1
00:00:12,384 --> 00:00:14,544
Welcome to the Swallow Your Pride podcast. I'm

2
00:00:14,544 --> 00:00:16,804
your host, Teresa Richard. I'm a board certified

3
00:00:16,864 --> 00:00:18,964
specialist in swallowing and swallowing disorders,

4
00:00:19,345 --> 00:00:21,585
a mobile thieves business owner, and founder of

5
00:00:21,585 --> 00:00:22,964
the MedSLP Collective.

6
00:00:23,345 --> 00:00:25,505
This podcast is all about delivering the latest

7
00:00:25,505 --> 00:00:27,204
evidence based practice to medical

8
00:00:27,519 --> 00:00:28,260
SLPs everywhere.

9
00:00:28,560 --> 00:00:31,039
Whether you're a new clinician seeking tangible tools

10
00:00:31,039 --> 00:00:33,119
for treatment or a seasoned vet stuck in

11
00:00:33,119 --> 00:00:35,039
a rut, my goal is to help ditch

12
00:00:35,039 --> 00:00:36,640
the old school ways of the past that

13
00:00:36,640 --> 00:00:38,799
no longer serve you or your patients, to

14
00:00:38,799 --> 00:00:41,204
reinvigorate your passion for our field, to broaden

15
00:00:41,204 --> 00:00:43,364
your knowledge about our scope of practice, and

16
00:00:43,364 --> 00:00:45,125
to inspire you to practice at the top

17
00:00:45,125 --> 00:00:47,204
of your license. So if you're listening, I

18
00:00:47,204 --> 00:00:49,524
encourage you to swallow your pride, be open

19
00:00:49,524 --> 00:00:51,684
and willing to learn because let's face it,

20
00:00:51,684 --> 00:00:54,244
your patients deserve that kind of care. With

21
00:00:54,244 --> 00:00:56,104
that, let's dive right in.

22
00:00:56,649 --> 00:00:58,810
Just a quick disclaimer that all statements and

23
00:00:58,810 --> 00:01:01,289
opinions expressed in this episode do not reflect

24
00:01:01,289 --> 00:01:04,090
on the organizations associated with the speakers and

25
00:01:04,090 --> 00:01:05,709
are their own opinions solely.

26
00:01:06,090 --> 00:01:07,630
Alright. Good morning, Yvette.

27
00:01:08,170 --> 00:01:08,909
Good morning,

28
00:01:09,290 --> 00:01:09,790
Theresa.

29
00:01:10,250 --> 00:01:12,375
Thank you so much for joining me. Oh

30
00:01:12,375 --> 00:01:14,454
my goodness. I'm so excited to be here.

31
00:01:14,454 --> 00:01:16,314
I I appreciate the invitation.

32
00:01:16,775 --> 00:01:19,015
Yes. Yes. Of course. Alright. So for those

33
00:01:19,015 --> 00:01:20,775
of you that don't know, this is doctor

34
00:01:20,775 --> 00:01:23,594
Yvette McCoy. She's an assistant professor at Moravian

35
00:01:23,655 --> 00:01:25,655
University and the author of two books, The

36
00:01:25,655 --> 00:01:28,409
Adult Dysphagia Pocket Guide second edition and The

37
00:01:28,409 --> 00:01:30,670
Clinical Process, both by Plural Publishing.

38
00:01:31,129 --> 00:01:34,250
Her research interests include rehabilitation of the swallowing

39
00:01:34,250 --> 00:01:38,270
mechanism via exercise, specifically in community dwelling elderly.

40
00:01:38,650 --> 00:01:40,829
She also has a strong interest in interprofessional

41
00:01:41,290 --> 00:01:42,750
education and collaboration.

42
00:01:43,370 --> 00:01:43,870
So

43
00:01:44,275 --> 00:01:46,435
welcome to the show, my dear friend. I

44
00:01:46,435 --> 00:01:48,515
just love that we're doing this together. I

45
00:01:48,754 --> 00:01:50,135
Yvette's been one of my

46
00:01:51,075 --> 00:01:52,754
longest I was gonna say oldest friends in

47
00:01:52,754 --> 00:01:53,954
the field, but you were definitely not my

48
00:01:53,954 --> 00:01:55,555
oldest friend in the field. One of my

49
00:01:55,555 --> 00:01:57,780
longest friends in the field. Yeah. Long time

50
00:01:57,780 --> 00:01:59,540
friend. Yeah. Long time friend. And I and

51
00:01:59,540 --> 00:02:01,060
I think what's so what I love is

52
00:02:01,060 --> 00:02:02,500
we're at this point of in our career

53
00:02:02,500 --> 00:02:04,180
where so many of us had talked about

54
00:02:04,180 --> 00:02:06,579
getting PhDs and going on and getting more

55
00:02:06,579 --> 00:02:08,259
involved into research. And now I'm at that

56
00:02:08,259 --> 00:02:10,455
point in my career where, like, my friends

57
00:02:10,455 --> 00:02:12,294
have actually done that, and I'm so close

58
00:02:12,294 --> 00:02:14,294
to doing it too. But I'm so excited,

59
00:02:14,294 --> 00:02:16,134
and and thank you for being here. Many,

60
00:02:16,134 --> 00:02:17,414
many years later, you were one of the

61
00:02:17,414 --> 00:02:20,215
first people on this this show, gosh, six,

62
00:02:20,215 --> 00:02:22,389
seven years ago probably. So Yeah. And I

63
00:02:22,389 --> 00:02:24,550
think what's so what's really is so great

64
00:02:24,550 --> 00:02:26,949
about this is people always my students, whenever

65
00:02:26,949 --> 00:02:28,870
I tell them, you know, that I know

66
00:02:28,870 --> 00:02:31,110
Teresa Richard, they get all excited. They can't

67
00:02:31,110 --> 00:02:31,509
believe

68
00:02:32,069 --> 00:02:33,990
they're like, you know her. And I say,

69
00:02:33,990 --> 00:02:36,365
oh, my goodness. I knew her before she

70
00:02:36,365 --> 00:02:37,264
was the MetSLP

71
00:02:37,564 --> 00:02:39,425
club. I know. Before she was anybody.

72
00:02:39,805 --> 00:02:42,205
But I knew her when we were trying

73
00:02:42,205 --> 00:02:43,805
to figure out what we were gonna do

74
00:02:43,805 --> 00:02:46,724
with our careers being frustrated together and Yeah.

75
00:02:46,844 --> 00:02:48,205
You know, if we were gonna take this

76
00:02:48,205 --> 00:02:50,230
PhD journey. So just to see, I I

77
00:02:50,230 --> 00:02:52,069
think our careers have sort of followed a

78
00:02:52,069 --> 00:02:55,210
similar trajectory, although we've gone different, you know,

79
00:02:55,590 --> 00:02:57,909
directions. I I just think it's so great

80
00:02:57,909 --> 00:02:59,750
that we have sort of both come full

81
00:02:59,750 --> 00:03:01,129
circle, and I'm just so

82
00:03:01,590 --> 00:03:03,830
grateful that you asked me to chat with

83
00:03:03,830 --> 00:03:06,905
you today. Yeah. Yeah. So so, yeah, Yvette

84
00:03:06,905 --> 00:03:08,584
and I, you know, both she started her

85
00:03:08,584 --> 00:03:10,664
PhD journey first, and and then I started

86
00:03:10,664 --> 00:03:12,504
mine. And, you know, it's it's interesting the

87
00:03:12,504 --> 00:03:13,644
way that the PhD

88
00:03:13,944 --> 00:03:15,864
journey takes you because it's where you thought

89
00:03:15,864 --> 00:03:17,465
you were gonna be is really never where

90
00:03:17,465 --> 00:03:19,144
it ends up, and there's a million you

91
00:03:19,144 --> 00:03:20,584
know, it's like that meme you see online

92
00:03:20,584 --> 00:03:22,669
with the million spirals in between. And, you

93
00:03:22,669 --> 00:03:24,509
know, I know that my topic is somewhat

94
00:03:24,509 --> 00:03:26,049
the same, but it's just been

95
00:03:27,389 --> 00:03:30,209
rolled over forwards and backwards a million times

96
00:03:30,509 --> 00:03:32,989
before we arrived here. Yeah. So I I'd

97
00:03:32,989 --> 00:03:34,189
love if you could just share a little

98
00:03:34,189 --> 00:03:36,269
bit about what your dissertation topic was, Yvette,

99
00:03:36,269 --> 00:03:38,175
because it's such a fascinating

100
00:03:38,715 --> 00:03:41,594
and really, really well needed body of work.

101
00:03:41,594 --> 00:03:43,194
And yeah. So go ahead if you can

102
00:03:43,194 --> 00:03:44,955
share with us what it is and where

103
00:03:44,955 --> 00:03:47,275
you got to it. Well, the if the

104
00:03:47,275 --> 00:03:47,775
formal,

105
00:03:48,555 --> 00:03:49,855
title of my dissertation

106
00:03:51,310 --> 00:03:53,329
is physical performance measures

107
00:03:53,949 --> 00:03:54,769
as predictors

108
00:03:55,229 --> 00:03:56,609
of swallowing related

109
00:03:56,909 --> 00:03:59,969
measures in community dwelling elderly. And I think

110
00:04:00,189 --> 00:04:02,030
and, you know, before I get to talking,

111
00:04:02,030 --> 00:04:04,305
because I'll you know, I'm quite verbose. So

112
00:04:04,465 --> 00:04:06,625
before I start talking, I cannot I would

113
00:04:06,625 --> 00:04:08,305
be remiss if I did not thank my

114
00:04:08,305 --> 00:04:08,805
committee.

115
00:04:09,984 --> 00:04:11,284
Doctor Jason Winchester

116
00:04:11,745 --> 00:04:12,405
out of

117
00:04:13,025 --> 00:04:14,805
Concordia University of Chicago,

118
00:04:15,264 --> 00:04:17,204
who was my dissertation chair,

119
00:04:17,879 --> 00:04:18,860
Sonya Molfinter,

120
00:04:19,959 --> 00:04:22,300
from New York University, NYU,

121
00:04:23,079 --> 00:04:23,560
and,

122
00:04:23,959 --> 00:04:24,459
doctor

123
00:04:24,839 --> 00:04:25,660
Deb Souter

124
00:04:26,199 --> 00:04:30,039
from the, University of Kentucky. So the my

125
00:04:30,039 --> 00:04:30,539
committee,

126
00:04:30,919 --> 00:04:31,500
it was

127
00:04:31,875 --> 00:04:34,675
incredible in terms of mentorship and guidance, and

128
00:04:34,675 --> 00:04:36,194
I I don't I know for sure that

129
00:04:36,194 --> 00:04:37,415
I would not be here,

130
00:04:38,275 --> 00:04:39,975
without them. This has been

131
00:04:40,514 --> 00:04:42,754
quite a journey. But I think part of

132
00:04:42,754 --> 00:04:44,435
the reason why I became so interested in

133
00:04:44,435 --> 00:04:46,860
this topic, it was it started out as

134
00:04:46,860 --> 00:04:49,360
being more personal than professional, really.

135
00:04:49,740 --> 00:04:52,959
I've worked for so many years in outpatient

136
00:04:53,100 --> 00:04:53,600
rehab

137
00:04:54,379 --> 00:04:57,660
alongside physical therapists and occupational therapists, and I

138
00:04:57,660 --> 00:04:59,039
just I've really watched

139
00:04:59,444 --> 00:05:02,084
how they use the principle of exercise to

140
00:05:02,084 --> 00:05:04,644
rehabilitate their patients. And, you know, I as

141
00:05:04,644 --> 00:05:06,745
I'm watching them, I'm thinking they're just not

142
00:05:07,204 --> 00:05:10,324
doing therapy. That what they're doing is really

143
00:05:10,324 --> 00:05:11,544
taking these principles

144
00:05:12,170 --> 00:05:15,389
of exercise science and applying them, right? Progressive

145
00:05:15,529 --> 00:05:18,270
overload, they measure strength, they track endurance,

146
00:05:18,970 --> 00:05:21,790
they think about dosage and frequency and intensity

147
00:05:22,089 --> 00:05:22,589
and

148
00:05:22,889 --> 00:05:25,365
all of that, And as a result, over

149
00:05:25,365 --> 00:05:27,125
time, what we began to see with their

150
00:05:27,125 --> 00:05:30,004
patients is this meaningful measurable change in what?

151
00:05:30,004 --> 00:05:31,064
In gait speed,

152
00:05:31,524 --> 00:05:33,865
in grip strength, and how they transfer,

153
00:05:34,485 --> 00:05:37,144
you know, their overall mobility. And so

154
00:05:37,524 --> 00:05:39,784
I I started asking myself, if

155
00:05:40,139 --> 00:05:42,540
if swallowing is a neuromuscular task, and if

156
00:05:42,540 --> 00:05:43,600
swallowing decline

157
00:05:44,060 --> 00:05:47,199
sort of mirrors a systemic physical decline,

158
00:05:47,899 --> 00:05:49,819
why wouldn't we approach it the same way?

159
00:05:49,819 --> 00:05:51,600
Why wouldn't we use these exercise

160
00:05:52,154 --> 00:05:52,654
principles?

161
00:05:52,955 --> 00:05:54,955
And, you know, I mean, that just started

162
00:05:54,955 --> 00:05:57,035
me down a complete rabbit hole, and and

163
00:05:57,035 --> 00:05:59,675
granted, we're talking about sort of large limb

164
00:05:59,675 --> 00:06:02,975
muscles, right, versus our tiny swallowing muscles.

165
00:06:04,959 --> 00:06:06,720
But I don't know. I just started thinking

166
00:06:06,720 --> 00:06:08,079
more and more about this, and I thought

167
00:06:08,079 --> 00:06:10,259
muscle mass declines with age, neuromuscular

168
00:06:10,560 --> 00:06:12,500
integrity declines with age.

169
00:06:13,279 --> 00:06:16,819
And so then maybe swallowing reflects that broader

170
00:06:17,120 --> 00:06:18,659
decline. And if it does,

171
00:06:18,974 --> 00:06:21,314
then maybe we should be thinking beyond compensation.

172
00:06:22,574 --> 00:06:25,615
Now I I should say that please do

173
00:06:25,615 --> 00:06:28,495
not come away from this discussion saying that

174
00:06:28,495 --> 00:06:31,235
that Yvette said we shouldn't use compensation.

175
00:06:31,709 --> 00:06:34,589
I'm not suggesting that compensation and diet modifications

176
00:06:34,589 --> 00:06:36,509
and all those things are not necessary in

177
00:06:36,509 --> 00:06:38,529
some cases. I mean, albeit temporarily,

178
00:06:39,629 --> 00:06:42,029
but and specifically in our critically ill, we

179
00:06:42,029 --> 00:06:43,649
do need diet modifications.

180
00:06:44,029 --> 00:06:45,009
We do need

181
00:06:45,675 --> 00:06:47,375
short term solutions

182
00:06:47,754 --> 00:06:50,475
to protect the airway, right, and improve bolus

183
00:06:50,475 --> 00:06:50,975
efficiency.

184
00:06:52,074 --> 00:06:52,574
But,

185
00:06:52,955 --> 00:06:53,535
you know,

186
00:06:54,475 --> 00:06:57,055
I started thinking that maybe we should also

187
00:06:57,115 --> 00:06:59,055
be thinking about, you know,

188
00:06:59,550 --> 00:07:00,050
rehabilitation

189
00:07:00,990 --> 00:07:02,689
that is grounded

190
00:07:03,069 --> 00:07:05,970
in exercise science, specifically after our patients

191
00:07:06,350 --> 00:07:07,810
move past that stage

192
00:07:08,430 --> 00:07:08,930
of,

193
00:07:09,949 --> 00:07:12,670
critical illness. And so that shift, I think,

194
00:07:12,670 --> 00:07:13,410
for me

195
00:07:14,354 --> 00:07:15,974
was really seeing swallowing

196
00:07:16,914 --> 00:07:19,095
not seeing swallowing as just sort of this

197
00:07:20,115 --> 00:07:21,974
isolated function. Right?

198
00:07:22,595 --> 00:07:24,514
But to sort of look at it as

199
00:07:24,514 --> 00:07:25,574
part of a larger

200
00:07:26,435 --> 00:07:29,910
system, and that's what really motivated me to

201
00:07:29,910 --> 00:07:32,389
to look into this. Before I reflect on

202
00:07:32,389 --> 00:07:34,149
my findings before you know, and I don't

203
00:07:34,149 --> 00:07:35,289
wanna get too,

204
00:07:36,069 --> 00:07:37,449
quote, unquote scientific.

205
00:07:37,990 --> 00:07:40,069
I do wanna talk briefly about the findings,

206
00:07:40,069 --> 00:07:41,849
but even before I get to that,

207
00:07:42,735 --> 00:07:43,634
you know, I I

208
00:07:44,254 --> 00:07:46,334
think we have to consider the science that

209
00:07:46,334 --> 00:07:48,354
even got us to this point. Right?

210
00:07:49,694 --> 00:07:52,414
And we we've known for years that if

211
00:07:52,414 --> 00:07:55,134
a patient has reduced cough peak flow, that

212
00:07:55,134 --> 00:07:56,194
that could potentially

213
00:07:58,000 --> 00:08:00,339
manifest itself in in difficulties

214
00:08:01,439 --> 00:08:04,319
in swallowing. And we knew that lingual strength

215
00:08:04,319 --> 00:08:06,639
and endurance and swallowing reserve and all of

216
00:08:06,639 --> 00:08:07,459
those things,

217
00:08:09,120 --> 00:08:11,620
can impact swallowing performance.

218
00:08:12,245 --> 00:08:13,925
What else do we know? We all we

219
00:08:13,925 --> 00:08:15,944
already knew about frailty and sarcopenia

220
00:08:16,324 --> 00:08:18,324
and all of that sort of co occurring

221
00:08:18,324 --> 00:08:19,064
with dysphasia.

222
00:08:19,764 --> 00:08:22,805
But what hadn't been done and what hadn't

223
00:08:22,805 --> 00:08:25,784
been really studied was to

224
00:08:26,400 --> 00:08:28,660
systematically look at a broader physical

225
00:08:29,120 --> 00:08:32,180
performance profile. Right? One that would include,

226
00:08:33,279 --> 00:08:35,360
upper body power. So, you know, looking from

227
00:08:35,360 --> 00:08:37,220
sort of a whole body perspective

228
00:08:38,095 --> 00:08:41,455
and really ask the question, do these fitness

229
00:08:41,455 --> 00:08:42,995
measures or do these,

230
00:08:44,254 --> 00:08:46,514
physical performance measures predict

231
00:08:46,975 --> 00:08:50,414
swallowing outcomes in in healthy older adults who

232
00:08:50,414 --> 00:08:53,315
really aren't necessarily complaining about swallowing?

233
00:08:54,149 --> 00:08:56,070
And that's one of the reasons that I

234
00:08:56,070 --> 00:08:59,769
chose the demographic of community dwelling elderly because,

235
00:09:00,389 --> 00:09:02,230
you know, these are people that are in

236
00:09:02,230 --> 00:09:04,709
assisted living facilities or people that are living

237
00:09:04,709 --> 00:09:06,089
independently at home.

238
00:09:06,914 --> 00:09:08,274
They're 65.

239
00:09:08,274 --> 00:09:11,075
They're probably experiencing some of the normal age

240
00:09:11,075 --> 00:09:13,815
related changes that we see in swallowing, but,

241
00:09:14,914 --> 00:09:17,095
you know, they're all they're they're

242
00:09:17,554 --> 00:09:19,735
sometimes overlooked. Right? Or,

243
00:09:21,315 --> 00:09:21,815
just,

244
00:09:22,809 --> 00:09:24,970
you know, we don't think about them much

245
00:09:24,970 --> 00:09:26,429
because of their perceived

246
00:09:26,889 --> 00:09:27,389
independence.

247
00:09:27,929 --> 00:09:30,909
Right? But we know that they

248
00:09:31,690 --> 00:09:33,629
are going to experience,

249
00:09:34,009 --> 00:09:35,709
like, some of these age related

250
00:09:36,329 --> 00:09:36,829
changes.

251
00:09:37,985 --> 00:09:40,304
And so I wanted to just take that

252
00:09:40,304 --> 00:09:42,725
demographic and look at them, you know, healthy,

253
00:09:43,424 --> 00:09:44,404
elderly people.

254
00:09:45,424 --> 00:09:46,245
And so

255
00:09:46,865 --> 00:09:48,384
what did what did we do? What did

256
00:09:48,384 --> 00:09:49,845
I do? Well, I looked at

257
00:09:50,625 --> 00:09:51,684
five physical

258
00:09:52,384 --> 00:09:52,884
performance

259
00:09:53,629 --> 00:09:55,009
measures. K? So

260
00:09:55,389 --> 00:09:55,870
I,

261
00:09:56,350 --> 00:09:57,970
I examined gait speed,

262
00:09:58,429 --> 00:10:00,929
via the ten minute 10 meter walk test,

263
00:10:02,750 --> 00:10:04,850
aerobic capacity and endurance

264
00:10:05,470 --> 00:10:07,809
via the six minute walk test,

265
00:10:08,245 --> 00:10:10,184
upper body strength and power

266
00:10:10,644 --> 00:10:12,585
via a seated med ball throw.

267
00:10:13,524 --> 00:10:16,245
Lower body strength and endurance was also assessed

268
00:10:16,245 --> 00:10:18,965
via the thirty second sit to stand test,

269
00:10:18,965 --> 00:10:21,065
and also hand grip strength.

270
00:10:21,870 --> 00:10:23,409
And then for our swallowing,

271
00:10:24,029 --> 00:10:26,669
performance measures, I use the E10 and the

272
00:10:26,669 --> 00:10:27,809
Yale swallow protocol,

273
00:10:28,909 --> 00:10:30,929
lingual pressures via the IOPI.

274
00:10:31,389 --> 00:10:33,070
We also looked at the,

275
00:10:33,549 --> 00:10:36,370
a mastication assessment. Right? The test of mastication

276
00:10:36,429 --> 00:10:37,809
and swallowing of solids,

277
00:10:38,804 --> 00:10:41,044
as well as cough peak flow. So our

278
00:10:41,044 --> 00:10:44,644
measurement tools consisted of five swallowing measures and

279
00:10:44,644 --> 00:10:47,125
five physical performance measures. Now I could talk

280
00:10:47,125 --> 00:10:48,964
about this for hours, but Can I yeah?

281
00:10:48,964 --> 00:10:50,404
Can I can I stop you and back

282
00:10:50,404 --> 00:10:51,544
you up a second? Sure.

283
00:10:51,889 --> 00:10:54,289
Talk to me about when you were coming

284
00:10:54,289 --> 00:10:56,370
up with this with this topic. I'm assuming

285
00:10:56,370 --> 00:10:58,289
you had to recruit a PT to be

286
00:10:58,289 --> 00:11:00,529
on your committee. No. You did not. Okay.

287
00:11:00,529 --> 00:11:02,769
No. No. And I'm just wondering No. Yeah.

288
00:11:02,769 --> 00:11:05,250
Did anyone think you were absolutely crazy in

289
00:11:05,250 --> 00:11:07,334
left field? Is this the most bizarre study

290
00:11:07,334 --> 00:11:09,414
that's ever been done on swallowing? Talk to

291
00:11:09,414 --> 00:11:10,855
me more a little bit about how that

292
00:11:10,855 --> 00:11:12,074
process fleshed out.

293
00:11:12,855 --> 00:11:14,774
So it's funny that you asked that because

294
00:11:14,934 --> 00:11:15,914
so my doctorate,

295
00:11:16,774 --> 00:11:19,814
I didn't did not get a PhD in

296
00:11:19,814 --> 00:11:22,314
communication sciences disorders and speech pathology.

297
00:11:22,830 --> 00:11:24,210
My doctorate was,

298
00:11:24,910 --> 00:11:25,410
in

299
00:11:27,550 --> 00:11:29,250
health and human performance

300
00:11:29,870 --> 00:11:32,910
with an with an emphasis in exercise science.

301
00:11:32,910 --> 00:11:35,170
And so my committee chair, my mentor,

302
00:11:35,565 --> 00:11:37,745
he's an exercise physiology guy. So,

303
00:11:38,524 --> 00:11:41,085
you know, when I did my doctoral work

304
00:11:41,085 --> 00:11:42,845
and I got to this point of looking

305
00:11:42,845 --> 00:11:46,544
for a mentor, I asked probably 13 faculty

306
00:11:46,684 --> 00:11:47,504
in the department,

307
00:11:47,965 --> 00:11:49,200
and they all said no

308
00:11:50,000 --> 00:11:50,500
because,

309
00:11:51,360 --> 00:11:53,460
I don't know how you're going to

310
00:11:54,160 --> 00:11:56,000
you know, you wanna look at swallowing and

311
00:11:56,000 --> 00:11:59,120
exercise? Well, there's how how and why? And

312
00:11:59,120 --> 00:12:01,440
I don't have any experience that I could

313
00:12:01,440 --> 00:12:03,625
even guide you in this. And so,

314
00:12:04,804 --> 00:12:06,884
thankfully, one person said yes, and that was

315
00:12:06,884 --> 00:12:09,144
doctor Jason Winchester, as I said.

316
00:12:09,845 --> 00:12:12,024
And he was really intrigued by it because,

317
00:12:12,964 --> 00:12:14,105
of some personal

318
00:12:14,964 --> 00:12:17,544
swallowing problems that had occurred in his family,

319
00:12:17,820 --> 00:12:19,899
and he was really intrigued by what he

320
00:12:19,899 --> 00:12:23,120
was seeing being done. And so he enthusiastically

321
00:12:24,220 --> 00:12:26,240
said, sure. Let's take this on.

322
00:12:27,019 --> 00:12:29,919
And and that is how we started.

323
00:12:30,620 --> 00:12:32,539
That's how I started. So I didn't recruit

324
00:12:32,539 --> 00:12:34,815
any PT, but but because of my,

325
00:12:35,674 --> 00:12:36,254
my actual,

326
00:12:37,595 --> 00:12:38,095
doctoral

327
00:12:38,794 --> 00:12:40,975
major, you know, in health and human performance,

328
00:12:41,595 --> 00:12:42,495
I had to

329
00:12:43,595 --> 00:12:46,394
recruit some faculty who were already in that

330
00:12:46,394 --> 00:12:49,120
field of exercise. And so that's how how

331
00:12:49,120 --> 00:12:50,179
we got started.

332
00:12:52,000 --> 00:12:53,759
And I will tell you and you know

333
00:12:53,759 --> 00:12:54,259
this,

334
00:12:54,720 --> 00:12:55,220
being

335
00:12:55,679 --> 00:12:57,600
a person who is just sort of in

336
00:12:57,600 --> 00:13:00,339
the throes of this doctoral work, that

337
00:13:01,945 --> 00:13:02,764
when you,

338
00:13:04,745 --> 00:13:05,565
start this,

339
00:13:06,825 --> 00:13:09,865
you don't really you're you do your literature

340
00:13:09,865 --> 00:13:12,024
review. Right? And you think you're going one

341
00:13:12,024 --> 00:13:14,264
direction, and that literature review takes you in

342
00:13:14,264 --> 00:13:15,884
a completely different direction.

343
00:13:16,269 --> 00:13:18,589
Yep. And before you know it, you're doing

344
00:13:18,589 --> 00:13:21,070
something completely different than what you'd initially set

345
00:13:21,070 --> 00:13:22,850
out to do. Yep. Initially,

346
00:13:23,309 --> 00:13:24,850
I wanted to do something

347
00:13:25,470 --> 00:13:25,970
that

348
00:13:27,549 --> 00:13:28,529
looked at

349
00:13:29,725 --> 00:13:30,225
SEMG

350
00:13:31,245 --> 00:13:33,264
and the utility of SEMG

351
00:13:34,524 --> 00:13:35,264
and biofeedback

352
00:13:35,804 --> 00:13:38,284
and, you know, and and there I went

353
00:13:38,284 --> 00:13:39,985
through the litter and there had been already

354
00:13:40,044 --> 00:13:41,985
so much done on that.

355
00:13:43,809 --> 00:13:45,909
Boy. And then I came across a paper

356
00:13:46,049 --> 00:13:48,230
as I started doing my literature review,

357
00:13:48,769 --> 00:13:51,329
and it just blew the world wide open

358
00:13:51,329 --> 00:13:52,069
for me.

359
00:13:52,610 --> 00:13:55,250
When I came across doctor Van Ravenhorst Bell,

360
00:13:55,250 --> 00:13:56,549
boy, I came across her

361
00:13:57,055 --> 00:13:59,774
papers, and that just sort of took me

362
00:13:59,774 --> 00:14:01,855
down a completely different path. And I can

363
00:14:01,855 --> 00:14:03,555
remember even saying to my

364
00:14:03,935 --> 00:14:06,915
chair, have you seen this paper about weightlifters'

365
00:14:07,215 --> 00:14:07,715
tongue

366
00:14:08,415 --> 00:14:09,715
strength and runners'

367
00:14:10,399 --> 00:14:12,879
endurance in their tongue. Have you seen this?

368
00:14:12,879 --> 00:14:14,340
Somebody's looking at this.

369
00:14:15,200 --> 00:14:17,940
And so that's really how we we started,

370
00:14:18,000 --> 00:14:19,940
you know, just looking more and more

371
00:14:20,320 --> 00:14:20,820
into,

372
00:14:21,759 --> 00:14:24,615
physical performance and how it ties in. It

373
00:14:24,615 --> 00:14:27,254
started off as just oral function, looking at

374
00:14:27,254 --> 00:14:29,575
just the tongue, but, again, as we started

375
00:14:29,575 --> 00:14:31,335
diving more and more into the literature, it

376
00:14:31,335 --> 00:14:31,995
was just,

377
00:14:32,935 --> 00:14:34,315
amazing what we found.

378
00:14:34,615 --> 00:14:36,134
So I don't did that answer your question

379
00:14:36,134 --> 00:14:37,575
or not? Yeah. Do you wanna dive into

380
00:14:37,575 --> 00:14:39,629
those papers now? Let's let's give people a

381
00:14:39,710 --> 00:14:41,250
little bit more of an idea of those.

382
00:14:41,470 --> 00:14:43,970
But in her 2016 study, doctor Van Ravenhorst

383
00:14:44,110 --> 00:14:44,610
Bell,

384
00:14:45,389 --> 00:14:48,769
she assessed tongue strength and endurance in 48

385
00:14:48,910 --> 00:14:51,470
subjects. Right? And she found that the and

386
00:14:51,470 --> 00:14:54,190
they were elderly. She did, she looked at

387
00:14:54,190 --> 00:14:55,330
people in their sixties

388
00:14:57,095 --> 00:14:58,794
and people in their twenties, I believe.

389
00:14:59,095 --> 00:15:01,115
And what she found was that those who

390
00:15:01,335 --> 00:15:03,195
classified as highly active

391
00:15:03,575 --> 00:15:04,475
scored higher

392
00:15:05,654 --> 00:15:08,554
on their tongue measures than their sedentary peers,

393
00:15:08,855 --> 00:15:11,014
and that effect was more pronounced in people

394
00:15:11,014 --> 00:15:13,009
in their 60s than people in their 20s.

395
00:15:13,389 --> 00:15:15,730
And so what that suggests then that regular

396
00:15:16,269 --> 00:15:16,769
exercise

397
00:15:17,070 --> 00:15:20,110
can sort of help stave off the the

398
00:15:20,110 --> 00:15:23,089
the usual age related decline that we see

399
00:15:23,309 --> 00:15:26,529
in lingual muscle performance. And so, again,

400
00:15:26,934 --> 00:15:30,154
sort of this overarching idea that being physically

401
00:15:30,215 --> 00:15:33,195
active or engaging in physical exercise

402
00:15:33,654 --> 00:15:34,715
might slow

403
00:15:35,415 --> 00:15:38,634
age related tongue muscle performance decline.

404
00:15:39,110 --> 00:15:40,709
And I think the other thing that I

405
00:15:40,709 --> 00:15:43,190
wanna say about this is there's I think

406
00:15:43,190 --> 00:15:44,970
we need to define something

407
00:15:45,509 --> 00:15:47,289
clearly because the terms

408
00:15:47,829 --> 00:15:50,409
physical activity and physical exercise

409
00:15:51,029 --> 00:15:53,804
are often really used interchangeably, and they're not

410
00:15:53,804 --> 00:15:54,304
the

411
00:15:54,684 --> 00:15:58,044
same. And so in physical activity, we're looking

412
00:15:58,044 --> 00:15:59,504
at any bodily movement

413
00:16:00,044 --> 00:16:02,445
that is produced by skeletal muscles that's gonna

414
00:16:02,445 --> 00:16:06,445
result in energy expenditure. Right? That's physical activity.

415
00:16:06,445 --> 00:16:09,430
Anything that we do that's gonna result in

416
00:16:09,430 --> 00:16:11,750
energy expenditure. That could be walking to the

417
00:16:11,750 --> 00:16:14,310
mailbox. Right? That could be standing up from

418
00:16:14,310 --> 00:16:14,889
a chair,

419
00:16:15,910 --> 00:16:18,970
climbing upstairs, doing laundry even,

420
00:16:19,590 --> 00:16:21,910
or transferring from the bed to the chair.

421
00:16:21,910 --> 00:16:24,389
It's really this broad sort of spectrum of

422
00:16:24,389 --> 00:16:24,889
things,

423
00:16:25,725 --> 00:16:26,865
and it's cumulative.

424
00:16:27,325 --> 00:16:29,825
It reflects how much somebody moves

425
00:16:30,285 --> 00:16:33,565
across their day, right, and essentially across their

426
00:16:33,565 --> 00:16:37,585
their lives. But exercise is is distinctly different.

427
00:16:37,644 --> 00:16:39,184
Okay? It's a subset

428
00:16:39,620 --> 00:16:42,100
of physical activity. I think it's important to

429
00:16:42,100 --> 00:16:43,720
make that distinction because

430
00:16:44,100 --> 00:16:45,879
physical exercise is planned,

431
00:16:46,339 --> 00:16:47,799
it's it's structured,

432
00:16:48,579 --> 00:16:50,679
it's repetitive, it's intentional,

433
00:16:51,379 --> 00:16:52,519
and it's performed

434
00:16:53,059 --> 00:16:54,120
with the objective

435
00:16:54,554 --> 00:16:55,534
of improving

436
00:16:56,875 --> 00:16:59,514
physical fitness or at maybe at some point

437
00:16:59,514 --> 00:17:03,294
even maintaining it. Right? So all exercise

438
00:17:03,835 --> 00:17:06,554
is physical activity. We could say that pretty

439
00:17:06,554 --> 00:17:07,054
broadly,

440
00:17:07,480 --> 00:17:09,339
but not all physical activity

441
00:17:09,720 --> 00:17:11,980
is exercise. And I think that distinction

442
00:17:12,839 --> 00:17:15,019
matters. It matters a lot because

443
00:17:15,799 --> 00:17:17,339
exercise reflects intervention.

444
00:17:17,799 --> 00:17:19,259
Right? A targeted

445
00:17:19,559 --> 00:17:21,019
a targeted stimulus

446
00:17:21,704 --> 00:17:24,605
that is applied with a specific training goal.

447
00:17:24,825 --> 00:17:27,325
Right? And so when we're talking about,

448
00:17:28,345 --> 00:17:31,784
swallowing decline or frailty or rehab, we have

449
00:17:31,784 --> 00:17:32,765
to be clear

450
00:17:33,304 --> 00:17:34,605
about what we're actually

451
00:17:34,984 --> 00:17:35,484
discussing.

452
00:17:36,150 --> 00:17:38,150
And I know that, you know, sometimes as

453
00:17:38,150 --> 00:17:39,769
speech pathologists, we,

454
00:17:40,950 --> 00:17:42,570
talk about physical activity,

455
00:17:42,950 --> 00:17:45,910
and and we might think we're talking about

456
00:17:45,910 --> 00:17:46,410
physical

457
00:17:46,710 --> 00:17:47,210
exercise,

458
00:17:47,904 --> 00:17:49,904
but but we're not. Okay? And so what

459
00:17:49,904 --> 00:17:51,744
we need to ask ourselves, are we talking

460
00:17:51,744 --> 00:17:52,244
about

461
00:17:52,865 --> 00:17:53,365
structured

462
00:17:53,825 --> 00:17:54,325
swallowing

463
00:17:54,625 --> 00:17:56,565
exercises that are going to improve

464
00:17:56,944 --> 00:17:58,244
a specific function,

465
00:17:58,704 --> 00:18:00,640
or are we asking about whether a person's

466
00:18:00,640 --> 00:18:01,140
overall

467
00:18:01,839 --> 00:18:04,420
physical activity level, right, influencing

468
00:18:05,039 --> 00:18:05,539
their

469
00:18:06,000 --> 00:18:07,920
swallowing capacity? And I think that those are

470
00:18:07,920 --> 00:18:09,059
two very different

471
00:18:09,359 --> 00:18:11,599
questions. And so in my research, I'm looking

472
00:18:11,599 --> 00:18:12,099
more

473
00:18:12,720 --> 00:18:13,940
at physical

474
00:18:14,815 --> 00:18:17,075
exercise and not just physical

475
00:18:17,455 --> 00:18:19,695
activity. And even more importantly, I'm looking at

476
00:18:19,695 --> 00:18:20,755
the entire body.

477
00:18:21,055 --> 00:18:24,515
Right? I'm concerned about whole body Yeah. Exercise

478
00:18:24,654 --> 00:18:25,475
and intervention.

479
00:18:27,640 --> 00:18:29,900
And often people have asked me, you know,

480
00:18:30,200 --> 00:18:31,419
why did you choose

481
00:18:31,720 --> 00:18:32,539
the five

482
00:18:34,759 --> 00:18:36,919
physical performance measures? That's the next question out

483
00:18:36,919 --> 00:18:38,140
of my mouth. So yeah.

484
00:18:39,319 --> 00:18:41,339
Why did you choose those? Well,

485
00:18:42,005 --> 00:18:44,345
you know, if we're looking at gait speed,

486
00:18:44,804 --> 00:18:47,284
we cannot just look at the look at

487
00:18:47,284 --> 00:18:49,684
the timed up and go test. The timed

488
00:18:49,684 --> 00:18:52,404
up and go test is not a true,

489
00:18:52,404 --> 00:18:53,464
true, true measure

490
00:18:53,845 --> 00:18:55,684
of gait speed. Right? If we're looking at

491
00:18:55,684 --> 00:18:56,664
a true measure

492
00:18:57,059 --> 00:18:59,700
of gait of a person's gait speed, we

493
00:18:59,700 --> 00:19:02,500
don't wanna stop them by, you know, having

494
00:19:02,500 --> 00:19:03,000
them

495
00:19:04,259 --> 00:19:06,740
sit down and then stand up. That might

496
00:19:06,740 --> 00:19:09,319
be a really good measure of of functional,

497
00:19:10,259 --> 00:19:11,799
their functional physical

498
00:19:12,514 --> 00:19:14,694
performance, but I wanted to measure,

499
00:19:15,714 --> 00:19:17,815
gait speed. And to order to truly,

500
00:19:18,914 --> 00:19:20,595
measure gait speed, we need to look at

501
00:19:20,595 --> 00:19:22,054
the 10 meter walk test.

502
00:19:22,835 --> 00:19:25,859
If I want if I'm measuring endurance,

503
00:19:26,480 --> 00:19:28,259
right, and aerobic capacity,

504
00:19:28,720 --> 00:19:30,960
the best way to do that is via

505
00:19:30,960 --> 00:19:32,880
the six minute walk test. And these are

506
00:19:32,880 --> 00:19:35,200
things that I don't expect us as speech

507
00:19:35,200 --> 00:19:36,960
and language pathologists to know. You know? I'm

508
00:19:36,960 --> 00:19:39,494
just weird and I don't you know, I'm

509
00:19:39,494 --> 00:19:40,934
not thinking that we should learn all this,

510
00:19:40,934 --> 00:19:42,795
but I'm just weird and find it intriguing.

511
00:19:44,295 --> 00:19:45,994
Upper body strength and power.

512
00:19:47,174 --> 00:19:49,355
You know, if I'm looking at the entire

513
00:19:49,414 --> 00:19:51,815
body, I've gotta look at upper body and

514
00:19:51,815 --> 00:19:54,480
lower body, you know, individually. So we we

515
00:19:54,480 --> 00:19:56,740
chose the seated med ball throw where,

516
00:19:57,440 --> 00:19:59,359
you know, patients are sitting and they they've

517
00:19:59,359 --> 00:20:00,900
got a three to four pound,

518
00:20:01,679 --> 00:20:04,000
like a three pound medicine ball, which is

519
00:20:04,000 --> 00:20:05,059
which is the

520
00:20:06,000 --> 00:20:07,684
recommended weight for,

521
00:20:08,225 --> 00:20:11,265
elderly community dwelling, elderly 65 and older. So

522
00:20:11,265 --> 00:20:13,345
we're looking at how far they can throw

523
00:20:13,345 --> 00:20:16,144
that. Lower body strength, we're gonna see and

524
00:20:16,144 --> 00:20:18,725
endurance, how many times they can sit sit

525
00:20:18,945 --> 00:20:21,519
to stand in thirty seconds. And, of course,

526
00:20:21,519 --> 00:20:23,599
hand grip strength, which is something that, you

527
00:20:23,599 --> 00:20:25,680
know, has been in the literature for many,

528
00:20:25,680 --> 00:20:27,059
many years as being,

529
00:20:27,839 --> 00:20:30,579
this surrogate to lingual strength as well.

530
00:20:30,880 --> 00:20:32,339
And so those

531
00:20:32,640 --> 00:20:33,859
five were chosen

532
00:20:34,214 --> 00:20:37,414
because of the fact that they reflect the

533
00:20:37,414 --> 00:20:37,914
entire

534
00:20:38,294 --> 00:20:38,794
body,

535
00:20:39,095 --> 00:20:41,034
and we're looking at true measures

536
00:20:41,734 --> 00:20:44,534
of gait speed, upper body power, lower body

537
00:20:44,534 --> 00:20:45,034
strength,

538
00:20:45,734 --> 00:20:48,375
and endurance as well. Yeah. I I wanna

539
00:20:48,375 --> 00:20:50,900
I wanna ask you, So you figured out

540
00:20:50,900 --> 00:20:53,720
all of these physical therapy or exercise physiology

541
00:20:53,779 --> 00:20:55,779
components or of exercise that you wanted to

542
00:20:55,779 --> 00:20:58,420
add in. How did how did you now

543
00:20:58,420 --> 00:21:01,460
bring those over to your swallowing mentors and

544
00:21:01,460 --> 00:21:03,404
say, hey. Would you guys be interested in

545
00:21:03,404 --> 00:21:04,924
doing this project with me? Because we're gonna

546
00:21:04,924 --> 00:21:07,424
look at all of these different exercise physiology

547
00:21:07,565 --> 00:21:08,065
components.

548
00:21:09,005 --> 00:21:11,724
Well, it was great because, initially, I was

549
00:21:11,724 --> 00:21:13,424
only looking at lingual pressures

550
00:21:13,724 --> 00:21:14,224
and

551
00:21:15,759 --> 00:21:16,259
chewing.

552
00:21:16,799 --> 00:21:19,619
And so my amazing mentors, when I brought

553
00:21:20,079 --> 00:21:20,579
this

554
00:21:20,880 --> 00:21:23,539
to them, the first thought was, okay.

555
00:21:24,160 --> 00:21:26,400
These are all great, but let's look at

556
00:21:26,400 --> 00:21:28,179
what what is the literature

557
00:21:28,640 --> 00:21:31,515
telling us, you know, for the logistic regression,

558
00:21:33,095 --> 00:21:35,195
what ended up happening was we dichotomized

559
00:21:36,134 --> 00:21:37,595
the Yale swallow protocol

560
00:21:38,134 --> 00:21:40,474
to assess dysphagia risk. Right?

561
00:21:41,335 --> 00:21:43,595
And so and we used the e 10.

562
00:21:44,359 --> 00:21:44,859
And

563
00:21:45,160 --> 00:21:47,180
so what we ended up doing

564
00:21:47,640 --> 00:21:49,160
was so the e 10, we know that's

565
00:21:49,160 --> 00:21:51,980
an ordinal variable. Right? But for descriptive purposes,

566
00:21:52,599 --> 00:21:55,340
we reported the mean and the standard deviation

567
00:21:55,799 --> 00:21:58,519
as a sum score, and so we treated

568
00:21:58,519 --> 00:21:59,500
it as a continuous

569
00:21:59,799 --> 00:22:01,775
variable. But then when we went and did

570
00:22:01,775 --> 00:22:02,275
the

571
00:22:02,654 --> 00:22:03,555
logistic regression,

572
00:22:04,414 --> 00:22:06,275
we dichotomized greater than,

573
00:22:07,134 --> 00:22:10,674
three and above three to assess dysphasia risk,

574
00:22:10,815 --> 00:22:12,194
which made it,

575
00:22:12,839 --> 00:22:15,960
sort of binary. So and then we again,

576
00:22:15,960 --> 00:22:17,420
we know that the,

577
00:22:18,519 --> 00:22:19,740
cough peak flow

578
00:22:20,119 --> 00:22:23,000
we we there's lots of literature to suggest

579
00:22:23,000 --> 00:22:24,619
that reduced cough peak flow,

580
00:22:25,865 --> 00:22:27,565
you know, can impact

581
00:22:28,345 --> 00:22:28,845
swallowing

582
00:22:29,465 --> 00:22:31,085
function. We we know that.

583
00:22:32,184 --> 00:22:34,984
And so why don't we use cough peak

584
00:22:34,984 --> 00:22:35,484
flow

585
00:22:35,865 --> 00:22:38,904
as one of the swallowing performance variables? So

586
00:22:38,904 --> 00:22:40,765
I hadn't I hadn't considered,

587
00:22:42,700 --> 00:22:45,259
you know, a self reported measure like the

588
00:22:45,259 --> 00:22:45,919
e 10.

589
00:22:46,700 --> 00:22:47,919
I hadn't considered

590
00:22:48,859 --> 00:22:51,659
thinking about the Yale swallow protocol in this

591
00:22:51,659 --> 00:22:54,220
process or cough peak flow. And so I

592
00:22:54,220 --> 00:22:54,720
think

593
00:22:55,154 --> 00:22:56,375
that, for me,

594
00:22:56,674 --> 00:22:57,494
was really

595
00:22:57,955 --> 00:23:00,275
the way we married the two, and it

596
00:23:00,275 --> 00:23:03,734
really wasn't until doctor Molfentor and doctor Souter

597
00:23:03,795 --> 00:23:04,455
came into

598
00:23:06,035 --> 00:23:06,775
the conversation

599
00:23:07,819 --> 00:23:09,660
that I began to think a little bit

600
00:23:09,660 --> 00:23:11,740
differently about it. And it again, it speak

601
00:23:11,819 --> 00:23:14,539
to me, it speaks to the beauty of

602
00:23:14,539 --> 00:23:15,039
interprofessional

603
00:23:15,500 --> 00:23:15,900
Yeah.

604
00:23:16,299 --> 00:23:16,799
Collaboration,

605
00:23:17,900 --> 00:23:19,819
which, you know, again, I could talk about

606
00:23:19,819 --> 00:23:20,319
that

607
00:23:20,779 --> 00:23:22,000
for a while too.

608
00:23:23,464 --> 00:23:26,184
But it wasn't until because, you know, my

609
00:23:26,184 --> 00:23:28,984
my chair wasn't thinking along those lines. And

610
00:23:28,984 --> 00:23:30,205
I don't know that

611
00:23:30,904 --> 00:23:32,664
I you know, for the last three years,

612
00:23:32,664 --> 00:23:34,285
my head was in

613
00:23:34,664 --> 00:23:37,065
exercise, and so I needed somebody to sort

614
00:23:37,065 --> 00:23:38,710
of bring me out of that and see

615
00:23:38,710 --> 00:23:40,410
how we could marry the two.

616
00:23:40,870 --> 00:23:41,370
And,

617
00:23:42,390 --> 00:23:44,890
you know, I I think that is what

618
00:23:45,750 --> 00:23:47,450
the my swallowing mentors

619
00:23:47,830 --> 00:23:48,890
brought to the table.

620
00:23:49,430 --> 00:23:51,509
Yeah. Yeah. Alright. Do you wanna dive into

621
00:23:51,509 --> 00:23:52,009
findings?

622
00:23:52,785 --> 00:23:53,744
Well, I can.

623
00:23:55,505 --> 00:23:56,884
I think, again,

624
00:23:57,585 --> 00:24:00,625
the big takeaway here is that when when

625
00:24:00,625 --> 00:24:03,365
I examined all five of these physical performance

626
00:24:03,505 --> 00:24:04,005
measures

627
00:24:04,384 --> 00:24:06,484
in healthy community dwelling elderly,

628
00:24:07,559 --> 00:24:10,200
The the biggest surprise to me was that

629
00:24:10,200 --> 00:24:11,339
all five

630
00:24:12,440 --> 00:24:15,339
all five of these physical performance measures showed

631
00:24:15,399 --> 00:24:18,779
significant correlations with cough peak flow. Interesting.

632
00:24:19,565 --> 00:24:21,565
Here's what was novel, and then and we

633
00:24:21,565 --> 00:24:23,484
didn't find this out until we did the

634
00:24:23,484 --> 00:24:23,984
stepwise,

635
00:24:24,525 --> 00:24:26,285
progression to, you know, to figure out which

636
00:24:26,285 --> 00:24:27,505
one was most predictive.

637
00:24:28,365 --> 00:24:31,664
And upper body power was the strongest

638
00:24:32,045 --> 00:24:32,545
predictor

639
00:24:33,059 --> 00:24:35,059
among all of them, and and that hadn't

640
00:24:35,059 --> 00:24:36,119
been shown before.

641
00:24:36,659 --> 00:24:39,240
And so when we looked at swallowing outcomes

642
00:24:39,299 --> 00:24:39,799
directly,

643
00:24:40,740 --> 00:24:42,440
upper body power consistently

644
00:24:43,220 --> 00:24:44,679
predicted lingual pressures,

645
00:24:45,139 --> 00:24:46,039
lingual endurance,

646
00:24:46,659 --> 00:24:47,799
cough pee flow,

647
00:24:48,224 --> 00:24:48,884
and swallowing

648
00:24:49,664 --> 00:24:50,964
reserve. K?

649
00:24:52,065 --> 00:24:53,984
And so what this tell told me is

650
00:24:53,984 --> 00:24:55,765
that this isn't, like, just one

651
00:24:56,384 --> 00:24:58,164
measure. This was sort of a multidimensional

652
00:24:58,785 --> 00:25:00,565
pattern that we were seeing here,

653
00:25:01,424 --> 00:25:01,924
consistently

654
00:25:02,950 --> 00:25:05,430
correlating and and being more predictive of upper

655
00:25:05,430 --> 00:25:06,890
body power. And so

656
00:25:07,590 --> 00:25:09,590
what I think the big piece to this

657
00:25:09,590 --> 00:25:12,250
is I think it's important because it extends

658
00:25:12,390 --> 00:25:13,769
what we already know

659
00:25:14,549 --> 00:25:17,424
about cough, peak, flow, and swallowing. Yeah. But

660
00:25:17,424 --> 00:25:19,445
it but it adds upper body

661
00:25:19,984 --> 00:25:20,484
power

662
00:25:20,785 --> 00:25:23,125
as maybe a new, you know, clinical

663
00:25:24,225 --> 00:25:24,725
flag.

664
00:25:25,265 --> 00:25:25,765
Now

665
00:25:26,065 --> 00:25:28,805
am I suggesting that speech language pathologists

666
00:25:29,184 --> 00:25:29,684
become

667
00:25:30,210 --> 00:25:33,750
exercise scientists and start testing upper body power?

668
00:25:34,210 --> 00:25:35,750
No. That's not what

669
00:25:36,130 --> 00:25:37,429
I am suggesting

670
00:25:38,130 --> 00:25:38,789
at all.

671
00:25:40,289 --> 00:25:42,950
But what I am thinking about

672
00:25:43,250 --> 00:25:43,750
is

673
00:25:44,204 --> 00:25:46,204
clinically because I get asked this question too.

674
00:25:46,204 --> 00:25:48,784
What what does this all mean clinically? Yep.

675
00:25:49,085 --> 00:25:50,544
When I think about this

676
00:25:51,005 --> 00:25:51,505
clinically,

677
00:25:52,365 --> 00:25:53,585
I'm thinking about

678
00:25:54,125 --> 00:25:56,625
PT and OT, sort of changing

679
00:25:57,644 --> 00:25:58,304
the culture

680
00:25:59,320 --> 00:25:59,820
of,

681
00:26:00,279 --> 00:26:02,859
you know, how we communicate

682
00:26:03,160 --> 00:26:05,640
with PT and OT. You know, I know

683
00:26:05,640 --> 00:26:06,840
a lot of people are thinking, oh, this

684
00:26:06,840 --> 00:26:07,900
is great in theory.

685
00:26:08,200 --> 00:26:09,880
But how do you actually get PT and

686
00:26:09,880 --> 00:26:12,039
OT to think about swallowing? And the the

687
00:26:12,039 --> 00:26:14,119
the honest answer really for me is I

688
00:26:14,119 --> 00:26:14,355
don't

689
00:26:15,234 --> 00:26:16,674
know. We don't have a system for it,

690
00:26:16,674 --> 00:26:18,194
and I think that that's part of the

691
00:26:18,194 --> 00:26:18,694
gap.

692
00:26:19,154 --> 00:26:19,654
But

693
00:26:20,194 --> 00:26:22,035
I think that if we look at what

694
00:26:22,035 --> 00:26:22,694
the literature

695
00:26:23,315 --> 00:26:24,054
on interprofessional

696
00:26:24,515 --> 00:26:25,015
practice

697
00:26:25,634 --> 00:26:27,015
practice talks to us about,

698
00:26:28,930 --> 00:26:30,230
I think we could start

699
00:26:30,529 --> 00:26:33,650
with shared language. Right? So, I mean, think

700
00:26:33,650 --> 00:26:35,970
about it from this perspective. PT and OT,

701
00:26:35,970 --> 00:26:38,130
they already measure gait speed. Right? They already

702
00:26:38,130 --> 00:26:39,750
measure grip strength for

703
00:26:40,130 --> 00:26:41,830
for upper body. They already

704
00:26:42,325 --> 00:26:44,404
look at other areas of upper body power

705
00:26:44,404 --> 00:26:47,445
and functional performance, and so we're not only

706
00:26:47,445 --> 00:26:50,244
asking them to learn something new. We're not

707
00:26:50,244 --> 00:26:51,305
asking them to

708
00:26:51,605 --> 00:26:54,005
learn all about swallowing. I'm not asking speech

709
00:26:54,005 --> 00:26:56,505
pathologists to learn all about physical performance,

710
00:26:56,970 --> 00:26:58,890
But what I am asking, I think, is

711
00:26:58,890 --> 00:27:01,150
to think about maybe a connection

712
00:27:01,769 --> 00:27:02,269
that

713
00:27:02,650 --> 00:27:03,789
we haven't made

714
00:27:04,490 --> 00:27:04,990
before

715
00:27:06,009 --> 00:27:08,109
together. Right? And so

716
00:27:09,174 --> 00:27:10,855
sort of if if we could think about

717
00:27:10,855 --> 00:27:13,894
maybe embedding it into all of into our

718
00:27:13,894 --> 00:27:16,075
already existing workflows. Right?

719
00:27:16,454 --> 00:27:16,954
So

720
00:27:17,255 --> 00:27:19,654
for example, if PT is already measuring upper

721
00:27:19,654 --> 00:27:21,275
body power and gait speed,

722
00:27:21,734 --> 00:27:23,914
what if a low score became

723
00:27:24,440 --> 00:27:27,240
sort of a red flag referral for speech

724
00:27:27,240 --> 00:27:27,740
therapy?

725
00:27:28,200 --> 00:27:30,059
Right? That's just, like, a minimal

726
00:27:30,599 --> 00:27:33,400
behavior change to shift our thinking, like, from

727
00:27:33,400 --> 00:27:33,900
reactive

728
00:27:34,519 --> 00:27:35,259
to proactive.

729
00:27:36,200 --> 00:27:37,880
And then the other question that I always

730
00:27:37,880 --> 00:27:40,065
get, well, who's gonna pay for this? Because

731
00:27:40,065 --> 00:27:43,424
insurance doesn't pay for preventative care for us.

732
00:27:43,424 --> 00:27:45,265
Well, I don't know. They didn't pay for

733
00:27:45,265 --> 00:27:48,545
preventative mammogram screens or colonoscopy screens at first.

734
00:27:48,545 --> 00:27:50,384
Right? They didn't pay for any of that

735
00:27:50,384 --> 00:27:52,625
preventative care until the science was there to

736
00:27:52,625 --> 00:27:55,000
back it. So I think I think we

737
00:27:55,000 --> 00:27:57,960
have to start somewhere. Conversation has to start

738
00:27:57,960 --> 00:28:00,119
somewhere. Yeah. I do. I do think that,

739
00:28:00,119 --> 00:28:01,179
and I think that,

740
00:28:01,480 --> 00:28:02,140
you know,

741
00:28:03,079 --> 00:28:06,519
there's not a a complete answer to all

742
00:28:06,519 --> 00:28:07,579
of those questions.

743
00:28:07,880 --> 00:28:08,380
Right?

744
00:28:08,920 --> 00:28:09,579
I think

745
00:28:10,365 --> 00:28:13,484
that if we can just start talking about

746
00:28:13,484 --> 00:28:16,144
it, and we do that here at Moravian.

747
00:28:16,365 --> 00:28:17,025
We are,

748
00:28:17,565 --> 00:28:18,285
we have,

749
00:28:18,845 --> 00:28:19,825
huge interprofessional

750
00:28:20,765 --> 00:28:21,244
care,

751
00:28:21,644 --> 00:28:23,424
education, and not only,

752
00:28:24,179 --> 00:28:26,819
do we all of our students learn together

753
00:28:26,819 --> 00:28:27,880
here, PTOT,

754
00:28:28,500 --> 00:28:29,880
speech athletic training,

755
00:28:30,659 --> 00:28:32,659
they all have classes together. We all learn

756
00:28:32,659 --> 00:28:33,960
here. We have interprofessional

757
00:28:34,259 --> 00:28:36,919
education sessions every single Friday,

758
00:28:37,664 --> 00:28:38,805
so that we're starting

759
00:28:39,505 --> 00:28:42,865
the students early, so that they understand the

760
00:28:42,865 --> 00:28:43,365
language

761
00:28:43,745 --> 00:28:45,125
of PT SLPs,

762
00:28:45,745 --> 00:28:48,144
and that they understand the language of OT,

763
00:28:48,144 --> 00:28:50,144
and so on and so forth. And so

764
00:28:50,144 --> 00:28:50,805
I think,

765
00:28:51,105 --> 00:28:54,079
you know, if we sort of change the

766
00:28:54,079 --> 00:28:54,579
culture

767
00:28:56,480 --> 00:28:57,940
between our communication,

768
00:28:59,359 --> 00:29:02,099
and maybe PT and OT can start thinking,

769
00:29:03,039 --> 00:29:05,039
maybe I need to refer for a swallow

770
00:29:05,039 --> 00:29:05,539
screening,

771
00:29:06,525 --> 00:29:08,625
based on the fact that I'm seeing

772
00:29:08,924 --> 00:29:09,825
this specific

773
00:29:10,445 --> 00:29:13,884
physical performance indicator. Right? Right. Right. We all

774
00:29:14,125 --> 00:29:16,285
we already have a payment model for screening.

775
00:29:16,285 --> 00:29:18,625
So as SLPs, we're not asking for anything

776
00:29:19,085 --> 00:29:20,625
particularly new. Right?

777
00:29:20,950 --> 00:29:22,090
We are just offering

778
00:29:22,630 --> 00:29:25,430
or I'm asking maybe to think about a

779
00:29:25,430 --> 00:29:26,410
different justification,

780
00:29:26,869 --> 00:29:27,529
you know,

781
00:29:28,630 --> 00:29:30,390
and that could go both ways. You know,

782
00:29:30,390 --> 00:29:32,869
that could lead us back to referring to

783
00:29:32,869 --> 00:29:36,090
PT for evaluating and potentially treating a patient,

784
00:29:37,015 --> 00:29:39,674
that we see has impaired strength,

785
00:29:40,454 --> 00:29:40,954
weakness,

786
00:29:41,255 --> 00:29:44,474
just sort of overall that sort of generalized,

787
00:29:45,734 --> 00:29:46,234
deconditioning

788
00:29:46,535 --> 00:29:48,535
that may be impacting their swallowing. We see

789
00:29:48,535 --> 00:29:50,615
that all the time. So can we refer

790
00:29:50,615 --> 00:29:51,674
them back to PT

791
00:29:52,170 --> 00:29:52,910
for a prescriptive,

792
00:29:53,930 --> 00:29:55,630
sort of exercise program

793
00:29:56,009 --> 00:29:58,410
to help them build up their strength and

794
00:29:58,410 --> 00:30:01,289
their, you know, overall functional reserve, which might

795
00:30:01,289 --> 00:30:03,850
help improve their swallowing reserve? I mean, there's

796
00:30:03,850 --> 00:30:05,309
so many different ways

797
00:30:05,724 --> 00:30:07,504
to think about that. Right?

798
00:30:07,884 --> 00:30:10,444
We're we're not I'm not asking SLPs to

799
00:30:10,444 --> 00:30:13,884
become PTs or OTs. Just, again, thinking about

800
00:30:13,884 --> 00:30:15,024
changing the discourse

801
00:30:15,884 --> 00:30:18,704
about it with our exercise colleagues and really

802
00:30:19,579 --> 00:30:21,359
begin true interdisciplinary

803
00:30:22,700 --> 00:30:24,720
care from a cross systems

804
00:30:25,099 --> 00:30:25,599
approach.

805
00:30:26,140 --> 00:30:28,299
Does does that make sense? Yeah. Yeah. Yeah.

806
00:30:28,299 --> 00:30:30,380
Yeah. Very well so. Very beautifully said. Can

807
00:30:30,380 --> 00:30:32,160
I ask you just a few clarifying questions?

808
00:30:32,365 --> 00:30:35,005
Yes. Of course. Tell me again exactly how

809
00:30:35,005 --> 00:30:36,944
you measured upper body power.

810
00:30:37,804 --> 00:30:40,204
We measured upper body power via the seated

811
00:30:40,204 --> 00:30:42,684
med ball throw. Seated med ball throw. Okay.

812
00:30:42,684 --> 00:30:43,664
Was there a specific

813
00:30:44,380 --> 00:30:46,140
weight that everyone had to do? Like, how

814
00:30:46,140 --> 00:30:48,619
was that calculated? Yes. So so in the

815
00:30:48,619 --> 00:30:51,200
seated med ball throw, the patients are seated,

816
00:30:51,740 --> 00:30:53,740
in the chair, their arms at their sides.

817
00:30:53,740 --> 00:30:55,119
They're holding a three

818
00:30:55,579 --> 00:30:56,079
pound

819
00:30:56,539 --> 00:30:58,619
medicine ball. I wish we were on video

820
00:30:58,619 --> 00:31:00,565
because I got one. I got this three

821
00:31:00,805 --> 00:31:02,725
like, I'm the only speech pathologist that has

822
00:31:02,725 --> 00:31:05,205
the date walk the the med ball in

823
00:31:05,205 --> 00:31:07,445
my office. So and so patients are asked

824
00:31:07,525 --> 00:31:09,605
I mean, the subjects were asked to throw

825
00:31:09,605 --> 00:31:11,765
it. K? Just signature and throw it as

826
00:31:11,765 --> 00:31:14,309
far as they can. Okay. K? And that

827
00:31:14,470 --> 00:31:15,849
and then we measured that.

828
00:31:17,589 --> 00:31:19,589
And so that's how we measured upper body

829
00:31:19,589 --> 00:31:20,650
power. Okay.

830
00:31:21,509 --> 00:31:23,990
Alright. Fascinating. And it's so fascinating that that

831
00:31:23,990 --> 00:31:25,369
was what you said

832
00:31:25,750 --> 00:31:27,450
always correlated to

833
00:31:27,829 --> 00:31:28,569
tongue pressure.

834
00:31:29,224 --> 00:31:31,805
And cough peak flow. And cough peak flow.

835
00:31:31,865 --> 00:31:33,085
Cough peak flow.

836
00:31:34,025 --> 00:31:36,664
But think about it. We need we in

837
00:31:36,664 --> 00:31:38,445
order for us to cough effectively,

838
00:31:38,984 --> 00:31:42,025
to have a really strong productive cough, we've

839
00:31:42,025 --> 00:31:42,845
gotta have

840
00:31:43,700 --> 00:31:46,099
good upper body power. Right? I mean, it

841
00:31:46,099 --> 00:31:48,500
makes it makes so much sense to us.

842
00:31:48,500 --> 00:31:50,980
Yeah. Yeah. Makes Yes. Oh, and, you know,

843
00:31:50,980 --> 00:31:52,820
I think that's you know, where we I

844
00:31:52,820 --> 00:31:55,220
think we got sidetracked because I was talking

845
00:31:55,220 --> 00:31:57,640
about doctor Van Ravenhorst Bell's study

846
00:31:57,940 --> 00:31:58,845
and sort of,

847
00:31:59,404 --> 00:32:00,384
you know, what

848
00:32:00,765 --> 00:32:04,384
made me just sort of think about this

849
00:32:04,684 --> 00:32:06,144
all differently. Because

850
00:32:07,484 --> 00:32:08,704
in her study,

851
00:32:09,484 --> 00:32:09,984
she,

852
00:32:10,765 --> 00:32:11,984
in her 2016

853
00:32:12,125 --> 00:32:14,384
study that she was looking at

854
00:32:16,150 --> 00:32:17,930
tongue measures in

855
00:32:19,269 --> 00:32:22,150
48 people. She was looking at, tongue pressures

856
00:32:22,150 --> 00:32:24,470
and exercise. Right? But the one that just

857
00:32:24,470 --> 00:32:26,230
really blew my mind was her study in

858
00:32:26,230 --> 00:32:27,049
2018

859
00:32:27,509 --> 00:32:29,690
where she recruited 21 weightlifters

860
00:32:31,434 --> 00:32:33,295
and 23 runners. K?

861
00:32:33,674 --> 00:32:36,095
And so the findings of that study

862
00:32:36,715 --> 00:32:37,855
were that weightlifters

863
00:32:38,315 --> 00:32:41,914
produced it produced significantly greater tongue strengths than

864
00:32:41,914 --> 00:32:44,475
runners, particularly in the anterior region of the

865
00:32:44,475 --> 00:32:44,975
tongue.

866
00:32:45,440 --> 00:32:46,660
But then runners

867
00:32:47,039 --> 00:32:48,180
produce significantly

868
00:32:48,559 --> 00:32:49,059
greater

869
00:32:49,359 --> 00:32:50,259
tongue endurance

870
00:32:50,720 --> 00:32:51,539
than weightlifters.

871
00:32:52,240 --> 00:32:54,660
That, I mean, that just blew me away.

872
00:32:54,720 --> 00:32:57,539
And what she and she each of these

873
00:32:57,599 --> 00:32:58,740
runners and weightlifters

874
00:32:59,359 --> 00:33:00,660
engaged in their preferred

875
00:33:01,414 --> 00:33:04,154
exercise program at least four times a week.

876
00:33:04,534 --> 00:33:07,174
And this study was the first to investigate

877
00:33:07,174 --> 00:33:10,154
sort of the indirect effects of physical exercise,

878
00:33:11,414 --> 00:33:12,714
on tongue muscle.

879
00:33:13,095 --> 00:33:15,674
And I thought this is amazing.

880
00:33:16,869 --> 00:33:19,190
And the it it really did, I think,

881
00:33:19,190 --> 00:33:21,589
or it it's paving the way for future

882
00:33:21,589 --> 00:33:22,089
research

883
00:33:22,710 --> 00:33:26,089
to invest investigate more approaches to this

884
00:33:26,470 --> 00:33:29,210
age related decline on tongue muscle performance,

885
00:33:29,750 --> 00:33:30,890
right, that can maybe,

886
00:33:31,750 --> 00:33:32,250
prevent

887
00:33:32,684 --> 00:33:33,585
the decline

888
00:33:34,125 --> 00:33:34,625
of,

889
00:33:35,005 --> 00:33:35,585
you know,

890
00:33:36,605 --> 00:33:38,705
swallowing function. I mean, that's a big,

891
00:33:39,565 --> 00:33:42,125
leap to say that, but I think that

892
00:33:42,125 --> 00:33:42,865
it just

893
00:33:43,485 --> 00:33:45,565
is paving the way for us to think

894
00:33:45,565 --> 00:33:46,065
about

895
00:33:46,605 --> 00:33:47,105
physical

896
00:33:48,099 --> 00:33:51,559
exercise, not physical activity, but physical exercise,

897
00:33:53,059 --> 00:33:55,059
in a different way, and what are the

898
00:33:55,059 --> 00:33:56,279
broader implications

899
00:33:56,980 --> 00:33:59,700
then for swallowing. And I have to tell

900
00:33:59,700 --> 00:34:01,539
you about this fangirl moment. So let me

901
00:34:01,539 --> 00:34:03,345
just tell you about doctor Van Raven Horst

902
00:34:03,424 --> 00:34:05,204
She's at the University of Wichita.

903
00:34:05,505 --> 00:34:06,724
Let me just tell you this.

904
00:34:07,105 --> 00:34:09,844
So here I am, unicorn speech pathologist,

905
00:34:10,385 --> 00:34:12,405
you know, holding my med ball.

906
00:34:13,184 --> 00:34:13,684
I

907
00:34:14,465 --> 00:34:15,605
love this med ball.

908
00:34:16,779 --> 00:34:20,079
I'm I'm unicorn speech pathologist getting a doctorate

909
00:34:20,619 --> 00:34:21,119
in,

910
00:34:21,819 --> 00:34:23,119
health and human performance

911
00:34:23,739 --> 00:34:25,819
and an emphasis in exercise science. So I'm

912
00:34:25,819 --> 00:34:28,619
reading these papers by doctor Van Ravenhorst Bell,

913
00:34:28,619 --> 00:34:29,679
and I met ASHA

914
00:34:30,059 --> 00:34:31,420
in 2024.

915
00:34:31,420 --> 00:34:31,920
Right?

916
00:34:32,424 --> 00:34:34,505
Doctor Molfinster says, Jevan, you've gotta come you

917
00:34:34,505 --> 00:34:36,105
gotta come over here. We're in the posters.

918
00:34:36,105 --> 00:34:38,105
You gotta come over here. You're not gonna

919
00:34:38,105 --> 00:34:39,385
believe who's here. And I'm like, who's here?

920
00:34:39,385 --> 00:34:41,005
Who's here? And she says,

921
00:34:41,864 --> 00:34:44,424
doctor Van Ravenhorst Bell, and she was just

922
00:34:44,424 --> 00:34:46,344
at your poster. I'm like, you gotta be

923
00:34:46,344 --> 00:34:47,404
kidding me.

924
00:34:47,760 --> 00:34:50,000
And I was, you know, I'm fangirly. I'm

925
00:34:50,000 --> 00:34:51,119
like, oh my god. I'm gonna meet her.

926
00:34:51,119 --> 00:34:52,659
I'm gonna meet her. I'm gonna meet her.

927
00:34:52,800 --> 00:34:56,179
She doctor Van Ravenhorst Bell is an exercise

928
00:34:57,199 --> 00:34:59,300
scientist. She's an exercise physiologist

929
00:34:59,905 --> 00:35:02,885
who happened to get a doctorate in communication

930
00:35:03,184 --> 00:35:05,825
sciences and disorders. And so I thought, oh,

931
00:35:05,825 --> 00:35:06,644
this person

932
00:35:06,945 --> 00:35:09,184
is somebody who gets me. She's Oh, that's

933
00:35:09,184 --> 00:35:11,425
so funny. Yeah. Isn't it so funny? She's

934
00:35:11,425 --> 00:35:13,925
the one person in the world who understands

935
00:35:14,224 --> 00:35:15,929
me. And so subsequently

936
00:35:16,309 --> 00:35:18,710
she and I have had, oh my word,

937
00:35:18,710 --> 00:35:19,449
some wonderful

938
00:35:19,750 --> 00:35:20,250
conversations,

939
00:35:20,630 --> 00:35:22,630
and I mean I could just talk to

940
00:35:22,630 --> 00:35:24,010
her for hours.

941
00:35:25,190 --> 00:35:27,210
She's really quite remarkable.

942
00:35:28,085 --> 00:35:30,244
But, yeah, we did just the opposite. So

943
00:35:30,244 --> 00:35:31,224
she's an exercise,

944
00:35:31,924 --> 00:35:34,505
physiologist who wanted to learn more about communication

945
00:35:34,565 --> 00:35:37,125
sciences and disorders, and then I did just

946
00:35:37,125 --> 00:35:39,364
the opposite. So we have lots of great,

947
00:35:39,364 --> 00:35:41,924
great conversation, she and I. Oh, I love

948
00:35:41,924 --> 00:35:44,059
that. Thank you for sharing that. Love when

949
00:35:44,280 --> 00:35:46,860
love when you find your unicorn besties in

950
00:35:47,160 --> 00:35:49,559
totally different fields. Yeah. Oh, good. I love

951
00:35:49,559 --> 00:35:50,380
that. Yeah. But

952
00:35:50,680 --> 00:35:52,519
yeah. My my brain was just thinking this

953
00:35:52,519 --> 00:35:53,880
whole time as you were talking about, you

954
00:35:53,880 --> 00:35:56,625
know, how does this become part of screening

955
00:35:56,625 --> 00:35:57,824
and who pays for it and all you

956
00:35:57,824 --> 00:35:59,184
know? And I love the analogy you gave

957
00:35:59,184 --> 00:36:01,284
about, you know, breast cancer screenings and colonoscopies

958
00:36:01,505 --> 00:36:03,344
and things like that. And I think where

959
00:36:03,344 --> 00:36:04,804
my brain went was,

960
00:36:05,184 --> 00:36:07,344
you know, I know there's different researchers working

961
00:36:07,344 --> 00:36:08,485
on sort of these

962
00:36:09,090 --> 00:36:11,989
swallowing algorithms. Right? Like, these algorithms for

963
00:36:12,530 --> 00:36:13,030
determining

964
00:36:13,329 --> 00:36:16,130
aspiration risk or patients that are really at

965
00:36:16,130 --> 00:36:17,030
risk of having

966
00:36:17,489 --> 00:36:20,050
swallowing impairments that can cause all these down

967
00:36:20,050 --> 00:36:20,710
the line

968
00:36:21,025 --> 00:36:23,664
real medical complications. Right? And so I think

969
00:36:23,664 --> 00:36:25,585
that's what I was thinking. This is part

970
00:36:25,585 --> 00:36:27,905
of that big play. Like, this is part

971
00:36:27,905 --> 00:36:28,804
of that big

972
00:36:29,105 --> 00:36:32,224
screening for, you know, at risk older adults

973
00:36:32,224 --> 00:36:34,639
or at risk adults that have some of

974
00:36:34,639 --> 00:36:37,059
these conditions that we know impact swallowing.

975
00:36:37,359 --> 00:36:39,039
You know, is this something that is a

976
00:36:39,039 --> 00:36:40,880
screening in and of itself, or is this

977
00:36:40,880 --> 00:36:41,859
packaged in

978
00:36:42,159 --> 00:36:43,839
one of those algorithms? I think, you know,

979
00:36:43,839 --> 00:36:47,219
there's there's so much opportunity for this information

980
00:36:47,359 --> 00:36:48,875
to to find its

981
00:36:49,175 --> 00:36:51,675
home. Yeah. I agree with you, and I,

982
00:36:52,775 --> 00:36:53,275
I

983
00:36:53,815 --> 00:36:55,594
yes. I have the utmost respect,

984
00:36:56,054 --> 00:36:58,614
for all of our researchers who are working

985
00:36:58,614 --> 00:37:00,695
to improve the lives of those with swallowing

986
00:37:00,695 --> 00:37:02,394
problems. But I think

987
00:37:03,179 --> 00:37:04,480
often when we think about

988
00:37:04,780 --> 00:37:08,079
swallowing problems in aging, we do just focus

989
00:37:08,300 --> 00:37:08,800
on

990
00:37:09,500 --> 00:37:11,280
sort of our little

991
00:37:11,980 --> 00:37:12,480
throat.

992
00:37:12,780 --> 00:37:15,760
Right? We we focus on our little area

993
00:37:15,819 --> 00:37:16,559
right here.

994
00:37:17,005 --> 00:37:20,144
And in reality, I think it may be

995
00:37:20,364 --> 00:37:22,605
a much bigger picture than that. I mean,

996
00:37:22,605 --> 00:37:24,204
you know, as we get older, we don't

997
00:37:24,204 --> 00:37:26,144
just lose strength in one area.

998
00:37:26,445 --> 00:37:26,945
Right?

999
00:37:27,644 --> 00:37:30,945
Skeletal muscle mass declines across the entire body.

1000
00:37:32,369 --> 00:37:33,269
You know, neuromuscular

1001
00:37:33,890 --> 00:37:36,930
integrity, though, that communication between nerves and muscles,

1002
00:37:36,930 --> 00:37:38,230
that also deteriorates

1003
00:37:39,170 --> 00:37:39,670
globally.

1004
00:37:40,210 --> 00:37:42,530
So I think, you know, thinking about it

1005
00:37:42,530 --> 00:37:44,289
out of the box a little bit, the

1006
00:37:44,289 --> 00:37:46,869
same processes that slow gait speed,

1007
00:37:47,175 --> 00:37:48,715
that reduce grip strength,

1008
00:37:49,255 --> 00:37:50,394
and affect mobility,

1009
00:37:51,015 --> 00:37:51,515
maybe

1010
00:37:51,974 --> 00:37:53,815
it also has the potential

1011
00:37:54,135 --> 00:37:55,894
I mean, it could be plausible that it

1012
00:37:55,894 --> 00:37:58,074
could impact swallowing. Right?

1013
00:37:58,375 --> 00:38:00,535
I mean, you know, in that sense, we

1014
00:38:00,535 --> 00:38:01,275
think about

1015
00:38:02,099 --> 00:38:04,099
if we think about swallowing as maybe not

1016
00:38:04,099 --> 00:38:05,160
being this isolated

1017
00:38:05,460 --> 00:38:05,960
dysfunction,

1018
00:38:06,900 --> 00:38:08,280
think about it as reflecting,

1019
00:38:09,220 --> 00:38:11,640
you know, this broader sort of systemic

1020
00:38:12,260 --> 00:38:14,820
aging that it could have the potential to

1021
00:38:14,820 --> 00:38:16,280
mirror overall physical

1022
00:38:17,005 --> 00:38:19,565
decline sort of, you know, as this cross

1023
00:38:19,565 --> 00:38:20,065
system

1024
00:38:20,364 --> 00:38:22,945
deterioration that goes beyond what we traditionally

1025
00:38:23,965 --> 00:38:25,505
label as purely,

1026
00:38:27,324 --> 00:38:30,045
a swallowing problem. You know? And I think

1027
00:38:30,045 --> 00:38:32,224
if we can think a little bit

1028
00:38:33,860 --> 00:38:34,760
about swallowing,

1029
00:38:35,460 --> 00:38:37,880
not just as a stand alone problem,

1030
00:38:38,340 --> 00:38:40,180
that if we can start thinking it of

1031
00:38:40,180 --> 00:38:42,739
it as an expression of, you know, sort

1032
00:38:42,739 --> 00:38:44,519
of our whole body neuromuscular

1033
00:38:44,820 --> 00:38:45,320
health,

1034
00:38:46,325 --> 00:38:48,485
you know, such that when the body declines,

1035
00:38:48,485 --> 00:38:51,765
guess what? Swallowing might decline with it. And

1036
00:38:51,765 --> 00:38:53,765
I, you know, I recognize that what I'm

1037
00:38:53,765 --> 00:38:54,585
saying is

1038
00:38:55,045 --> 00:38:55,545
probably,

1039
00:38:57,445 --> 00:38:59,125
you know, for some people, they're like, what

1040
00:38:59,125 --> 00:39:00,025
is she talking

1041
00:39:01,710 --> 00:39:04,190
but I do recognize that there's limitations to

1042
00:39:04,190 --> 00:39:05,789
what I'm do what I've done and what

1043
00:39:05,789 --> 00:39:07,869
I'm doing. And, again, all of what I've

1044
00:39:07,869 --> 00:39:09,869
done is cross sectional data. Right? I can

1045
00:39:09,869 --> 00:39:12,449
show that upper body power and swallowing measures

1046
00:39:12,829 --> 00:39:14,614
are associated. Right?

1047
00:39:15,715 --> 00:39:18,514
There's correlated, but it maybe what's the the

1048
00:39:18,514 --> 00:39:20,775
causal factors are not there. And I can't

1049
00:39:20,914 --> 00:39:23,635
definitively say that improving upper body power will

1050
00:39:23,635 --> 00:39:24,135
improve

1051
00:39:24,514 --> 00:39:26,695
swallowing. Right? So it's important distinction.

1052
00:39:27,559 --> 00:39:29,639
But I think instead of seeing it as

1053
00:39:29,639 --> 00:39:31,400
a as a weakness, we can maybe use

1054
00:39:31,400 --> 00:39:32,619
it as a road map

1055
00:39:33,239 --> 00:39:35,800
to take us to the next step. There's

1056
00:39:35,800 --> 00:39:36,300
so

1057
00:39:37,239 --> 00:39:39,019
much more work to be done.

1058
00:39:39,320 --> 00:39:42,039
The next logical step, in in my opinion,

1059
00:39:42,039 --> 00:39:44,315
would be a perspective more longitudinal

1060
00:39:44,695 --> 00:39:46,614
design and sort of that we look at

1061
00:39:46,614 --> 00:39:49,175
the same people over time to see if

1062
00:39:49,175 --> 00:39:51,034
changes in their fitness program

1063
00:39:51,655 --> 00:39:53,114
predict swallowing changes.

1064
00:39:53,894 --> 00:39:57,099
We need instrumental assessments like MBS and FEES

1065
00:39:57,099 --> 00:39:59,519
to confirm these predictive relationships

1066
00:40:00,059 --> 00:40:02,239
just beyond, you know, the the clinical

1067
00:40:03,179 --> 00:40:04,800
measurements. And then I think, ultimately,

1068
00:40:05,659 --> 00:40:06,960
really, we need to,

1069
00:40:07,420 --> 00:40:08,000
you know,

1070
00:40:08,744 --> 00:40:09,804
sort of test

1071
00:40:10,344 --> 00:40:12,125
whether fitness based rehabilitation

1072
00:40:12,505 --> 00:40:15,464
protocols can actually move the needle on swaddled

1073
00:40:15,464 --> 00:40:17,085
outcome. You know? I don't know.

1074
00:40:17,464 --> 00:40:19,304
I just I I don't think that the

1075
00:40:19,304 --> 00:40:19,804
limitations

1076
00:40:20,264 --> 00:40:22,684
undermine the findings. I think they

1077
00:40:23,059 --> 00:40:25,860
really define what needs to happen next. And

1078
00:40:25,860 --> 00:40:27,699
I think, you know, I mean, I how

1079
00:40:27,699 --> 00:40:29,219
how much time we got? I can talk

1080
00:40:29,219 --> 00:40:31,300
about this for hours. But I but I

1081
00:40:31,300 --> 00:40:33,139
think, you know, I think there needs to

1082
00:40:33,139 --> 00:40:34,820
be a call to action. And I think

1083
00:40:34,820 --> 00:40:37,139
if I had to describe what my call

1084
00:40:37,139 --> 00:40:37,719
to action

1085
00:40:38,304 --> 00:40:38,965
would be,

1086
00:40:40,065 --> 00:40:41,045
I would say,

1087
00:40:41,664 --> 00:40:44,945
let's look at what we're doing now. Are

1088
00:40:44,945 --> 00:40:46,324
we truly interprofessional?

1089
00:40:47,425 --> 00:40:48,085
Are we

1090
00:40:48,545 --> 00:40:49,045
multidisciplinary,

1091
00:40:50,180 --> 00:40:51,559
or are we interdisciplinary?

1092
00:40:52,099 --> 00:40:55,140
And I remember, I love interprofessional care education,

1093
00:40:55,140 --> 00:40:57,000
so I'm always, you know,

1094
00:40:57,940 --> 00:41:00,099
doing a webinar or listening to a talk

1095
00:41:00,099 --> 00:41:02,500
on something about interprofessional education. And I was

1096
00:41:02,500 --> 00:41:03,960
listening to someone say

1097
00:41:05,765 --> 00:41:07,144
that if we imagine

1098
00:41:07,844 --> 00:41:08,344
sort

1099
00:41:09,364 --> 00:41:11,844
of the layers of a yogurt parfait. Right?

1100
00:41:11,844 --> 00:41:13,364
We've got we get up. We make our

1101
00:41:13,364 --> 00:41:15,285
yogurt parfait in the morning. We've got our

1102
00:41:15,285 --> 00:41:17,545
we've got our yogurt, then we've got our

1103
00:41:17,605 --> 00:41:20,579
strawberries or blueberries, then we've got our, you

1104
00:41:20,579 --> 00:41:22,420
know, other fruit, and then we've got our

1105
00:41:22,420 --> 00:41:22,920
granola,

1106
00:41:23,300 --> 00:41:25,219
and then we might have another layer of

1107
00:41:25,219 --> 00:41:27,860
yogurt and granola, whatever, but they're each stacked

1108
00:41:27,860 --> 00:41:30,599
sort of separately. Right? So that each

1109
00:41:30,980 --> 00:41:34,019
ingredient is maintaining its own identity. And I

1110
00:41:34,019 --> 00:41:35,239
think that's what

1111
00:41:35,724 --> 00:41:37,505
really represents a multidisciplinary

1112
00:41:38,364 --> 00:41:41,484
approach where we've got different professionals. We've got

1113
00:41:41,484 --> 00:41:43,105
SLP, PT, OT,

1114
00:41:43,484 --> 00:41:44,545
nurses, physicians.

1115
00:41:45,484 --> 00:41:47,744
We've got everybody on the multidisciplinary

1116
00:41:48,684 --> 00:41:50,625
team contributing their expertise,

1117
00:41:51,380 --> 00:41:52,519
but we're working

1118
00:41:52,900 --> 00:41:53,400
parallel.

1119
00:41:53,780 --> 00:41:54,280
Right?

1120
00:41:54,660 --> 00:41:56,039
Our roles are distinctly

1121
00:41:56,420 --> 00:41:57,719
and clearly separated

1122
00:41:58,340 --> 00:41:59,079
even though

1123
00:41:59,380 --> 00:42:01,539
we're all in the same parfait, we're serving

1124
00:42:01,539 --> 00:42:02,840
the same patient.

1125
00:42:03,219 --> 00:42:04,885
Right? But we're distinctly

1126
00:42:05,184 --> 00:42:05,684
separated.

1127
00:42:06,065 --> 00:42:08,144
Now if you think about that same parfait,

1128
00:42:08,144 --> 00:42:09,824
and this is what really you know, when

1129
00:42:09,824 --> 00:42:11,184
I heard the speaker say this, and I

1130
00:42:11,184 --> 00:42:12,545
can't remember where I heard it, but it's

1131
00:42:12,545 --> 00:42:15,344
what really sort of shifted my thinking. You

1132
00:42:15,344 --> 00:42:16,885
think about that same parfait

1133
00:42:17,184 --> 00:42:20,039
blended up. Now it's a smoothie. Right? The

1134
00:42:20,039 --> 00:42:23,079
ingredients are all blended together in one uniform

1135
00:42:23,079 --> 00:42:23,579
drink,

1136
00:42:23,960 --> 00:42:27,160
and you can't really distinguish the individual components

1137
00:42:27,160 --> 00:42:28,140
anymore. Right?

1138
00:42:28,760 --> 00:42:31,720
That to me really represents sort of our

1139
00:42:31,720 --> 00:42:32,220
interprofessional

1140
00:42:32,680 --> 00:42:33,885
or interdisciplinary

1141
00:42:34,184 --> 00:42:35,965
approach, right, where we

1142
00:42:36,265 --> 00:42:36,925
are collaborating

1143
00:42:37,305 --> 00:42:38,845
closely, we're integrated,

1144
00:42:39,305 --> 00:42:41,704
we've got shared decision making, and we work

1145
00:42:41,704 --> 00:42:44,664
together as a cohesive unit. That that plan

1146
00:42:44,664 --> 00:42:45,885
of care is now

1147
00:42:46,449 --> 00:42:46,949
cocreated

1148
00:42:47,890 --> 00:42:49,670
rather than sort of layered

1149
00:42:50,210 --> 00:42:50,710
separately.

1150
00:42:51,410 --> 00:42:52,150
And so,

1151
00:42:52,530 --> 00:42:54,050
you know, I guess what I'm saying is

1152
00:42:54,050 --> 00:42:54,789
that multidisciplinary

1153
00:42:55,250 --> 00:42:57,329
is just sort of this layered collaboration where

1154
00:42:57,329 --> 00:42:58,929
we're doing sort of these side by side

1155
00:42:58,929 --> 00:43:00,070
parallel contributions,

1156
00:43:00,764 --> 00:43:01,585
But interdisciplinary

1157
00:43:02,364 --> 00:43:03,664
is really that blended,

1158
00:43:04,684 --> 00:43:05,184
collaborations

1159
00:43:05,484 --> 00:43:08,224
where we're integrated and we have this

1160
00:43:08,525 --> 00:43:11,184
shared approach. And so we we have evidence

1161
00:43:11,724 --> 00:43:14,219
that tells us that there are some physical

1162
00:43:14,219 --> 00:43:17,340
performance measures that are correlated with swallowing performance

1163
00:43:17,340 --> 00:43:17,840
measures.

1164
00:43:18,300 --> 00:43:20,619
That is not new. But I think this

1165
00:43:20,619 --> 00:43:23,179
is another reason. And, again, I I feel

1166
00:43:23,179 --> 00:43:24,619
like the work that I've done just sort

1167
00:43:24,619 --> 00:43:26,880
of adds to that already,

1168
00:43:27,605 --> 00:43:29,364
and it's just another reason why we should

1169
00:43:29,364 --> 00:43:31,844
all be playing in the sandbox together. So

1170
00:43:31,844 --> 00:43:33,525
if that if, you know, if there was

1171
00:43:33,525 --> 00:43:34,664
a call to action,

1172
00:43:35,525 --> 00:43:38,585
that would be it for me. Yeah. Yeah.

1173
00:43:39,059 --> 00:43:40,900
Talk to me about what's next, Yvette. Where

1174
00:43:41,300 --> 00:43:43,300
obviously, that is your call to action, but

1175
00:43:43,300 --> 00:43:44,599
where do you personally

1176
00:43:45,059 --> 00:43:47,699
see taking this now? You know, do you

1177
00:43:47,699 --> 00:43:50,260
wanna test it in different specific populations? Are

1178
00:43:50,260 --> 00:43:51,559
you wishing for just

1179
00:43:51,984 --> 00:43:55,025
Well, I don't I don't know. I mean,

1180
00:43:55,025 --> 00:43:56,964
I think I think that there's

1181
00:43:57,264 --> 00:43:57,844
a lot.

1182
00:43:58,385 --> 00:44:00,304
But like I said earlier, I think the

1183
00:44:00,304 --> 00:44:03,125
logical next step is a perspective longitudinal

1184
00:44:03,425 --> 00:44:05,664
design. So I'd like to follow the same

1185
00:44:05,664 --> 00:44:06,164
people,

1186
00:44:06,789 --> 00:44:08,630
community dwelling elderly. I just have a heart

1187
00:44:08,630 --> 00:44:10,489
for them. I love them so much,

1188
00:44:11,510 --> 00:44:12,969
just because they don't

1189
00:44:13,429 --> 00:44:14,329
get a lot attention

1190
00:44:14,710 --> 00:44:16,869
attention. They're overlooked because of their, like I

1191
00:44:16,869 --> 00:44:19,049
said, perceived independence. Yeah.

1192
00:44:19,545 --> 00:44:21,864
But I think swallowing the following the same

1193
00:44:21,864 --> 00:44:22,364
people

1194
00:44:22,824 --> 00:44:23,644
over time,

1195
00:44:24,585 --> 00:44:26,684
to see if changes in fitness

1196
00:44:27,545 --> 00:44:29,964
actually predict changes in swallowing. And so,

1197
00:44:30,505 --> 00:44:31,565
instrumental assessments

1198
00:44:32,264 --> 00:44:33,164
to confirm

1199
00:44:33,929 --> 00:44:35,150
these predictive relationships

1200
00:44:35,769 --> 00:44:37,230
and intervention study,

1201
00:44:39,210 --> 00:44:42,349
maybe not first, but leading up to that.

1202
00:44:42,650 --> 00:44:45,369
Yeah. Yeah. Lots to think about. Yeah. I'm

1203
00:44:45,369 --> 00:44:48,030
get I'm getting old though, you know, so

1204
00:44:48,474 --> 00:44:49,594
I I don't know if I'm gonna have

1205
00:44:49,594 --> 00:44:51,114
time to do all of this. Of course

1206
00:44:51,114 --> 00:44:52,394
you are. But What what else are you

1207
00:44:52,394 --> 00:44:53,534
gonna do with your time?

1208
00:44:53,835 --> 00:44:54,954
I feel like you're not gonna just sit

1209
00:44:54,954 --> 00:44:56,554
around and think about swallowing all the time.

1210
00:44:56,554 --> 00:44:59,295
You're full of it. Yeah. Well, you know.

1211
00:45:00,710 --> 00:45:02,549
So yeah. I mean, I I don't know,

1212
00:45:02,549 --> 00:45:05,289
but there's there's so many conversations

1213
00:45:05,829 --> 00:45:06,730
to be had.

1214
00:45:07,269 --> 00:45:10,389
And right now, I really want to focus

1215
00:45:10,389 --> 00:45:11,130
on changing

1216
00:45:11,670 --> 00:45:12,409
the culture,

1217
00:45:15,054 --> 00:45:16,355
you know, just among

1218
00:45:16,655 --> 00:45:19,235
our colleagues and really thinking more

1219
00:45:19,535 --> 00:45:20,035
interprofessionally

1220
00:45:20,735 --> 00:45:21,875
rather than multi

1221
00:45:22,255 --> 00:45:22,755
professional

1222
00:45:23,135 --> 00:45:23,795
or multidisciplinary.

1223
00:45:24,655 --> 00:45:26,815
Yep. Good. I love it. Thank you so

1224
00:45:26,815 --> 00:45:28,655
much for sharing this. This is awesome work,

1225
00:45:28,655 --> 00:45:30,630
and I'm I'm so happy. I've been hearing

1226
00:45:30,630 --> 00:45:32,389
bits and pieces for years of what you

1227
00:45:32,389 --> 00:45:34,550
were doing, so thank you for explaining it

1228
00:45:34,550 --> 00:45:36,069
directly from your mouth. I just love to

1229
00:45:36,069 --> 00:45:38,630
hear it. Any final thoughts? Anything else you'd

1230
00:45:38,630 --> 00:45:40,010
like to share with the people?

1231
00:45:40,789 --> 00:45:42,469
No. I mean, I don't I don't have

1232
00:45:42,469 --> 00:45:44,934
anything that is I feel like, you know,

1233
00:45:44,934 --> 00:45:47,135
just glaring. I think I've talked about it

1234
00:45:47,135 --> 00:45:48,574
so much. I I could talk about this

1235
00:45:48,574 --> 00:45:49,635
for hours, though.

1236
00:45:49,934 --> 00:45:52,175
So I've tried to condense it and not

1237
00:45:52,175 --> 00:45:53,875
bore the people with my

1238
00:45:55,614 --> 00:45:57,474
with my interest in exercise.

1239
00:45:59,000 --> 00:46:00,519
But, yeah, I know. I don't I think

1240
00:46:00,519 --> 00:46:02,780
that we just need to start having

1241
00:46:03,159 --> 00:46:04,299
different conversations.

1242
00:46:04,839 --> 00:46:05,339
And,

1243
00:46:06,679 --> 00:46:08,599
I I really don't want people to go

1244
00:46:08,599 --> 00:46:11,079
away thinking that I'm suggesting that we become

1245
00:46:11,079 --> 00:46:14,324
physical therapists or occupational therapists and start testing

1246
00:46:14,324 --> 00:46:16,085
upper body strength and hand grip strength and

1247
00:46:16,085 --> 00:46:17,605
gait speed. That is not at all what

1248
00:46:17,605 --> 00:46:18,344
I'm suggesting.

1249
00:46:18,724 --> 00:46:19,125
Yeah.

1250
00:46:20,085 --> 00:46:22,824
And and yeah. Again, I don't wanna

1251
00:46:23,525 --> 00:46:25,684
have people come away thinking that that lady

1252
00:46:25,684 --> 00:46:27,385
said on Teresa's podcast,

1253
00:46:27,969 --> 00:46:30,390
we shouldn't be doing any sort of compensations

1254
00:46:30,530 --> 00:46:32,690
or diet modifications. They're just gonna be throwing

1255
00:46:32,690 --> 00:46:33,750
med ball all day.

1256
00:46:34,690 --> 00:46:36,690
That's right. Yep. They heard it here first,

1257
00:46:36,690 --> 00:46:37,190
everyone.

1258
00:46:37,890 --> 00:46:39,730
All those med balls and you're swallowing the

1259
00:46:39,730 --> 00:46:42,175
food. That's it. That's not what I'm suggesting.

1260
00:46:42,235 --> 00:46:45,054
But just, you know, a more broad conversation

1261
00:46:45,514 --> 00:46:46,014
Yeah.

1262
00:46:46,394 --> 00:46:46,894
About

1263
00:46:47,755 --> 00:46:50,954
the the principles of exercise, and maybe we

1264
00:46:50,954 --> 00:46:52,574
should start thinking about this

1265
00:46:52,949 --> 00:46:54,170
more from an interdisciplinary

1266
00:46:54,710 --> 00:46:55,210
perspective.

1267
00:46:55,670 --> 00:46:57,609
And that's a wrap for this episode.

1268
00:46:57,989 --> 00:47:00,250
As always, thank you so much for listening.

1269
00:47:00,550 --> 00:47:02,070
If you'd like to download the show notes

1270
00:47:02,070 --> 00:47:05,985
from this episode, please visit swallowyourpridepodcast.com.

1271
00:47:06,224 --> 00:47:07,825
There you can also sign up for our

1272
00:47:07,825 --> 00:47:09,744
email list so that you'll never miss another

1273
00:47:09,744 --> 00:47:10,244
episode.

1274
00:47:10,704 --> 00:47:12,385
If you do like what you hear, then

1275
00:47:12,385 --> 00:47:15,045
please subscribe and leave a review on iTunes

1276
00:47:15,585 --> 00:47:17,345
or share it on social media with your

1277
00:47:17,345 --> 00:47:19,585
friends and colleagues because that is what keeps

1278
00:47:19,585 --> 00:47:20,885
these episodes coming.

1279
00:47:21,410 --> 00:47:23,250
If you'd like to be a guest, share

1280
00:47:23,250 --> 00:47:25,890
feedback, or request a topic to be discussed

1281
00:47:25,890 --> 00:47:30,289
on the show, please email podcast@TeresaRichard.com.

1282
00:47:30,289 --> 00:47:32,369
Thank you so much for listening, and we'll

1283
00:47:32,369 --> 00:47:33,590
catch you next week.