This week on Speech Talk, we're diving into one of the most medically complex—and often intimidating—areas of speech-language pathology: tracheostomy rehabilitation.

We break down the research on how speech-language pathologists are involved (or unfortunately, often not involved) in tracheostomy care and why early SLP intervention can make a significant difference in communication, swallowing, and successful decannulation. We discuss speaking valves, swallow evaluations, common barriers to rehabilitation, and what every clinician should know when working with patients with tracheostomies across acute care and rehabilitation settings.

Plus, we cover this week's SLP headlines, including:

Whether you're a student, medical SLP, or simply want to feel more confident around trach patients, this episode translates the latest evidence into practical clinical takeaways you can use tomorrow.

Citations

Ash S, Weyh A, Salman SO, Madbak F, Fraker JT. Speech Pathology Services Are Integral, but Underutilized in Tracheostomy Rehabilitation. ⁠https://pmc.ncbi.nlm.nih.gov/articles/PMC8108103/

https://www.passymuir.com/education/

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Do oral and pharyngeal exercises help post-stroke dysarthria? Emily and Eva examine a recent review (Yunusova et al.), unpack why swallowing outcomes often show benefit while speech outcomes do not, discuss goal-writing pitfalls, and get into practical treatment. Talking about their own practice and how they address dysarthria treatment- because if we don't talk we can't learn from each other.

Citations:

Marzouqah R, Huynh A, Chen JL, Boulos MI, Yunusova Y. The role of oral and pharyngeal motor exercises in post-stroke recovery: A scoping review. Clin Rehabil. 2023 May;37(5):620-635. doi: 10.1177/02692155221141395. Epub 2022 Nov 25. PMID: 36426582; PMCID: PMC10041576. 

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Supervision is so much more than signing off on competencies. It shapes clinician confidence, patient care, and the future of our profession.

In this episode of Speech Talk, Emily and Eva welcome their very first guest, Olivia, to reflect on her completed externship and unpack what effective supervision really looks like. Together, they explore the research on clinical supervision, discuss different supervisory styles, and share honest stories about balancing mentorship with productivity demands in skilled nursing facilities.

Whether you're supervising students, preparing for an externship, or reflecting on your own clinical training, this episode offers practical strategies grounded in research and real-world experience.

Research discussed:Terry, D., Nguyen, H., Perkins, A. J., & Peck, B. "Supervision in Healthcare: A Critical Review of the Role, Function and Capacity for Training."

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How many repetitions does it take to improve swallowing? How hard should dysphagia exercises be? And are we prescribing enough therapy to make a meaningful difference?

In this episode of Speech Talk, Emily and Eva tackle a question many clinicians have asked but few were formally taught to answer: how do we dose dysphagia therapy?

Using the article Exercise Prescription for Dysphagia: Intensity and Duration Manipulation by Sapienza and colleagues, they explore how principles of exercise science can help guide swallowing rehabilitation. The discussion breaks down the concepts of treatment intensity and duration, why different energy systems matter for swallowing function, and how direct and indirect dysphagia exercises may target different physiologic goals.

The conversation also moves beyond the research and into real-world practice. Emily and Eva discuss the challenges of delivering adequate treatment intensity in skilled nursing facilities, strategies for increasing patient participation outside of therapy sessions, and practical ways to improve carryover without overwhelming patients or clinicians.

Whether you're prescribing effortful swallows, EMST, Shaker exercises, lingual strengthening, or sensory-based swallowing tasks, this episode will leave you thinking differently about the question: not just what exercise should I use, but how much exercise is enough?

Citations

Exercise prescription for dysphagia: Intensity and duration. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 17(2), 50–55.https://doi.org/10.1044/sasd17.2.50

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A patient survives a stroke, starts rehab, and begins making progress. But what if their greatest risk isn't behind them?

In this episode of Speech Talk, Emily and Eva dive into the often-overlooked topic of recurrent stroke. While many clinicians focus on recovery, research suggests the first 90 days after a stroke may carry a surprisingly high risk for another cerebrovascular event—and the way researchers define "stroke recurrence" dramatically changes the numbers.

Join us as we unpack the article Underestimation of the Early Risk of Recurrent Stroke: Evidence of the Need for a Standard Definition and discuss what these findings mean for speech-language pathologists, rehabilitation professionals, and the patients we serve.

Whether you work in a SNF, hospital, home health, or outpatient setting, this episode will leave you thinking differently about patient education and the critical role clinicians play during those first three months after stroke.

Because sometimes the most important therapy conversation isn't about recovery—it's about preventing the next stroke.

Citations

https://pmc.ncbi.nlm.nih.gov/articles/PMC11641623/

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What happens when we can’t stop aspiration?

In this episode, Eva and Emily talk about chronic aspiration and what happens when small, repeated events start to add up. From inflammation and airway damage to serious complications like pneumonitis and lung abscess, we break down what’s really happening in the lungs.

We also connect the research to real clinical practice—what this means for your patients, how to approach treatment, and why oral care will forever be in the mix when talking about aspiration. 

Citations

Ficke B, Rajasurya V, Sanghavi DK, et al. Chronic Aspiration. [Updated 2023 Jul 4]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560734/

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Ever feel like you’re fighting your patient just to get through a session?

Explore Acceptance and Commitment Therapy (ACT) as a framework for speech therapy—not psychotherapy, but a way to rethink how we approach resistance, engagement, and progress.

Using the metaphor of “the river and the rock,” Eva and Emily unpack how ACT shifts us away from power struggles and toward flexibility, values-based care, and meeting patients where they are.

They break down the research on ACT in post-stroke depression and emerging work in aphasia, showing how emotional adjustment and communication recovery are deeply connected.

Plus, we translate ACT concepts into real clinical scenarios—from dysphagia refusals to cognitive pushback to aphasia shutdowns—and walk through how to respond without arguing, forcing, or “fixing.”

Because sometimes the most effective therapy isn’t pushing harder—it’s learning how to flow.

Citations

Niu, Y., Sheng, S., Chen, Y., Ding, J., Li, H., Shi, S., Wu, J., & Ye, D. (2022). The efficacy of group acceptance and commitment therapy for preventing post-stroke depression: A randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases, 31(2), 106225. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106225

Evans, W. S. (Principal Investigator). (2021–2025). Adapting acceptance and commitment therapy for stroke survivors with aphasia (ClinicalTrials.gov Identifier: NCT04984239). University of Pittsburgh.

https://clinicaltrials.gov/study/NCT04984239

Evans, W. S. (n.d.).Acceptance and commitment therapy (ACT) framework [Continuing education course]. https://www.speechpathology.com/slp-ceus/course/acceptance-and-commitment-therapy-introduction-10771

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Choking is one of those moments where everything goes from normal to crisis in seconds—but how well are we actually measuring that risk?

In this episode of Speech Talk, Emily and Eva break down the integrative review “Dying for a Meal” to explore what really contributes to choking across populations. From who is most at risk to the foods most commonly involved, the research reveals that choking isn’t always as straightforward as we think—and dysphagia isn’t always the main factor.

We dive into five key prevention strategies, including mealtime modifications, oral health, medication management, interdisciplinary care, and system-level training. But beyond the strategies, we tackle the bigger question: how do we balance safety with autonomy?

Because when it comes to choking risk, it’s not just about what’s on the plate—it’s everything around it

Citations

Hemsley, B., Steel, J., Sheppard, J. J., Malandraki, G. A., Bryant, L., & Balandin, S. (2019). Dying for a Meal: An Integrative Review of Characteristics of Choking Incidents and Recommendations to Prevent Fatal and Nonfatal Choking Across Populations. American journal of speech-language pathology, 28(3), 1283–1297. https://doi.org/10.1044/2018_AJSLP-18-0150

-This article link contains the choking risk scale for use in your practice!

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Research is supposed to guide our practice—but what happens when we can’t actually access it?

In this episode of Speech Talk, Eva and Emily get into the reality of paywalled research and what it means for evidence-based practice in speech-language pathology. Breaking down the article “The Effect of Open Access on Scholarly and Societal Metrics of Impact in the ASHA Journals,” they explore how access (or lack of it) shapes who reads, shares, and applies research.

From citation counts to social media reach, the data is clear: the more accessible the research, the greater its impact. But with thousands of articles still behind paywalls, clinicians are often left out of the conversation.

This episode gets real about the barriers SLPs face—and why making research more accessible isn’t just convenient, it’s essential for better patient care.

Citations

Long, H. L., Drown, L., & El Amin, M. (2023). The effect of open access on scholarly and societal metrics of impact in the ASHA journals. Journal of Speech, Language, and Hearing Research, 66(5), 1784–1796.

https://doi.org/10.1044/2022_JSLHR-22-00315

ASHA website for free resource links! https://www.asha.org/siteassets/uploadedfiles/asha/research/ebp/finding-free-access-research.pdf

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Does a “wet” voice really mean your patient is aspirating?

In this episode, Eva and Emily unpack research that challenges one of the most common clinical signs used in dysphagia assessment, wet vocal quality. Turns out, what we’ve been trained to hear might not be as reliable as we think.

The need for instrumentals hasn't gone away, but the biggest national providers of mobile FEEs has...So what happens when we know we can’t solely rely on bedside exams and access to gold standard tools is limited?

Let's talk about it.

Citations:

Centers for Medicare & Medicaid Services. (n.d.). Skilled nursing facility consolidated billing. U.S. Department of Health and Human Services. https://www.cms.gov/medicare/coding-billing/skilled-nursing-facility-snf-consolidated-billing

American Speech-Language-Hearing Association. (2023). The case for FEES in skilled nursing facilities. https://leader.pubs.asha.org/do/10.1044/leader.OTP.28072023.fees-snf-slp.36/full/

Weldon, K., Kelchner, L., Silbert, N., & Rule, D. W. (2023). Listening for dysphagia: Voice quality sequelae of material in the airway. Journal of Speech, Language, and Hearing Research. https://doi.org/10.1044/2022_JSLHR-22-0012

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