Speech Talk

In this episode we discuss burnout and productivity pressure in adult medical speech-language pathology and related rehab settings. We focus on how long workdays, inconsistent hours, documentation demands, and holiday coverage contribute to stress in skilled nursing facilities, assisted living, hospitals, and outpatient clinics.
We look at a 2024 study of rehab practitioners in skilled nursing and assisted living facilities that used the Maslach Burnout Inventory. The study found that one in five practitioners scored in the extreme range for burnout, and 25% scored in the extreme range on all three burnout domains: emotional exhaustion, depersonalization, and reduced personal accomplishment.
We also review how productivity standards relate to burnout and ethically questionable behaviors. The study found a measurable link between productivity requirements and all three burnout domains, even after other factors were accounted for, and productivity standards were tied to five of six ethical gray-area behaviors that were measured.
We discuss how these pressures are shaped more by role and workplace culture than by facility type alone. The conversation highlights differences between evaluators and assistants, the demands placed on SLPs in particular, and the impact of settings where clinicians are expected to meet numbers while still providing clinically appropriate care.
We close by reflecting on three burnout-related questions from the inventory: feeling emotionally drained, not caring what happens to patients, and feeling that work has accomplished worthwhile things. We emphasize that these responses can signal the need to step back, get support, and recognize burnout early.

Citations

Coleman A, McLaughlin E, Floren M. Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account. Am J Occup Ther. 2024 Jan 1;78(1):7801205090. doi: 10.5014/ajot.2024.050341. PMID: 38224353.

Mahrukh, Malik , S., Khan, H., Khalil , R., & Akram , A. (2023). Level of Stress Among Speech and Language Pathologists Working in Clinical Setups. Journal of Health and Rehabilitation Research, 3(2), 30–36. https://doi.org/10.61919/jhrr.v3i2.58

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How do we actually diagnose apraxia of speech when there’s no gold-standard diagnostic test? In this episode, we break down recent research on apraxia differential diagnosis and discuss how to distinguish apraxia from aphasia and dysarthria. We cover common characteristics of apraxia, clinical impressions, the Apraxia of Speech Rating Scale (ASRS), and why relying on obvious signs like groping may cause us to miss milder presentations. We also talk about why accurate diagnosis matters for treatment planning—and what clinicians can do differently during their next evaluation.

Citations

Haley, K. L., Jacks, A., & Mailend, M.-L. (2026). Diagnosing apraxia of speech in children and adults when there is no gold standard: A scoping review about the diagnostic process. American Journal of Speech-Language Pathology, 35(2), 840–859. https://doi.org/10.1044/2025_ajslp-25-00178

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In this episode of Speech Talk, Emily and Eva explore how chewing, food texture, and swallowing are connected—and why diet texture matters for swallowing safety and patient care. Why do we care about diet texture? Because the texture of the food changes as we chew or don’t chew and food factors like gumminess, hardness, and moisture impact the strength we recruit for the swallow. 

They break down the basics of mastication and the pharyngeal swallow, discuss IDDSI texture modifications, and take a closer look at healthy chewing patterns. They also explore why certain foods, like bread, can be surprisingly challenging and why swallowing recommendations need to be individualized for each patient.

Whether you’re an SLP, SLP student, or interested in dysphagia and swallowing, this episode offers a practical look at the complex process behind something we do every day

Citations

Matsuo, K., & Fujishima, I. (2020). Textural Changes by Mastication and Proper Food Texture for Patients with Oropharyngeal Dysphagia. Nutrients, 12(6), 1613. https://doi.org/10.3390/nu12061613

Sari KI, Rafisa A. Chewing and Swallowing Patterns for Different Food Textures in Healthy Subjects. Int J Dent. 2023 Jun 17;2023:6709350. doi: 10.1155/2023/6709350. PMID: 37361412; PMCID: PMC10290560.

Gandhi, P., Barrett, E., Mancopes, R., Panes, V., Peladeau-Pigeon, M., Simmons, M. M., & Steele, C. M. (2026). What about foods? The influence of food texture on the safety, timing, kinematics, and efficiency of pharyngeal phase swallowing in healthy adults. Journal of Speech, Language, and Hearing Research, 69(4), 1528–1541. https://doi.org/10.1044/2025_JSLHR-25-00546

Free Resources on Dietary Textures with educational hand outs: https://www.iddsi.org/ 

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What happens when the brain can’t hear its own speech errors?

In this episode of Speech Talk, Emily and Eva explore the speech-auditory feedback loop and how it can be disrupted after brain injury. They unpack new research on error detection, automatic versus voluntary correction, and what these findings mean for aphasia therapy.

Plus, practical strategies for helping patients build awareness, self-monitoring, and more successful communication.

Citations

Impairment of Speech Auditory Feedback Error Detection and Motor Correction in Post-Stroke Aphasia," from Bereznyak and colleagues out of the University of South Carolina, published in 2021 

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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/

Get in Touch: [email protected]

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