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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Thickened liquids are one of the most common recommendations in dysphagia management—but are they always the safest option?

In this episode of Speech Talk, Emily and Eva review The Adverse Effects and Events of Thickened Liquid Use in Adults: A Systematic Review and dig into the real evidence behind thickened liquids. We talk aspiration risk, dehydration, pneumonia, quality of life, and why dysphagia management is rarely as simple as “just thicken it.”

From the proxy problem in aspiration research to free water protocols and real-world SNF decision-making, this conversation explores why thickened liquids can help some patients, harm others, and almost always require careful clinical judgment.

Because when it comes to dysphagia management… thickened liquids are complicated.

Citations

Abrams, S. W., Gandhi, P., & Namasivayam-MacDonald, A. M. (2023). The adverse effects and events of thickened liquid use in adults: A systematic review. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2023_AJSLP-22-00380

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What does evidence-based practice look like when the disease is progressive, fatal, and relentlessly complex?

This week on Speech Talk, Emily and Eva discuss clinical management of Huntington’s disease in long-term and residential care settings. Using a comprehensive 2007 primer for speech-language pathologists, we explore dysphagia progression, dysarthria, AAC challenges, behavioral supports, staff training, and the importance of early education.

We also reflect on real-world clinical decision making with a late-stage patient — including thickened liquids, unintelligible speech, low-tech and high tech AAC, impulsivity, weight loss, and the emotional weight of progressive decline. Because sometimes evidence-based practice isn’t about fixing — it’s about guiding, adapting, and supporting with intention.

Note to our listeners: Your headphones are not broken, the audio on this episode is a little funky (all Emily's fault). It is still worth a listen and we promise it won't happen again :)

Citations

Klasner, E. R., & Yorkston, K. M. (2007). A primer for speech-language pathologists managing clients with Huntington’s disease in a residential care facility. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 17(2), 59–64. https://pmc.ncbi.nlm.nih.gov/articles/PMC4958906/

George Huntington (1872). On chorea. The Medical and Surgical Reporter.

Huntington’s Disease Society of America. History of Huntington’s Disease. https://hdsa.org/what-is-hd/history-and-genetics-of-huntingtons-disease/history-of-huntingtons-disease/

BBC News. (2024). Experimental gene therapy slows progression of Huntington’s disease. https://www.bbc.com/news/articles/cevz13xkxpro

Mentioned websites: Dysphagiaoutreach.org

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In this episode of Speech Talk, Emily and Eva dive into cervical osteophytes (aka bone spurs in the neck) and how they can mechanically impact swallowing. We break down what osteophytes are, why they form, and how they can present just like “typical” dysphagia — globus, coughing, choking, wet vocal quality — but may gradually worsen over time.

We talk about imaging (Because how else would we even know it’s there!?), conservative management strategies like texture modification and suprasubglottic swallow, and when a surgical consult might be appropriate.

Citations

Bakshi, S. S., & Ramesh, S. (2021). Cervical osteophytes causing dysphagia: A case report. The American Journal of the Medical Sciences, 361(5), e43. https://doi.org/10.1016/j.amjms.2020.10.014

Lyrtzis, C., Poutoglidis, A., Stamati, A., Lazaridis, N., & Paraskevas, G. (2024). A case of dysphagia due to large osteophytic lesions in the cervical spine: A conservative approach. Cureus, 16(4), e59011. https://doi.org/10.7759/cureus.59011

Egerter, A. C., Kim, E. S., Lee, D. J., Liu, J. J., Cadena, G., Panchal, R. R., & Kim, K. D. (2015). Dysphagia secondary to anterior osteophytes of the cervical spine: A retrospective case series and literature review. Global Spine Journal, 5(5), e78–e83. https://doi.org/10.1055/s-0035-1546954

Park, B. J., Gold, C. J., Piscopo, A., Schwickerath, L., Bathla, G., Chieng, L.-O., Yamaguchi, S., & Hitchon, P. W. (2021). Outcomes and complications of surgical treatment of anterior osteophytes causing dysphagia: A single center experience. Clinical Neurology and Neurosurgery, 207, 106814. https://doi.org/10.1016/j.clineuro.2021.106814

Melbourne Swallow Analysis Centre. (n.d.). Cervical osteophytes and dysphagia. Retrieved February 13, 2026, from https://www.melbswallow.com.au/resources/cervical-osteophytes-and-dysphagia/

HealthCentral. (n.d.). Osteophytes (bone spurs). Retrieved February 13, 2026, from https://www.healthcentral.com/condition/spondylosis/osteophytes-bone-spurs

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How do we decide what to treat—and how—as dementia progresses?

In this episode of Speech Talk, Emily and Eva break down the article Staging and Treatment Frameworks for Dementia Management by Mason-Baughman, Raupp, and Corman. We review how dementia is staged clinically, how those stages show up in communication and daily function, and what evidence-based treatment actually looks like across early, middle, and late stages.

We walk through practical interventions for each stage—from compensatory strategies and functional maintenance in early dementia, to environmental supports and caregiver collaboration in moderate stages, to sensory-based and Montessori-informed approaches in late-stage dementia. We also discuss testing frameworks, documentation strategies, and how staging can guide ethical, realistic goal setting in long-term care.

If you work with patients with dementia (especially in LTC or SNFs), this episode offers a clear, stage-based roadmap for treatment that supports dignity, function, and quality of life.

Citations:Mason-Baughman, M. B., Raupp, S., & Corman, K. (2016). Staging and treatment frameworks for dementia management. Perspectives of the ASHA Special Interest Groups, 1(SIG 15), 53–62. https://pubs.asha.org/doi/10.1044/persp1.SIG15.53

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Up to 80% of patients treated for oropharyngeal head and neck cancer experience swallowing dysfunction—but what if we intervened before impairment starts?

In this episode of Speech Talk, Eva and Emily break down the evidence behind prehabilitation for head and neck cancer, drawing from the literature review by Loewen et al. We unpack what prehab actually is, how swallowing therapy before and during treatment can preserve function, and why prevention is becoming central to dysphagia care.

We cover evidence-based swallowing exercises, dosing considerations, nutrition and psychosocial support, patient education, and real-world clinical takeaways—including why timing matters more than you think. If you work with HNC patients (or want to), this episode will shift how you think about dysphagia intervention timelines.

Citations:

Loewen, I., et al. (2020). Prehabilitation for head and neck cancer patients: A systematic review. Current Oncology, 27(4), e382–e395. https://pmc.ncbi.nlm.nih.gov/articles/PMC7789666/

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Traumatic brain injury isn’t just a young‑guy‑playing‑sports problem. This week on Speech Talk, we’re diving into TBI in older adults—a population with the highest rates of hospitalization, morbidity, and mortality related to brain injury.

Using the ASHA review Traumatic Brain Injury in Older Adults: Epidemiology, Etiology, Rehabilitation, and Outcomes, we break down why TBIs are so common (and so often missed) in geriatrics, especially in SNFs and hospital settings. From falls and car accidents without a concussion diagnosis, to chronic health conditions and polypharmacy, this episode connects the dots between normal aging and TBI‑related cognitive‑communication changes.

We talk through what TBIs actually look like in older adults, how to tell aging apart from injury, what assessments clinicians are really using in rehab, and how functional, fall‑focused, real‑world therapy can make a difference. If you’ve ever felt underprepared when a “no concussion noted” patient suddenly isn’t making sense—this one’s for you.

Citations:
Most of today’s data comes from a 2022 ASHA review synthesizing multiple large epidemiologic studies on traumatic brain injury in older adults.

Mattingly, E., & Roth, C. R. (2022). Traumatic brain injury in older adults: Epidemiology, etiology, rehabilitation, and outcomes. Perspectives of the ASHA Special Interest Groups, 7(3), 648–662. https://doi.org/10.1044/2022_PERSP-21-00129

Albrecht, J. S., McCunn, M., Stein, D. M., Simoni-Wastila, L., & Smith, G. S. (2016). Sex differences in mortality following isolated traumatic brain injury among older adults. Journal of Trauma and Acute Care Surgery, 81(3), 486–492. https://doi.org/10.1097/TA.0000000000001104

Taylor, C. A., Bell, J. M., Breiding, M. J., & Xu, L. (2017). Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveillance Summaries, 66(9), 1–16. https://doi.org/10.15585/mmwr.ss6609a1

Fu, W. W., Fu, T. S., Jing, R., McFaull, S. R., & Cusimano, M. D. (2017). Predictors of falls and mortality among elderly adults with traumatic brain injury: A nationwide, population-based study. PLOS ONE, 12(4), e0175868. https://doi.org/10.1371/journal.pone.0175868

Bhullar, I. S., Roberts, E. E., Brown, L., & Lipe, H. (2010). The effect of age on blunt traumatic brain-injured patients. The American Surgeon, 76(9), 966–968. https://pubmed.ncbi.nlm.nih.gov/20836344/

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This week on Speech Talk, we’re breaking down two of our favorite fast and evidence-backed dysphagia screeners: the TOMASS and the Yale Swallow Protocol. If you’ve ever been buried in a busy SNF day and wished for a quick but reliable way to check someone’s swallow, this episode is your new best friend.

We walk you through how each tool works, what the research says, and why a simple cracker and a cup of water can give you so much clinically relevant information. You’ll hear practical tips for saving time, collaborating with nursing and OT, knowing when NOT to use these screeners, and using the results to support stronger documentation and referrals.

Grab a saltine, pull up your badge buddy, and let’s talk about dysphagia screening you can actually use in your practice.

CitationsTodaro, F., Pizzorni, N., Scarponi, L., Ronzoni, C., Huckabee, M. L., & Schindler, A. (2021). The Test of Masticating and Swallowing Solids (TOMASS): Reliability and validity in patients with dysphagia. International journal of language & communication disorders, 56(3), 558–566. https://doi.org/10.1111/1460-6984.12613 Suiter, D. M., Sloggy, J., & Leder, S. B. (2014). Validation of the Yale Swallow Protocol: a prospective double-blinded videofluoroscopic study. Dysphagia, 29(2), 199–203. https://doi.org/10.1007/s00455-013-9488-3 

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Productivity: the push button topic in the SNF world. If you’ve ever felt torn between what’s ethical and what’s expected, this episode will hit home.

Instead of a research article, we dive into Akyko S. West’s dissertation on productivity requirements and moral distress in SNF rehab therapists (SLPs, PTs, OTs, RTs, and their assistants). This paper READS like every conversation we’ve had in break rooms for yearsss.

We get real about navigating profit-driven healthcare, maintaining integrity, advocating for yourself, and knowing when to walk away.

Citation: https://www.proquest.com/openview/0bd846d6fcbbeac4fd83aceacabfb8a7/1?pq-origsite=gscholar&cbl=18750&diss=y

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We break down the Dysphagia Outcome and Severity Scale (DOSS)—a 7-point scale created to bring consistency, clarity, and objective severity ratings to dysphagia evals. We dig into the original 1999 article, why the scale was developed, and how SLPs can use it to support documentation, payor justification, and person-centered goal writing.

Citation:

Dysphagia Outcome and Severity Scale (DOSS)
O’Neil, K. H., Purdy, M., Falk, J., & Gallo, L. (2014). The Dysphagia Outcome and Severity Scale. The ASHA Leader. https://leader.pubs.asha.org/doi/full/10.1044/leader.FTR1.19062014.36

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