52,319 into an adaptive test. And so I think 1013 00:38:52,319 --> 00:38:55,859 most listeners will be familiar with adaptive 1014 00:38:56,594 --> 00:38:59,494 standardized tests like the GREs or the, 1015 00:38:59,954 --> 00:39:01,954 the SATs. So if you get a question 1016 00:39:01,954 --> 00:39:03,795 correct, the next one's harder. And if you 1017 00:39:03,795 --> 00:39:05,795 get a question wrong, the next one's a 1018 00:39:05,795 --> 00:39:06,855 little bit easier. 1019 00:39:07,554 --> 00:39:08,855 And so with 1020 00:39:09,349 --> 00:39:11,690 an adaptive version of the motor speech exam, 1021 00:39:11,750 --> 00:39:12,489 if you 1022 00:39:13,429 --> 00:39:15,349 say a word, you make an error on 1023 00:39:15,349 --> 00:39:16,489 it, you either do, 1024 00:39:17,909 --> 00:39:20,309 substitution error or something that's just not quite 1025 00:39:20,309 --> 00:39:21,210 right with it, 1026 00:39:21,525 --> 00:39:24,244 then the next word will be phonetically a 1027 00:39:24,244 --> 00:39:25,144 little bit easier. 1028 00:39:26,085 --> 00:39:28,405 And if you keep getting them doing well 1029 00:39:28,405 --> 00:39:30,164 on them and producing them correctly, then the 1030 00:39:30,164 --> 00:39:32,664 next ones will get harder and harder, 1031 00:39:33,284 --> 00:39:33,784 until, 1032 00:39:34,164 --> 00:39:36,324 you know, there'll be an algorithm that says, 1033 00:39:36,324 --> 00:39:38,159 okay. This is we feel like we have 1034 00:39:38,159 --> 00:39:40,079 a good sense of what this person's speech 1035 00:39:40,079 --> 00:39:41,699 production ability is. 1036 00:39:42,079 --> 00:39:44,239 And we're pretty excited about this. And once 1037 00:39:44,239 --> 00:39:45,920 we're complete with this, where this is the 1038 00:39:45,920 --> 00:39:48,320 test that we're going to make available to 1039 00:39:48,320 --> 00:39:48,820 clinicians 1040 00:39:49,199 --> 00:39:50,179 and other researchers 1041 00:39:50,559 --> 00:39:51,219 to use. 1042 00:39:51,679 --> 00:39:52,179 Excellent. 1043 00:39:52,985 --> 00:39:53,485 Mhmm. 1044 00:39:53,785 --> 00:39:56,105 Yeah. So those are examples of things that 1045 00:39:56,105 --> 00:39:57,244 are going to be 1046 00:39:57,704 --> 00:39:58,204 or 1047 00:39:58,664 --> 00:40:00,605 there's more, but, like, things that are 1048 00:40:00,905 --> 00:40:03,485 for practical applications by SLPs 1049 00:40:03,785 --> 00:40:07,019 and also for clinical research. Aim one was 1050 00:40:07,019 --> 00:40:09,579 to develop a new assessment. It's digital. It's 1051 00:40:09,579 --> 00:40:10,880 a collection of different, 1052 00:40:11,820 --> 00:40:12,320 strategies. 1053 00:40:13,019 --> 00:40:15,119 Aim two is more about the discovery 1054 00:40:15,500 --> 00:40:16,400 and the innovation 1055 00:40:16,940 --> 00:40:19,119 here of science. So we are 1056 00:40:19,420 --> 00:40:19,920 proposing 1057 00:40:21,364 --> 00:40:22,984 that there may be more complexity 1058 00:40:23,444 --> 00:40:26,324 than just these buckets of apraxia of speech, 1059 00:40:26,324 --> 00:40:28,344 phagia with phonemic, paraphasia, and dysarthria. 1060 00:40:29,444 --> 00:40:31,224 And so we're doing exploratory 1061 00:40:31,525 --> 00:40:32,025 analysis 1062 00:40:32,324 --> 00:40:34,989 of all of the different features that we're 1063 00:40:34,989 --> 00:40:37,250 seeing to see what kind of patterns emerge. 1064 00:40:38,750 --> 00:40:41,469 We're expecting we've already seen that there's there's 1065 00:40:41,469 --> 00:40:42,769 some people that are 1066 00:40:43,389 --> 00:40:45,869 difficult to, like, cluster with with with 1067 00:40:46,505 --> 00:40:48,985 into a certain profile. But we think that 1068 00:40:48,985 --> 00:40:51,164 there's probably meaningful variation, 1069 00:40:53,785 --> 00:40:56,445 in terms of both quality and quantity. 1070 00:40:57,465 --> 00:41:00,050 And we're we're looking to to discover that 1071 00:41:00,050 --> 00:41:02,690 and maybe come up with a a slightly 1072 00:41:02,690 --> 00:41:03,670 different classification 1073 00:41:03,969 --> 00:41:05,989 system than what we're using today. 1074 00:41:06,769 --> 00:41:07,269 Awesome. 1075 00:41:07,650 --> 00:41:08,469 That's exciting. 1076 00:41:09,250 --> 00:41:09,750 Yeah. 1077 00:41:10,530 --> 00:41:12,844 And then that brings me to aim three, 1078 00:41:12,984 --> 00:41:13,724 which is 1079 00:41:16,264 --> 00:41:16,925 to really 1080 00:41:18,105 --> 00:41:20,505 just step back and ask ourselves, why are 1081 00:41:20,505 --> 00:41:23,644 we doing the differential diagnosis to begin with? 1082 00:41:23,784 --> 00:41:26,025 Like, we've been fighting over, like, what is 1083 00:41:26,025 --> 00:41:28,219 apraxia of speech and what is it not 1084 00:41:28,519 --> 00:41:31,420 for, you know, hundreds of years. But, ultimately, 1085 00:41:32,199 --> 00:41:35,400 it's not really, like, an academic exercise. It's 1086 00:41:35,400 --> 00:41:37,960 about are we going to how we're gonna 1087 00:41:37,960 --> 00:41:39,420 select the proper treatment. 1088 00:41:41,525 --> 00:41:44,105 And given that it's difficult to diagnose 1089 00:41:44,484 --> 00:41:45,464 in some cases 1090 00:41:46,324 --> 00:41:49,605 that we're we're wondering if maybe there's another 1091 00:41:49,605 --> 00:41:51,684 way where we can look at the the 1092 00:41:51,684 --> 00:41:52,984 profile of a person 1093 00:41:53,684 --> 00:41:54,664 and not necessarily 1094 00:41:54,964 --> 00:41:56,840 force them into a category. 1095 00:41:57,300 --> 00:41:59,300 Look at the profile and see how that 1096 00:41:59,300 --> 00:42:00,599 profile might predict 1097 00:42:00,900 --> 00:42:02,599 how they respond to queuing 1098 00:42:03,059 --> 00:42:05,780 or how they respond to different types of 1099 00:42:05,780 --> 00:42:06,280 intervention 1100 00:42:06,660 --> 00:42:07,160 strategies. 1101 00:42:09,905 --> 00:42:12,405 And so we're operating under the assumption that 1102 00:42:12,784 --> 00:42:13,684 this basic 1103 00:42:14,144 --> 00:42:15,125 three part classification 1104 00:42:15,425 --> 00:42:16,964 is outdated, maybe. 1105 00:42:18,545 --> 00:42:19,045 And, 1106 00:42:20,144 --> 00:42:21,844 we're we're hoping to 1107 00:42:22,650 --> 00:42:25,469 find how that connects to to treatment responsiveness. 1108 00:42:26,329 --> 00:42:27,769 I'll jump in here too. 1109 00:42:28,250 --> 00:42:30,329 Adam kinda touched on this with the MSE 1110 00:42:30,329 --> 00:42:31,549 99, but, 1111 00:42:31,849 --> 00:42:34,250 basically, how the test works is if the 1112 00:42:34,250 --> 00:42:34,750 patient, 1113 00:42:35,609 --> 00:42:36,109 responds 1114 00:42:36,409 --> 00:42:37,869 repeats a word correctly 1115 00:42:38,454 --> 00:42:41,894 to a certain word, then they score out 1116 00:42:41,894 --> 00:42:44,694 of doing an extra queuing test at the 1117 00:42:44,694 --> 00:42:45,194 end. 1118 00:42:45,494 --> 00:42:47,414 But if they do not, then they do 1119 00:42:47,414 --> 00:42:48,554 have to do a queued, 1120 00:42:49,335 --> 00:42:50,550 repetition task. 1121 00:42:51,670 --> 00:42:53,829 And that aim has been very exciting to 1122 00:42:53,829 --> 00:42:55,050 me to just see, 1123 00:42:55,829 --> 00:42:58,390 you know, what patients respond to to what 1124 00:42:58,390 --> 00:43:00,570 cues the best, and we don't have those 1125 00:43:00,630 --> 00:43:03,910 formal analysis all pulled yet. But even one 1126 00:43:03,910 --> 00:43:05,369 example is, you know, 1127 00:43:05,704 --> 00:43:08,905 providing a tactile cue to one patient with 1128 00:43:08,905 --> 00:43:11,065 maybe a severe apraxia of speech might be 1129 00:43:11,065 --> 00:43:11,804 really helpful, 1130 00:43:12,105 --> 00:43:14,344 but then providing a tactile cue to someone 1131 00:43:14,344 --> 00:43:16,284 with dysarthria might be distracting. 1132 00:43:17,144 --> 00:43:19,144 And that's been kind of interesting to see 1133 00:43:19,144 --> 00:43:22,400 from a more clinical perspective too. So aim 1134 00:43:22,400 --> 00:43:22,900 three 1135 00:43:23,199 --> 00:43:24,420 is to determine, 1136 00:43:24,960 --> 00:43:28,659 like, what impairment profiles benefit from specific treatments. 1137 00:43:28,880 --> 00:43:31,539 And we're here this is the first step. 1138 00:43:31,839 --> 00:43:33,139 Right? So we're anticipating 1139 00:43:33,440 --> 00:43:34,900 more research in this area. 1140 00:43:36,184 --> 00:43:37,804 But just really looking, 1141 00:43:38,184 --> 00:43:40,184 with an open mind to see how people 1142 00:43:40,184 --> 00:43:41,945 respond to to to treatment, 1143 00:43:42,425 --> 00:43:42,925 conditions. 1144 00:43:43,465 --> 00:43:46,045 One of the obvious next steps for, 1145 00:43:46,664 --> 00:43:47,885 this is to develop, 1146 00:43:48,664 --> 00:43:50,605 more dynamic assessment methods 1147 00:43:51,099 --> 00:43:53,659 for the clinician where you're really testing different 1148 00:43:53,659 --> 00:43:54,480 types of, 1149 00:43:56,460 --> 00:43:57,839 treatments, or conditions. 1150 00:43:59,019 --> 00:44:01,739 And we are hoping that the profiles that 1151 00:44:01,739 --> 00:44:03,119 you're observing quantitatively 1152 00:44:03,420 --> 00:44:04,875 also will kind of guide 1153 00:44:05,355 --> 00:44:07,454 you to what what kinds of, 1154 00:44:08,235 --> 00:44:10,074 treatment conditions you should be, 1155 00:44:10,635 --> 00:44:12,175 testing in that dynamic 1156 00:44:12,474 --> 00:44:12,974 assessment. 1157 00:44:13,514 --> 00:44:15,454 Yeah. So those were our three aims. 1158 00:44:16,554 --> 00:44:18,414 And as always, when you do research, 1159 00:44:19,434 --> 00:44:21,570 you are getting a lot of answers and 1160 00:44:21,570 --> 00:44:23,030 then you have more questions. 1161 00:44:23,329 --> 00:44:25,410 And then you realize a lot more research 1162 00:44:25,410 --> 00:44:26,470 needs to be done. 1163 00:44:27,329 --> 00:44:28,950 But we're we're pretty excited 1164 00:44:29,410 --> 00:44:30,789 about it so far. 1165 00:44:31,730 --> 00:44:33,195 I think Adam talked about 1166 00:44:33,755 --> 00:44:34,255 several 1167 00:44:34,875 --> 00:44:36,555 or we talked about some of the measures 1168 00:44:36,555 --> 00:44:38,894 that we are using, but 1169 00:44:39,515 --> 00:44:41,035 I wonder maybe you could talk a little 1170 00:44:41,035 --> 00:44:43,675 bit more about some of the perceptual and 1171 00:44:43,675 --> 00:44:46,015 acoustic measures also, Adam. Sure. 1172 00:44:46,409 --> 00:44:48,510 Yeah. No. I'd be glad to. And 1173 00:44:48,889 --> 00:44:50,429 I think, you know, one of the things 1174 00:44:50,730 --> 00:44:50,969 that, 1175 00:44:53,289 --> 00:44:55,849 Katarina and I have always tried to apply 1176 00:44:55,849 --> 00:44:58,409 a principle in our work to use the 1177 00:44:58,409 --> 00:45:01,075 the best or most appropriate tool for whatever 1178 00:45:01,075 --> 00:45:02,835 the thing is that we're trying to measure. 1179 00:45:02,835 --> 00:45:05,235 And so if there's something that's very easy 1180 00:45:05,235 --> 00:45:07,094 and reliable to measure acoustically, 1181 00:45:07,394 --> 00:45:10,114 we we do that, and not everything works 1182 00:45:10,114 --> 00:45:12,535 that way. And so other things that require 1183 00:45:12,594 --> 00:45:14,275 a person to make a judgment or a 1184 00:45:14,275 --> 00:45:14,775 rating, 1185 00:45:15,279 --> 00:45:17,920 we have well trained teams that work together 1186 00:45:17,920 --> 00:45:19,059 to complete those. 1187 00:45:19,519 --> 00:45:20,259 And so 1188 00:45:20,639 --> 00:45:22,319 part of what we're doing here is figuring 1189 00:45:22,319 --> 00:45:24,159 out, okay, well, which which of these measures 1190 00:45:24,159 --> 00:45:26,500 will do well to identify different profiles. 1191 00:45:27,035 --> 00:45:29,055 And I'll talk a little bit about more 1192 00:45:29,195 --> 00:45:30,335 of some of the measures 1193 00:45:30,635 --> 00:45:32,474 and maybe a sneak peek at some of 1194 00:45:32,474 --> 00:45:33,695 the tools we'll be 1195 00:45:34,155 --> 00:45:34,655 developing. 1196 00:45:35,594 --> 00:45:37,594 One of the I mean, very simply, one 1197 00:45:37,594 --> 00:45:39,914 of the things from the MSE 99 is 1198 00:45:39,914 --> 00:45:40,414 we, 1199 00:45:41,019 --> 00:45:42,400 are able to have clinicians 1200 00:45:42,940 --> 00:45:45,900 do a real time correct or incorrect, thumbs 1201 00:45:45,900 --> 00:45:48,800 up, thumbs down, was that word correctly produced. 1202 00:45:49,180 --> 00:45:51,280 And in the end, we get a percent 1203 00:45:51,579 --> 00:45:53,554 accuracy score on that test. 1204 00:45:54,014 --> 00:45:55,714 And and something that we found 1205 00:45:56,255 --> 00:45:56,994 so far 1206 00:45:57,775 --> 00:46:00,175 that probably is interesting is that there are 1207 00:46:00,175 --> 00:46:02,275 some people who do just fine on monosyllabic 1208 00:46:02,815 --> 00:46:03,315 and 1209 00:46:03,775 --> 00:46:06,114 disyllabic words, but when it comes to 1210 00:46:06,414 --> 00:46:08,914 multisyllabic words, that's where they start having 1211 00:46:09,480 --> 00:46:12,519 difficulty. And so we will obtain measures of 1212 00:46:12,519 --> 00:46:13,420 just correctness, 1213 00:46:14,119 --> 00:46:15,820 how correct are they on those words. 1214 00:46:16,440 --> 00:46:18,119 And then after that, we start getting into 1215 00:46:18,119 --> 00:46:19,739 things that are a little bit more, 1216 00:46:20,840 --> 00:46:23,179 you know, we might do some acoustic measurements. 1217 00:46:23,945 --> 00:46:25,784 I'll say a little bit about word syllable 1218 00:46:25,784 --> 00:46:26,284 duration. 1219 00:46:26,985 --> 00:46:29,625 That's something that we've been using for for 1220 00:46:29,625 --> 00:46:31,405 a few years. It's a very straightforward 1221 00:46:32,505 --> 00:46:34,925 acoustic metric that we can do without 1222 00:46:35,224 --> 00:46:38,280 a lot of training or even complicated software. 1223 00:46:38,980 --> 00:46:40,420 And so usually what we do is we 1224 00:46:40,420 --> 00:46:42,199 measure the length or the duration 1225 00:46:42,739 --> 00:46:43,639 of a multisyllabic 1226 00:46:44,019 --> 00:46:46,260 word and then divide it by the number 1227 00:46:46,260 --> 00:46:49,139 of syllables in the word. So for example, 1228 00:46:49,139 --> 00:46:49,880 if we say 1229 00:46:50,434 --> 00:46:52,054 a person says the word macaroni 1230 00:46:52,914 --> 00:46:55,635 and we measure the duration at one point 1231 00:46:55,635 --> 00:46:56,135 four 1232 00:46:56,434 --> 00:46:56,934 seconds, 1233 00:46:57,795 --> 00:47:00,195 so that that word has four syllables. So 1234 00:47:00,195 --> 00:47:01,715 we divide 1.4 1235 00:47:01,715 --> 00:47:04,195 by four, and that gives us point three 1236 00:47:04,195 --> 00:47:04,695 five 1237 00:47:05,315 --> 00:47:05,815 seconds 1238 00:47:06,410 --> 00:47:08,269 or three hundred and fifty milliseconds. 1239 00:47:09,930 --> 00:47:10,430 And 1240 00:47:10,809 --> 00:47:12,650 what we know based on our previous work, 1241 00:47:12,650 --> 00:47:14,750 that's a pretty long duration. 1242 00:47:15,050 --> 00:47:16,809 So if you take a minute and a 1243 00:47:16,809 --> 00:47:19,210 half no. Sorry. A second and a half 1244 00:47:19,210 --> 00:47:19,789 to say 1245 00:47:20,324 --> 00:47:20,824 macaroni, 1246 00:47:21,605 --> 00:47:23,385 that's slower than we expect. 1247 00:47:24,244 --> 00:47:26,984 And, you know, anything longer than about 1248 00:47:27,284 --> 00:47:28,664 point three two 1249 00:47:28,965 --> 00:47:29,465 seconds 1250 00:47:30,005 --> 00:47:31,704 or three hundred and twenty milliseconds, 1251 00:47:32,530 --> 00:47:33,030 that's 1252 00:47:33,329 --> 00:47:35,190 much longer than most neurotypical 1253 00:47:35,490 --> 00:47:36,630 talkers would do. 1254 00:47:37,170 --> 00:47:40,130 So if they have a really long production 1255 00:47:40,130 --> 00:47:41,970 or their their syllables are really long like 1256 00:47:41,970 --> 00:47:44,450 that and also they have significant speech sound 1257 00:47:44,450 --> 00:47:44,950 distortions, 1258 00:47:45,730 --> 00:47:48,445 we might give them an initial classification of 1259 00:47:48,445 --> 00:47:49,664 a proxy of speech, 1260 00:47:50,445 --> 00:47:52,684 unless there's some other reason that we think 1261 00:47:52,684 --> 00:47:53,664 that's not correct. 1262 00:47:54,684 --> 00:47:56,605 So word syllable duration is is a big 1263 00:47:56,605 --> 00:47:58,125 one that we use, and we think that 1264 00:47:58,125 --> 00:47:59,425 that is something that, 1265 00:48:00,489 --> 00:48:02,750 a lot of people can measure just on 1266 00:48:02,969 --> 00:48:05,690 just on a a simple recording device. You 1267 00:48:05,690 --> 00:48:06,510 don't need, 1268 00:48:07,369 --> 00:48:08,269 really involved 1269 00:48:08,730 --> 00:48:10,349 acoustic software for that. 1270 00:48:11,369 --> 00:48:13,130 I wanna jump in there and just say, 1271 00:48:13,130 --> 00:48:16,364 like, what why we measure it is, like, 1272 00:48:16,364 --> 00:48:17,105 for quantifications, 1273 00:48:17,965 --> 00:48:21,405 obviously, to, like, document. But also because when 1274 00:48:21,405 --> 00:48:24,045 it is locked, it's kind of slow, but 1275 00:48:24,045 --> 00:48:25,664 it's not super duper slow. 1276 00:48:26,525 --> 00:48:28,224 We may not recognize it 1277 00:48:28,525 --> 00:48:30,690 just through our ears, but we can measure 1278 00:48:30,690 --> 00:48:32,289 it. And we can see that this is 1279 00:48:32,289 --> 00:48:35,730 definitely longer than than normal. Right? So that 1280 00:48:35,730 --> 00:48:38,070 helps diagnose those milder cases. 1281 00:48:38,369 --> 00:48:40,150 Thank you. Yeah. And we're we've got 1282 00:48:40,449 --> 00:48:42,605 we have a paper out with some norms 1283 00:48:42,605 --> 00:48:44,444 on that. So it it gives us a 1284 00:48:44,444 --> 00:48:46,525 real idea of a there's a big range 1285 00:48:46,525 --> 00:48:49,484 of what neurotypical talkers do, but we can 1286 00:48:49,484 --> 00:48:51,885 feel pretty confident that with a long syllable 1287 00:48:51,885 --> 00:48:52,944 like that, that that's 1288 00:48:53,244 --> 00:48:54,944 beyond what we would expect. 1289 00:48:56,280 --> 00:48:58,119 One of the other measures we're looking at 1290 00:48:58,119 --> 00:48:58,599 and, 1291 00:48:59,079 --> 00:49:00,599 you know, I hope I don't, you know, 1292 00:49:00,599 --> 00:49:03,480 give people trauma going back to their speech 1293 00:49:03,480 --> 00:49:05,800 science days, but I'll talk a little bit 1294 00:49:05,800 --> 00:49:07,579 about voice onset time. 1295 00:49:07,974 --> 00:49:09,655 And this is a measure that we use 1296 00:49:09,655 --> 00:49:10,394 to differentiate 1297 00:49:10,775 --> 00:49:11,994 voice from voiceless 1298 00:49:12,295 --> 00:49:12,795 stops. 1299 00:49:13,574 --> 00:49:16,135 We basically measure it as the the time 1300 00:49:16,135 --> 00:49:18,934 difference between when you release a burst of 1301 00:49:18,934 --> 00:49:20,554 air for a stop sound like, 1302 00:49:21,094 --> 00:49:21,755 for example, 1303 00:49:22,670 --> 00:49:26,030 And then when phonation begins, so for for 1304 00:49:26,030 --> 00:49:28,430 the sound, this time interval could be anywhere 1305 00:49:28,430 --> 00:49:28,930 from 1306 00:49:29,550 --> 00:49:30,610 sixty to 1307 00:49:30,910 --> 00:49:32,369 hundred and fifteen milliseconds. 1308 00:49:32,829 --> 00:49:35,070 So there's a big range there. I mean, 1309 00:49:35,070 --> 00:49:35,809 it's very 1310 00:49:37,065 --> 00:49:37,565 short 1311 00:49:38,025 --> 00:49:38,525 time, 1312 00:49:39,065 --> 00:49:41,385 but it's something that we do automatically. We 1313 00:49:41,385 --> 00:49:43,644 don't think about it too much. And 1314 00:49:44,664 --> 00:49:46,925 when we think about people who have 1315 00:49:47,385 --> 00:49:50,184 speech motor programming difficulty, like somebody with apraxia 1316 00:49:50,184 --> 00:49:52,045 of speech or even somebody with dysarthria, 1317 00:49:52,530 --> 00:49:54,530 we might expect some of that timing to 1318 00:49:54,530 --> 00:49:55,909 break down a little bit. 1319 00:49:56,369 --> 00:49:57,969 So one of the things that we're doing 1320 00:49:57,969 --> 00:50:00,210 because we have in that 99 1321 00:50:00,210 --> 00:50:03,030 word sample of the motor speech exam, there's 1322 00:50:03,809 --> 00:50:05,829 a number of words that begin with 1323 00:50:06,264 --> 00:50:08,585 a. We have some that begin with g 1324 00:50:08,585 --> 00:50:10,585 as well. So k and g, k n 1325 00:50:10,585 --> 00:50:11,085 g, 1326 00:50:11,385 --> 00:50:13,704 and we're measuring voice onset time of those. 1327 00:50:13,704 --> 00:50:15,545 And and mainly the thing that we're looking 1328 00:50:15,545 --> 00:50:16,684 at right now is 1329 00:50:17,144 --> 00:50:20,519 how consistent are people in that timing. 1330 00:50:21,400 --> 00:50:23,000 And right now, it looks like our people 1331 00:50:23,000 --> 00:50:25,900 with apraxia of speech have more variable 1332 00:50:26,760 --> 00:50:27,260 timing 1333 00:50:27,719 --> 00:50:31,980 for the the voice onset time of k, 1334 00:50:32,519 --> 00:50:33,980 and, we'll be 1335 00:50:34,344 --> 00:50:36,045 working on that more and more, 1336 00:50:36,664 --> 00:50:38,664 in the next year or so. We'll be 1337 00:50:38,664 --> 00:50:40,684 reporting out on some of that. 1338 00:50:41,224 --> 00:50:42,905 And just to say, like, why are we 1339 00:50:42,905 --> 00:50:44,364 even doing that? Like, 1340 00:50:45,224 --> 00:50:46,765 we were doing that because 1341 00:50:47,144 --> 00:50:50,279 we know that voicing is like, that, 1342 00:50:51,000 --> 00:50:53,480 there's ambiguity in the voicing when you have 1343 00:50:53,480 --> 00:50:55,259 a proxy of speech, especially, 1344 00:50:56,759 --> 00:50:57,259 where, 1345 00:50:57,799 --> 00:51:00,440 we hear them as distortions. We've documented that. 1346 00:51:00,440 --> 00:51:02,199 We hear, like, it's kind of ambiguous as 1347 00:51:02,199 --> 00:51:04,164 a voice. Is it voiceless? Voiceless? And it's 1348 00:51:04,164 --> 00:51:04,664 difficult, 1349 00:51:05,284 --> 00:51:08,085 to, like, evaluate that in the moment as 1350 00:51:08,085 --> 00:51:09,144 an speech pathologist. 1351 00:51:09,525 --> 00:51:11,764 So what where our goal here is we 1352 00:51:11,764 --> 00:51:13,944 do recordings. We do semi automated 1353 00:51:14,405 --> 00:51:16,885 analysis. We're not asking SLPs to go and 1354 00:51:16,885 --> 00:51:18,340 do, like, these analysis 1355 00:51:18,640 --> 00:51:20,800 on their own, but it's gonna be built 1356 00:51:20,800 --> 00:51:22,739 into a package that then will 1357 00:51:23,199 --> 00:51:23,699 express, 1358 00:51:24,719 --> 00:51:27,599 for example, VOT variability for them as a 1359 00:51:27,599 --> 00:51:28,739 quantitative measure. 1360 00:51:29,280 --> 00:51:31,360 Alongside of that, we we also have a 1361 00:51:31,360 --> 00:51:32,159 number of 1362 00:51:33,815 --> 00:51:35,034 many people may recognize 1363 00:51:35,335 --> 00:51:38,134 that sounds can be difficult. They're they're late 1364 00:51:38,134 --> 00:51:39,434 developing in children, 1365 00:51:39,894 --> 00:51:42,054 and they're also more difficult to say in 1366 00:51:42,054 --> 00:51:45,835 adults with vulnerable speech motor programming abilities. 1367 00:51:47,130 --> 00:51:48,569 So one of the other ones we're looking 1368 00:51:48,569 --> 00:51:52,109 at that's difficult is fricatives like s and 1369 00:51:52,569 --> 00:51:53,069 so 1370 00:51:54,089 --> 00:51:54,589 those, 1371 00:51:55,049 --> 00:51:56,510 s and s h sounds. 1372 00:51:57,210 --> 00:51:59,230 We expect those to be 1373 00:51:59,804 --> 00:52:02,385 difficult in some people with apraxia of speech. 1374 00:52:02,764 --> 00:52:05,105 And so we're working on some acoustic measurements 1375 00:52:05,244 --> 00:52:06,704 for those as well. 1376 00:52:07,724 --> 00:52:08,704 And one 1377 00:52:09,005 --> 00:52:11,405 measure that's pretty easy to do is how 1378 00:52:11,405 --> 00:52:13,909 long does that fricative sound go on? So 1379 00:52:13,909 --> 00:52:15,769 measuring the duration of it. 1380 00:52:17,029 --> 00:52:20,250 So for most control participants, they might 1381 00:52:20,630 --> 00:52:22,010 produce an s between 1382 00:52:22,469 --> 00:52:23,989 a hundred and eighty and two hundred and 1383 00:52:23,989 --> 00:52:26,230 thirty milliseconds. These are just some initial results 1384 00:52:26,230 --> 00:52:27,049 that we have. 1385 00:52:28,055 --> 00:52:30,135 But we're finding in people with apraxia and 1386 00:52:30,135 --> 00:52:31,434 dysarthria that they 1387 00:52:31,815 --> 00:52:33,275 tend to produce longer, 1388 00:52:34,295 --> 00:52:35,755 duration of those sounds, 1389 00:52:36,215 --> 00:52:38,454 or much longer. So maybe a little longer, 1390 00:52:38,454 --> 00:52:39,434 maybe much longer. 1391 00:52:39,920 --> 00:52:41,920 And we think that this kind of a 1392 00:52:41,920 --> 00:52:43,599 measurement can tell us a little bit about 1393 00:52:43,599 --> 00:52:45,059 the timing of articulation, 1394 00:52:45,360 --> 00:52:47,360 coordination, and things that we might not pick 1395 00:52:47,360 --> 00:52:49,619 up well with our ears. So as Ekaterina 1396 00:52:49,680 --> 00:52:51,380 said, if there's some things that are 1397 00:52:51,680 --> 00:52:53,864 obvious that we hear, but other things might 1398 00:52:53,864 --> 00:52:55,784 be a little bit more subtle. And if 1399 00:52:55,784 --> 00:52:57,864 it's easy for us to measure, let's let's 1400 00:52:57,864 --> 00:52:58,605 do that. 1401 00:52:59,224 --> 00:53:02,025 So while we're while we're capturing the duration 1402 00:53:02,025 --> 00:53:02,925 of those fricatives, 1403 00:53:03,625 --> 00:53:06,125 the acoustic software can do some more complicated 1404 00:53:06,265 --> 00:53:09,430 things and identify which frequencies are stronger in 1405 00:53:09,430 --> 00:53:10,170 the signal. 1406 00:53:11,750 --> 00:53:13,530 Maybe you can remember that 1407 00:53:13,989 --> 00:53:16,630 s kinda has a higher hissy type sound 1408 00:53:16,630 --> 00:53:19,510 and s has a more ocean wave kind 1409 00:53:19,510 --> 00:53:21,930 of sound, and so there's lower frequencies present. 1410 00:53:22,390 --> 00:53:24,085 But when we identify 1411 00:53:24,385 --> 00:53:26,784 which frequencies are strongest in the signal, it 1412 00:53:26,784 --> 00:53:28,565 can tell us a little bit about articulatory 1413 00:53:29,424 --> 00:53:32,144 placement and how consistent somebody is or where 1414 00:53:32,144 --> 00:53:34,404 they're placing their tongue for these different sounds. 1415 00:53:34,784 --> 00:53:35,670 And so we're 1416 00:53:35,989 --> 00:53:36,489 in 1417 00:53:36,789 --> 00:53:38,309 the in the middle of doing some of 1418 00:53:38,309 --> 00:53:41,510 these analyses. And one of the expectations that 1419 00:53:41,510 --> 00:53:43,210 we have is that as we look at 1420 00:53:43,429 --> 00:53:44,969 variability of these measures, 1421 00:53:45,269 --> 00:53:47,429 this may help to sort out some of 1422 00:53:47,429 --> 00:53:49,989 our our groups, whether there's a a subtle 1423 00:53:49,989 --> 00:53:52,554 difficulty with speech motor planning 1424 00:53:53,174 --> 00:53:55,434 or if there's something that's more obvious. 1425 00:53:56,054 --> 00:53:58,454 Well, thanks. This this is awesome. This is 1426 00:53:58,454 --> 00:53:59,894 such good stuff. And thank you, Adam. I 1427 00:53:59,894 --> 00:54:02,054 don't have too much PTSD from speech science, 1428 00:54:02,054 --> 00:54:04,694 so thank you for for putting putting that 1429 00:54:04,694 --> 00:54:05,194 lightly, 1430 00:54:05,494 --> 00:54:07,559 gently, I should say. Alright. 1431 00:54:08,500 --> 00:54:09,539 Anything else we wanna 1432 00:54:10,179 --> 00:54:11,539 I I think you guys just wanted to 1433 00:54:11,539 --> 00:54:13,940 mention maybe future directions and we can wrap 1434 00:54:13,940 --> 00:54:16,099 this up. I think we wanted to talk 1435 00:54:16,099 --> 00:54:17,960 a little bit about you know, 1436 00:54:18,339 --> 00:54:21,000 we we're really interested I've said this that 1437 00:54:21,219 --> 00:54:22,875 we wanna make tools that are 1438 00:54:23,594 --> 00:54:26,074 easy to use for people and useful. And 1439 00:54:26,074 --> 00:54:27,835 some of the measures we've talked about today, 1440 00:54:27,835 --> 00:54:30,094 we'll be developing those into things that are 1441 00:54:30,155 --> 00:54:31,594 useful. But we do have a couple of 1442 00:54:31,594 --> 00:54:32,894 measures that are already 1443 00:54:33,514 --> 00:54:34,014 available. 1444 00:54:34,315 --> 00:54:34,815 And, 1445 00:54:35,940 --> 00:54:38,019 you know, maybe just as a a sneak 1446 00:54:38,019 --> 00:54:39,780 peek to what things might look like in 1447 00:54:39,780 --> 00:54:41,300 there, maybe one of the tools that people 1448 00:54:41,300 --> 00:54:42,359 will find useful. 1449 00:54:43,859 --> 00:54:46,679 We've mentioned how the MSE 99 1450 00:54:46,819 --> 00:54:49,639 was developed to to give a balanced 1451 00:54:50,704 --> 00:54:52,965 list of words in terms of word complexity. 1452 00:54:53,105 --> 00:54:55,025 And and the one of the main metrics 1453 00:54:55,025 --> 00:54:57,684 that we use is the word complexity measure 1454 00:54:58,144 --> 00:55:00,244 that was developed Carol Stolganin, 1455 00:55:01,265 --> 00:55:04,164 for evaluating complexity of child speech. 1456 00:55:04,704 --> 00:55:07,240 And it's something that is pretty easy. You 1457 00:55:07,240 --> 00:55:08,059 can calculate 1458 00:55:08,360 --> 00:55:10,840 the complexity of a word just by knowing, 1459 00:55:10,840 --> 00:55:13,660 okay, how many fricatives are there? Are there, 1460 00:55:15,079 --> 00:55:17,880 liquid sounds like rhotic, r sounds, or l 1461 00:55:17,880 --> 00:55:19,905 sounds? Are there clusters? Are there 1462 00:55:20,385 --> 00:55:22,244 velar sounds like k or g. 1463 00:55:22,704 --> 00:55:24,164 There's a lot of different rules. 1464 00:55:24,864 --> 00:55:25,364 And 1465 00:55:25,905 --> 00:55:27,505 to make it a little bit easier, we 1466 00:55:27,505 --> 00:55:28,885 created a web app 1467 00:55:29,265 --> 00:55:31,425 where you can copy and paste in a 1468 00:55:31,425 --> 00:55:33,204 list of words and identify 1469 00:55:33,505 --> 00:55:34,005 how 1470 00:55:34,329 --> 00:55:36,909 phonetically complex is each one of these 1471 00:55:37,289 --> 00:55:37,789 words. 1472 00:55:38,489 --> 00:55:40,650 And we use the tool for developing our 1473 00:55:40,650 --> 00:55:42,750 99 word list. So we 1474 00:55:43,130 --> 00:55:45,530 we were developing okay. Well, like, which words 1475 00:55:45,530 --> 00:55:47,210 are we gonna select so that this is 1476 00:55:47,210 --> 00:55:47,710 balanced? 1477 00:55:48,329 --> 00:55:50,724 But I think it's something that people could 1478 00:55:50,724 --> 00:55:52,905 find really useful in their clinical practice. 1479 00:55:54,244 --> 00:55:54,744 And, 1480 00:55:56,005 --> 00:55:58,824 you know, sometimes people don't know they're choosing 1481 00:55:58,885 --> 00:56:00,425 words that are easier. 1482 00:56:00,885 --> 00:56:02,824 We we think that some people with difficulty 1483 00:56:03,045 --> 00:56:03,545 talking 1484 00:56:04,089 --> 00:56:04,889 may avoid, 1485 00:56:06,170 --> 00:56:06,670 subconsciously, 1486 00:56:07,050 --> 00:56:08,569 they may avoid a word that is a 1487 00:56:08,569 --> 00:56:10,829 little bit more difficult. And so, 1488 00:56:11,289 --> 00:56:13,449 that word complexity measure app, 1489 00:56:13,769 --> 00:56:16,329 I'm interested in in seeing people use it 1490 00:56:16,329 --> 00:56:17,445 a little bit more. And, 1491 00:56:17,925 --> 00:56:19,925 there's a link from our website for it 1492 00:56:19,925 --> 00:56:22,005 in the there's a shortcut version of it, 1493 00:56:22,005 --> 00:56:31,605 which is very easy, go.unc.edu/wcmforwordcomplexitymeasure. 1494 00:56:31,605 --> 00:56:33,789 So I think that'll be a fun one. 1495 00:56:34,329 --> 00:56:36,590 Yeah. As people kind of progress through treatment 1496 00:56:36,650 --> 00:56:37,150 too, 1497 00:56:37,610 --> 00:56:40,829 we we think about zone of proximal development, 1498 00:56:41,929 --> 00:56:44,590 across the the scope of practice. It's like 1499 00:56:44,809 --> 00:56:47,015 you wanna give people something that they can 1500 00:56:47,015 --> 00:56:50,215 have some success at Yeah. But not so 1501 00:56:50,215 --> 00:56:52,454 easy that they're not making any growth. And 1502 00:56:52,454 --> 00:56:54,055 so this is something that we think of 1503 00:56:54,055 --> 00:56:55,434 as a as a tool where 1504 00:56:55,815 --> 00:56:57,494 I mean, even in in children, if you're 1505 00:56:57,494 --> 00:56:57,655 doing 1506 00:56:58,820 --> 00:57:00,420 we we don't do much work in children 1507 00:57:00,420 --> 00:57:02,280 right now. But if you were doing, like, 1508 00:57:02,980 --> 00:57:04,039 a a core vocabulary 1509 00:57:04,340 --> 00:57:05,940 approach and you come up with a list 1510 00:57:05,940 --> 00:57:07,940 of fifty, sixty words a kid is using 1511 00:57:07,940 --> 00:57:10,119 at home, well, some of those might naturally 1512 00:57:10,179 --> 00:57:10,679 be 1513 00:57:11,034 --> 00:57:13,835 really pretty easy to say or low phonetic 1514 00:57:13,835 --> 00:57:14,335 complexity 1515 00:57:14,795 --> 00:57:16,554 or low word complexity. And then some of 1516 00:57:16,554 --> 00:57:17,934 them might be harder in 1517 00:57:18,235 --> 00:57:19,215 in something that 1518 00:57:19,835 --> 00:57:21,054 can help us to, 1519 00:57:22,715 --> 00:57:25,619 grade our our treatment difficulty. What what are 1520 00:57:25,619 --> 00:57:27,139 we what are we gonna ask this person 1521 00:57:27,139 --> 00:57:29,539 to do today? So I think what she 1522 00:57:29,619 --> 00:57:31,719 she had had this this example of endocrinologist, 1523 00:57:32,179 --> 00:57:34,739 which is very difficult. And then, yeah, doctor 1524 00:57:34,739 --> 00:57:36,039 who treats diabetes, 1525 00:57:37,585 --> 00:57:40,144 doctor might be a little there's some difficult 1526 00:57:40,144 --> 00:57:42,465 things in there, but, also, that's much easier 1527 00:57:42,465 --> 00:57:43,605 to say than endocrinologist. 1528 00:57:44,385 --> 00:57:46,545 Yeah. Yeah. So so thank you guys, obviously, 1529 00:57:46,545 --> 00:57:48,385 so much for coming on this episode. Let's, 1530 00:57:49,340 --> 00:57:51,260 let's just talk about maybe some some future 1531 00:57:51,260 --> 00:57:53,360 directions, and and we'll wrap this up. 1532 00:57:54,539 --> 00:57:55,039 Yeah. 1533 00:57:55,820 --> 00:57:58,300 So we are going to be as we 1534 00:57:58,300 --> 00:58:00,699 mentioned before, we're gonna start disseminating a lot 1535 00:58:00,699 --> 00:58:02,244 of the stuff that we've learned so far 1536 00:58:02,244 --> 00:58:03,304 on this big project. 1537 00:58:04,005 --> 00:58:05,125 And then we, 1538 00:58:05,684 --> 00:58:06,425 are having, 1539 00:58:07,125 --> 00:58:07,864 more questions. 1540 00:58:08,565 --> 00:58:10,824 And some of those questions have to do 1541 00:58:10,885 --> 00:58:11,385 with, 1542 00:58:12,164 --> 00:58:15,210 recovery, like, what kind of prognosis can we 1543 00:58:15,690 --> 00:58:17,630 expect based on various types of 1544 00:58:17,929 --> 00:58:18,429 information 1545 00:58:19,050 --> 00:58:21,389 that we're gathering based on the different profiles 1546 00:58:21,530 --> 00:58:22,750 that we're an identifying? 1547 00:58:24,170 --> 00:58:26,829 We also wanna look at treatment responsiveness, 1548 00:58:27,289 --> 00:58:30,109 so, like, develop more of these dynamic assessments. 1549 00:58:31,184 --> 00:58:31,684 We 1550 00:58:32,144 --> 00:58:34,244 also are going to need to, 1551 00:58:34,704 --> 00:58:36,244 do a bit of 1552 00:58:36,545 --> 00:58:38,005 more work to make 1553 00:58:39,105 --> 00:58:40,785 or we think that we can make the, 1554 00:58:41,265 --> 00:58:43,204 the tools even more accessible 1555 00:58:43,585 --> 00:58:46,469 to clinicians. So there's gonna we we need 1556 00:58:46,469 --> 00:58:48,410 some engineering, and we need some more, 1557 00:58:50,309 --> 00:58:51,769 development or to automate, 1558 00:58:52,550 --> 00:58:55,269 the assessment so that it'll be really easy 1559 00:58:55,269 --> 00:58:57,194 for a speech language biologists to 1560 00:58:58,054 --> 00:59:00,855 to to use with the technology that most 1561 00:59:00,855 --> 00:59:01,755 of them have, 1562 00:59:02,295 --> 00:59:04,074 in their clinical practice. 1563 00:59:05,734 --> 00:59:06,234 And, 1564 00:59:07,174 --> 00:59:09,414 I think the another thing that we haven't 1565 00:59:09,414 --> 00:59:11,755 talked about today is that we are open 1566 00:59:12,269 --> 00:59:12,769 also 1567 00:59:13,630 --> 00:59:14,130 to 1568 00:59:14,670 --> 00:59:15,170 language 1569 00:59:16,030 --> 00:59:17,409 and how language 1570 00:59:17,710 --> 00:59:19,010 interacts with speech. 1571 00:59:20,030 --> 00:59:22,210 And so we are simultaneously 1572 00:59:23,070 --> 00:59:24,690 working out ways to 1573 00:59:24,989 --> 00:59:27,090 understand different language profiles 1574 00:59:28,155 --> 00:59:28,655 and, 1575 00:59:29,114 --> 00:59:31,215 quantify them and see how they 1576 00:59:31,515 --> 00:59:33,934 also relate to speech. So, 1577 00:59:34,795 --> 00:59:37,594 at our website at aphasia.unc.edu, 1578 00:59:37,594 --> 00:59:38,574 one of the resources 1579 00:59:39,035 --> 00:59:40,989 or some of the resources that we have 1580 00:59:40,989 --> 00:59:42,769 there are also automated, 1581 00:59:43,789 --> 00:59:44,930 analysis of, 1582 00:59:46,190 --> 00:59:49,329 of, like, connected speech. There are 1583 00:59:49,869 --> 00:59:53,090 fairly simple micro level discourse analysis methods 1584 00:59:53,694 --> 00:59:56,094 where you have a transcript to copy and 1585 00:59:56,094 --> 00:59:58,734 paste it, and you get information that can 1586 00:59:58,734 --> 01:00:01,554 help you understand also what words are used, 1587 01:00:03,214 --> 01:00:06,674 and in a way that's meaningful for understanding 1588 01:00:06,734 --> 01:00:08,414 of aphasia, for example. So 1589 01:00:09,460 --> 01:00:09,960 Excellent. 1590 01:00:10,660 --> 01:00:13,860 Mhmm. Alright. Awesome. Well, thank you guys both 1591 01:00:13,860 --> 01:00:15,320 so much and and, obviously, 1592 01:00:16,500 --> 01:00:17,559 Connor as well. 1593 01:00:18,099 --> 01:00:19,619 Is she is she we got lost we 1594 01:00:19,619 --> 01:00:21,394 lost her in cyberspace, but thank you so 1595 01:00:21,394 --> 01:00:22,914 much, Connor. I know she arranged having you 1596 01:00:22,914 --> 01:00:24,594 guys come on this podcast. So thank you 1597 01:00:24,594 --> 01:00:26,514 so much. This is this is awesome. I, 1598 01:00:26,514 --> 01:00:28,675 you know, I I know motor speech is 1599 01:00:28,675 --> 01:00:30,835 is not my forte at all, but I 1600 01:00:30,835 --> 01:00:32,434 I have so much respect for those of 1601 01:00:32,434 --> 01:00:33,714 you that do the work in it. I 1602 01:00:33,714 --> 01:00:35,940 know it's incredibly important. I, you know, love 1603 01:00:35,940 --> 01:00:38,739 working with patients post stroke. I'm love dysphagia, 1604 01:00:38,739 --> 01:00:40,340 but I've I've always said I know that 1605 01:00:40,340 --> 01:00:42,179 I'm doing my patients a disservice by not 1606 01:00:42,179 --> 01:00:43,239 knowing more about 1607 01:00:43,539 --> 01:00:46,019 aphasia, language, motor speech disorders, and how to 1608 01:00:46,019 --> 01:00:47,765 treat those kind of things. So thank you 1609 01:00:47,765 --> 01:00:49,765 for doing You're not you're not alone to 1610 01:00:49,765 --> 01:00:51,445 read. Yeah. Yeah. A lot of people are 1611 01:00:51,445 --> 01:00:54,324 frightened about it because it's a big leap 1612 01:00:54,324 --> 01:00:56,885 to to see and then do inferencing, and 1613 01:00:56,885 --> 01:00:58,965 that's exactly what we we wanna try to 1614 01:00:58,965 --> 01:01:01,445 demystify it and make it measurable and Awesome. 1615 01:01:01,605 --> 01:01:03,250 So that people will feel feel more comfortable. 1616 01:01:03,250 --> 01:01:04,930 Yeah. Yeah. So thank you for doing doing 1617 01:01:04,930 --> 01:01:07,890 the the real clinical research. So appreciate that. 1618 01:01:07,890 --> 01:01:09,410 So so nice to meet you guys. Thank 1619 01:01:09,410 --> 01:01:11,030 you so much for coming on today. 1620 01:01:11,650 --> 01:01:13,250 Thank you for having us. It was a 1621 01:01:13,250 --> 01:01:14,070 lot of fun. 1622 01:01:14,835 --> 01:01:17,474 And that's a wrap for this episode. As 1623 01:01:17,474 --> 01:01:19,494 always, thank you so much for listening. 1624 01:01:19,875 --> 01:01:21,315 If you'd like to download the show notes 1625 01:01:21,315 --> 01:01:25,255 from this episode, please visit swallowyourpridepodcast.com. 1626 01:01:25,474 --> 01:01:26,994 There you can also sign up for our 1627 01:01:26,994 --> 01:01:28,994 email list so that you'll never miss another 1628 01:01:28,994 --> 01:01:29,494 episode. 1629 01:01:29,930 --> 01:01:31,690 If you do like what you hear, then 1630 01:01:31,690 --> 01:01:34,269 please subscribe and leave a review on iTunes 1631 01:01:34,809 --> 01:01:36,570 or share it on social media with your 1632 01:01:36,570 --> 01:01:38,809 friends and colleagues because that is what keeps 1633 01:01:38,809 --> 01:01:40,190 these episodes coming. 1634 01:01:40,650 --> 01:01:42,505 If you'd like to be a guest, share 1635 01:01:42,505 --> 01:01:45,065 feedback, or request a topic to be discussed 1636 01:01:45,065 --> 01:01:49,545 on the show, please email podcast@TeresaRichard.com. 1637 01:01:49,545 --> 01:01:51,625 Thank you so much for listening, and we'll 1638 01:01:51,625 --> 01:01:52,844 catch you next week.