How Do We Even Treat Dysarthria?

Speaker1:
[0:15] Hi, everyone. I'm Emily.

Speaker0:
[0:17] And this is Eva. And you're listening to Speech Talk.

Speaker1:
[0:20] We're your research book club, so you can do evidence-based practice in practice.

Speaker0:
[0:25] So let's start talking. And let's start talking with, what did you do this week, Emily? What happened that was interesting?

Speaker1:
[0:33] There's like no space in my brain anymore for anything that's not related to sports. Everything at my house is all sports. The Cavs are in the playoffs, so my husband is unavailable every other day. He's also coaching my kid's baseball team. And then my other kid has baseball and soccer. And I didn't feel like I was going crazy enough, so I signed my daughter up for ballet. And I don't know. I don't know if I have a face anymore. I don't know what my legs look like. I just don't know how I'm feeding my family. So what happened this week? Your guess is as good as mine. I don't know what's happening over here.

Speaker0:
[1:12] What sports happened this week? There was a ball involved.

Speaker1:
[1:16] I will say I went to my son's baseball game last night. And they're starting to do like kid pitch stuff. And he hit his first, like the first time the kid threw it to him. He slugged it right out of there. So proud.

Speaker0:
[1:32] What a moment.

Speaker1:
[1:34] It is. It's very, it's very busy. It's very hectic over here, but it's also so cute and rewarding. And I love them.

Speaker0:
[1:42] We have a t-ball and I love it when Josie walks up with like the bat over her shoulder and just like takes a swing at it. And I'm like, I had a girl.

Speaker1:
[1:54] It is. It's so cute.

Speaker0:
[1:55] It's really special.

Speaker1:
[1:56] All right, Eva, what's up? What's new?

Speaker0:
[1:59] Similarly, I'm like, I don't know. I gardened a lot yesterday. That was very exciting. Clinically, I yet again have a Parkinson's patient. Sorry, Parkinsonism. Frankly, I don't really understand how that differential diagnosis happens, but it presents a lot like Parkinson's. I'll tell you that much. And yet again she's like not being followed by an outpatient speech therapist and I had to have the the talk of like so, you'll lose your voice and your ability to eat if we don't start mitigating these things I mean that may happen anyways but we can at least prolong it she was like oh yeah I guess we should get started I didn't know that that could happen I was like, I don't know who's out here working with these patients not telling them that this is the future but every time it happens. I get real upset about it. I want to be like, who's your neurologist? Let me at them or let me at them.

Speaker1:
[2:56] I have someone on caseload the same too. And I'm like, do I treat Parkinsonism the same way I do Parkinson's? And when I looked it up, it seems like one of the major differences is that when you have Parkinsonism, the medicine you use to treat Parkinson's doesn't work. So it seems like worse to me, like if they have all the same things, but the medicine doesn't work like that.

Speaker0:
[3:22] If you are a neurologist, I won't fight you. Come on and talk to us. Explain to us the difference.

Speaker1:
[3:29] We need it. Please help us.

Speaker0:
[3:32] So today, I really wanted to talk about dysarthria because I've had quite a few patients with dysarthria. And we'll get a little more into specifically why. But I think the essence of my feelings on this topic are in the episode title, What Even Is Dysarthria Treatment? Because I think it really encapsulates my complete spiraling after I had an interaction with my coworker. So to hear more about it, keep listening after the break. Okay, so here's really how I got on today's topic. I saw a patient who has post-stroke dysarthria with some like serious right side lucidity or like muscle looseness in her cheeks. And I told my co-worker who's her primary speech therapist that I was recommending that we both do manual techniques like put your fingers on your cheek to hold it kind of to your face while you talk, to make your speech sound clearer and some oral motor exercises and she was like well just so you know I haven't put any on her, you know regimen or her plan of care because oral motor exercises don't really have a lot of evidence to support them for this. And for those who can't see, Emily is in fact nodding her head.

Speaker1:
[4:58] Yes.

Speaker0:
[5:00] And I was like, oh, right. In grad school, we talked about how non-speech oral motor exercises can't be used to make people speech better. Do you remember that thing they told us about bubbles, like blowing bubbles?

Speaker1:
[5:15] I don't. Oh, yeah, yeah, yeah. Because they did like breath support or something or to get people say the ooh sound, they would have them blowing bubbles.

Speaker0:
[5:23] Yeah, exactly. And then that turned out to not be effective. And I was like, wait, no, was that for apraxia of speech, not dysarthria of speech? And wait a second, we give people oral, motor, and pharyngeal exercises for, swallowing impairments after stroke. Why not speech impairments after stroke? And I was like is this because somehow the nerve innervation is different between like your face and your throat and I was like wait a second there's so many different types of dysarthria, what does it all mean and I just completely lost it I was like I don't understand anything anymore so I don't know if you could if I like really painted the picture of me spiraling.

Speaker1:
[6:06] She just dropped a bombshell on you're like yeah let's do all these things and you're just like

Speaker0:
[6:12] What? Yeah, exactly. And that, yeah, of course I felt bad because then I told the patient that we were going to do this and now she's getting conflicting care

Speaker0:
[6:20] from different providers, which is always, it's not a cute look. It's not a cute look. Anyways, this brings me to a very fun word, epistemology. Have you heard that word before?

Speaker1:
[6:31] No, but you're always teaching me new words. You have like the biggest vocabulary of anyone I know.

Speaker0:
[6:35] So it's the study of knowledge. It's basically like, how do we know what we know? Which is a question I love. And so today's episode is both dedicated to my co-worker who got me to think about this, a new patient we'll talk about later, not the one I just mentioned, and to our forever research bestest buddies relationship where we're trying to understand what we understand about speech therapy.

Speaker1:
[7:02] Doing our best one day at a time.

Speaker0:
[7:03] One day at a time. I think one of the most beautiful things about doing this podcast is it takes that kind of, oh, my God, what do I even do? And provides a very good emotional outlet for it. Very productive outlet. Good for us.

Speaker1:
[7:19] I know. I hope other people feel the same way. We chat through our problems together and the world.

Speaker0:
[7:27] Exactly. So as per usual, this episode arose because I was like feeling confused and feeling like I didn't really do my best by a patient. And I wanted to look into something. And I found this article called The Role of Oral and Pharyngeal Post-Stroke Exercises in Post-Stroke Recovery by Unisova et al. And I'm going to start us off here with a question. Emily, how often do you think that dysarthria, so motor speech impairments, and dysphagia, swallowing impairments, co-occur? Like, what's the percentage?

Speaker1:
[8:02] 40%.

Speaker0:
[8:04] Oh, not bad. It is basically 30%. Well done.

Speaker0:
[8:09] So then I found myself again wondering, like, why can we treat swallowing with exercises, but not motor speech? And the research looked at three categories where clinicians use oropharyngeal exercises to improve an outcome. And these categories are... Drumroll. Speech, dysphagia, and sleep apnea. So I want you to go ahead and rank what you think is like the most effective to least effective.

Speaker1:
[8:40] Most effective, dysphagia, dysarthria, sleep apnea. I'm like baffled that was even listed in it. How are they going to address sleep apnea?

Speaker0:
[8:51] Yeah, I know. It's very confusing. So you're pretty close to being right. Yes, there was a large treatment effect for using exercises to improve dysphagia. Boom. They're basically like, people have accepted this in our practice. Then sleep apnea, which has some initial research that is highly promising. And then three, it was speech. Womp womp. And they said that speech outcomes like sentence level speech intelligibility were not affected.

Speaker1:
[9:19] At all? Nothing?

Speaker0:
[9:20] That was just what they said right there. Not even to like a specific degree. But then, you know, what do we always say about research? Is it really clear, Emily, or is it kind of in the gray area?

Speaker1:
[9:32] We always have shades of gray. Yeah.

Speaker0:
[9:35] As always, there's just like more questions. So they said that despite that speech outcomes like speech love intelligibility were not affected, They also said that for speech, maximum isometric muscle exercises are ones that strengthen the muscles through sustained high effort contractions against resistance. And I was like, wait, you just said that these are shown to be effective, but speech outcomes are not shown? What does that even mean?

Speaker1:
[10:06] Conflicting. That makes no sense.

Speaker0:
[10:08] I don't like that. I hate that in research. And I'm also like, that seems to be what research is. So conflicting. So, we have this confusing situation about speech outcomes. And then, do you want to know what they said about the known outcomes of dysphagia? I'd like you to take a guess.

Speaker1:
[10:24] That they're amazing. That there's all the outcomes are out of this world, sunshines and rainbows.

Speaker0:
[10:31] Wouldn't you like that? This is sort of an amended version of what they said. Previously published reviews of swallowing exercise intervention found positive evidence. However, the studies the authors reviewed rarely linked muscle movements and functional outcomes to improvements in a patient's performance. So, While there's positive evidence, also, there's no direct link between treatment and outcomes. What?

Speaker1:
[11:02] This is like one of those articles that I've been looking for. I've had co-workers say to me, like, do we even do swallowing exercises anymore because the evidence shows that they're not effective? And I've been digging for whatever they've been talking about, and it seems like you have found it. It's when we're talking about it, they're asking me and they're like, do you do these exercises? And I'm like, of course I do. And they say, no, I don't. Cause there's not a lot of research. And when we think about the research we do find, it's normally something that's promoted. Like who, like we said before, who is doing the research? So we're thinking AmpCare, LSVT, EMST, all the anacronyms, synchrony, like they have research that tell us like they're positive outcomes. They have made this specific marketable product that they want to, they're selling this marketable product that shows that there is improvements in diaphragmatic strength and there's improved swallowed outcomes and improved voice.

Speaker0:
[12:11] I think that's actually a really good thing you said there, because one of the interesting things about those products is there's numbers on them. And then just recently, we did that episode that talked about how swallow exercises

Speaker0:
[12:23] can be effective given proper dosing, because I think you asked a great question about dosing, right? So we're getting into the nitty gritty of what is our support base for, overall oral pharyngeal exercises. And I think the author's approach in this article was really interesting because they looked at it specifically through a goal-writing lens. So for example, if I were to write for my patient, their goal, patient will perform swallow strengthening exercises with 90% accuracy in order to improve swallow efficacy and safety. So that's like their treatment goal short-term. And then I link it to a long-term goal like patient will report ease of comfort with food intake as measured through improved patient-reported outcomes, or patient will return to their prior level of function for food intake, right? Those sound like something you might write. I bet you'd write them better. I'll bet you got cute goals. Emily, for our people who are maybe new clinicians or don't really do speech therapy very much, can you explain why we kind of do those short-term goals and then link it to a long-term goal like that?

Speaker1:
[13:34] Well, the long-term goal is their ultimate goal, right? We want to get them back to where they were before or as close to that as possible. And the short-term goal is the steps we take to get there. So we're writing that short-term goal to say, if they do this exercise at 90%, then that will give them steps towards that prior level of function.

Speaker0:
[14:02] That is exactly, I think, the answer as how we were taught to understand goal writing. Like, I could not have said that better myself, including the steps analogy. I love that. I don't know if you meant it as an analogy, but in my mind, And there was like little steps and they're going up the short term goal steps to the long term goal platform.

Speaker0:
[14:23] But so what they said here was really interesting. They're like, this actually doesn't add up. Here's another fun phrase, begs the question. And what the expression begging the question means is you've assumed the answer in your question. So our initial goals are, say, strength-based, but then our later goals are on functional outcomes, just like in the example I gave you. And so what this means is that we are assuming that strength exercises are leading to improving those functional outcomes long-term. They're trying to point out this logical flaw where they're like, hey, you gave the patient a regimen of strengthening exercises or range of motion exercises. And then your long-term goal is like, and then they'll just get back to eating regular food or they're back to talking really clearly.

Speaker0:
[15:20] But you don't necessarily know that the exercises you're giving are the things that are contributing to that long-term goal. Because how they were looking at patient outcomes was through this goal-writing logic, they were kind of like, we're missing a lot of steps. We got to figure out what strength or range of motion exercises actually do for patients. And that gets back to that whole big question of, what are these exercises doing? Are they still valid? And it seems like the more we kind of are diving into that research, the more questions we have, which is always good. Go out there, write your research, everybody.

Speaker0:
[15:58] So one thing I did want to talk to you specifically, Emily, about is that the research point out that the literature has some issues with dysphagia research. And I want you to think about, the things we've discussed. What do you think those limitations are in dysphagia research?

Speaker1:
[16:15] Controls, I'm sure. Like how much they're able to account for, I don't know, people's ability to complete the exercises. Are they doing what they're saying they're doing? Are they staying true to their diet? Or if they're an aspirator, are they just aspirating and causing other outcomes that skew the study. I would guess you could say participant retention, people die.

Speaker0:
[16:49] Yeah, that's so true. I feel like we always bring up dying at some point.

Speaker1:
[16:54] It's so heavy in my mind.

Speaker0:
[16:56] So I want to say that I think that your answers are reflecting this larger limitation in like study creation, like potential complications, limitations within certain populations, so on and so forth. And what I was really getting more towards is that it's what we've exactly discussed before. There is poor information out there on what exercises we should be doing and the dosing or regimen of performing them. So they're trying to like generate these good, cohesive things. Protocols on what should we do when we have a dysphagia patient? What should we do when we have a dysarthria patient? It just turns out there's not a lot of clear research on those practices, which does that, do you feel like that's kind of like validating?

Speaker1:
[17:45] No, it's not validating. It makes me feel like a sham. Doesn't it that you're like, yeah, you're really pushing for these exercises or you're really pushing to do these things and And it's just like, meh, the research is meh.

Speaker0:
[18:00] Yeah. Well, I will say that is definitely an interesting point. And it does make me kind of think back to a lot of sessions that I've done with people. And they're like, I'm not that involved. And retrospectively, I'm like, yeah, maybe that was valid, you know. Or kind of like we talked about in another episode, if they have to do it for four weeks in order for it to show any improvement, then like, yeah, of course it's hard to get by. And it doesn't feel effective right now, you know. But I think for me listening, not listening, I read it, listening to the research, no, reading the research, you guys are listening to the research, was that I was like, it's okay for me to feel a little confused. Like, I wish there were clearer guidelines and directives and protocols, but there aren't. And so the fact that I sometimes feel like, oh, my gosh, I'm just cobbling stuff together and just doing the best that I can. I'm like, well, it seems like that's just kind of where the field's at right now. Not just me, not just you. It's everybody.

Speaker1:
[19:05] Yeah. And it seems weird to continue on and keep doing the same old, same old when that is the notion, right? If we're just, there's not like a whole lot of research and we're supposed to be working within this evidence-based practice if we're There's not like a whole lot of good evidence. How can we truthfully stand behind continuing to do it?

Speaker0:
[19:29] Yeah, I think that we something we come back to all the time is like we need more research. Like this is at this point we're getting into like the foundational science of our field and there's not enough of it. And so I was reflecting on that and what my coworker had said to me that there's no evidence to support exercises for improving dysarthria. And that's technically true. But I think the implication means the evidence currently shows that exercises are not effective. That's a little bit true, but I think maybe a more accurate statement is there isn't currently enough evidence to show that it's effective, which leaves room for more research and better research. And who knows, maybe that research will say it's not effective, but maybe it could say if you do these three exercises this many times a day for four weeks, it will be effective. And I think this really taps into some frustration that other specialists within

Speaker0:
[20:28] speech pathology have been feeling. Do you know about orofacial myofunctional therapy?

Speaker1:
[20:34] I don't know a whole lot about it. I know that it's expensive to be certified in it. And it has to do with, like, releasing tension through exercises or stretching.

Speaker0:
[20:49] Right. So it's these specialized exercises and behavioral techniques that are supposed to kind of retrain the muscles of the face, mouth and throat. And during our grad school clinical rotations, I was at a pediatric clinic that specialized in orofacial myofunctional therapy. I think it's just OMT because that's a serious mouthful. And then the next placement i went to they were like oh i wouldn't tell people you did that it's really not like evidence-based, but then the whole world of omt therapy is going hey it's not evidence-based because no one's doing research, you know like there could be good outcomes and they're saying i work with my patients all the time and they are reporting improved outcomes for sleep apnea, for oral motor control, for dysphagia. Like, stop discrediting this when the fact of the matter is there's just not enough information. And I was wondering, have you come across any things that in your practice where you're like, I've been doing this and I think it's really worked for my patients, but it's not really like an official therapy. Like, no one told me I should do this or that I shouldn't do this. It's just kind of something I came up with.

Speaker1:
[22:06] I mean, yes. There are so many exercises that I do with my dysphagia clients that I do because they make sense. Nobody told me. So I have my own case study experience that I'm able to say my trophy. Here, you see? I did. I did good this one time.

Speaker0:
[22:28] Yeah. And actually, I think that's a great usage of the term case study because, when I started to go into my deep spiral and I was like, okay, so what do we even do for dysarthria? I came across a really interesting case study, which we'll get to in a second. And I just want to say, one, I love that you are really creative and come up

Speaker0:
[22:50] with a lot of different things in your practice. And one thing they highlighted in this article was that tactile feedback can be really good. There's other types of feedback. There's like knowledge of process, like how did you do the activity? Knowledge of results, did you do it correctly or incorrectly? And then there's like biofeedback showing somebody what's happening while it's going on. And I love the idea of like pop rocks as being this kind of sensory tactile feedback experience slash knowledge of results. Like I can still hear pop rocks in your mouth. You didn't follow them all. But to get back to the question, how do you treat dysarthria? Like in your day to day clinical experience?

Speaker1:
[23:38] Lots of over articulation. So what we do is we, and I almost always have to get somebody like alone almost, right? Because we're going to be making really big faces, really silly faces as we're talking. So like, how, like, oh, wait, oh, but how are you? Like we're holding our mouth open or keeping it there. Um, if... It's like maybe an endurance thing we're singing so i'll put on some of their songs and we'll we'll do karaoke and we're singing through the whole song so the goal is to keep moving your lips so that's i know that i've had a good jam session and i'm like oh my lips are tingly so i'm like it has that's what i'm like it has to work right like if i'm if i'm my normal mouth as normal goes, can get hurt from singing too crazily, then I'm doing something, right?

Speaker0:
[24:45] My mouth is working out. Yeah, that rendition of Stayin' Alive has me feeling like, wow, I need a break.

Speaker0:
[24:54] Those are all awesome. And you targeted some of the big ones. So things that are effective that I found just kind of going back to like the ASHA practice portal and some other ad hoc articles are, my job we call it the slop which is not a pretty acronym we need to rebrand it's for slow loud over articulation and pause, so we're talking more slowly we're increasing volume we're over articulating and we're trying to break down any slurring of words through pauses.

Speaker0:
[25:31] And this kind of gets into just targeting what i think is really basic speech therapy like foundations is the subsystems we're doing respiration phonation and articulation so if they need to get loud and they have poor breath support, let's do some breathing exercises right if they are having phonation problems let's, pick an appropriate phonation therapy articulation We're just doing that over articulation, like open your mouth so wide. And I used to do a singing. I used to be in choir and stuff. And they always told us like to project, you got to have like three fingers wide, like, ah, like that. And it's really weird. When you start doing it, like your body is not used to talking that way. And I'll put my patient's like camera on. So it's facing them on their phone if I don't have a mirror and I'll show them like put one finger between your teeth. Now two stacked, now stack three. And they're like, oh, that's what a wide mouth is.

Speaker1:
[26:33] Right.

Speaker0:
[26:35] And then there is also, have you ever worked with kinesio tape?

Speaker1:
[26:38] There is a research article I was going to talk about later that was referencing it, but I had not, I have not worked with kinesio tape.

Speaker0:
[26:49] Yeah. So for people who don't know what kinesio tape is therapy tape, and basically you can attach it to different parts of the body and people will use it to kind of tape up a flaccid or like loose side of a, of their lips or cheeks to kind of make their mouth a little more symmetrical, which can really improve their speech clarity. There's also kind of along that with that like manual manipulation.

Speaker1:
[27:17] I thought you were going for like a resistance because I'll do that sometimes too, where I'll have someone hold a part of their cheek to make it so that they have to be effortful through that movement.

Speaker0:
[27:31] Oh, I don't know about these. This is why we have to talk.

Speaker1:
[27:34] So it's like a resistance. So instead of just talking, I'll have them, I don't want to do it on air because then you can't hear me talk.

Speaker0:
[27:41] Oh, and I'm going to post that video.

Speaker1:
[27:45] You're holding it, so then it's, you're fighting your fingers or you're fighting your hands to talk through. So it's resistance training.

Speaker0:
[27:52] Which, as we learned earlier in this episode, isometric pressure is an effective exercise technique. And then.

Speaker0:
[28:02] In my homage for who this episode is dedicated to, I had a patient who has dysarthria. He has right-sided facial flaccidity, and he's an acupuncturist. And he was saying that he gets acupuncture done once a week. And since he's been in the hospital, he's still been getting it. And he's like, it's the only time that I feel relaxed or some relief from what has happened to my muscles. And I was like, oh, that's super interesting. We have nerve innervation and E-STEM does that too. So then I started looking at whether or not E-STEM and acupuncture are effective for dysarthria. And there was a case study, which is why I'm so glad you brought up case studies, where basically they were like, the authors were like, we had a patient who'd had a seriously traumatic accident, and traditional speech therapy where like you sit down, you follow directions, you do exercises are not applicable because his cognition was so impaired. It could not follow a direction. And so they're like, well, what kind of improvements can we make? And they tried to East him and it was effective for that patient. And so I kind of love the idea of, like, building a body of knowledge through case studies where you, like, submit extra case studies. And then people can look at a bunch of case studies and be like, are we getting an idea from any of these of what could be effective?

Speaker1:
[29:31] I thought that you weren't allowed to do e-STEM if somebody couldn't, was, like, cognitively impaired. They couldn't, like, tell you if something hurt.

Speaker0:
[29:39] Oh, that, I don't know how they monitored that. It was, like, a really brief article.

Speaker1:
[29:45] I'm coming.

Speaker0:
[29:46] And you're like, yeah, I'm coming. Emily's always like, potentially noncompliant. That's not right.

Speaker1:
[29:53] Do not make people hurt if they can't tell you that it hurts.

Speaker0:
[29:56] That's so true. So true. And an overall great point about communication limitations. But then also for acupuncture, in my continued apology tour to the entire acupuncture world, it turns out that acupuncture has been shown to be effective. Plus what was more effective was acupuncture plus traditional speech therapy methods. So doing your exercises and getting needles poked in your tongue or neck, again, gives me the heebie-jeebies, I'm so sorry, all of acupuncture, was shown to be quite effective and the authors drew on a ton of research from both England and China to get a broader picture of the effectiveness of it as a therapeutic technique.

Speaker1:
[30:43] For dysarthria again.

Speaker0:
[30:45] For dysarthria, specifically for post-stroke dysarthria.

Speaker1:
[30:49] That's super interesting. I don't know. We'll have to do another different dedicated episode to acupuncture because I'm sure there is a lot of different things out there that can be beneficial, but it's not something that we as a Western society over here in America really employ or know very many people who do. You probably do more out in California.

Speaker0:
[31:15] Yeah. Well, and even to that point, I was about to be like, well, we're more woo-woo over here. And in that is my implicit bias. And I totally recognize that. And also our hospitals and insurance are starting to reimburse acupuncture the more that it is being shown to be effective. And again it's like old school e-stim we're not putting electrodes on your body we're innervating your nerves through tiny tiny needles which again i know i have multiple tattoos but like i cannot, it just freaks me out.

Speaker1:
[31:47] You do i didn't know you had

Speaker0:
[31:48] Tattoos oh yeah i got a big old bird a poppy a peach and a few little symbols behind my ear.

Speaker1:
[31:55] Oh i didn't know that Yeah, my toddler. He was cool.

Speaker0:
[31:59] My toddler likes to walk into my bathroom and like point to and play with my tattoos. And I'm like, this is my private time. Please leave me alone. I'm vulnerable right now.

Speaker0:
[32:12] Yeah. Anyways, so that was my giant rabbit hole on dysarthria. Anyways, listeners, if you are a practicing therapist and are wondering about dysarthria or feel confused, So is everyone. You're not alone.

Speaker1:
[32:29] And apparently dysphagia.

Speaker0:
[32:31] And dysphagia. I have so many more questions. We're only getting deeper into the exercise questions.

Speaker1:
[32:39] We'll get there. One day we'll all feel like we have adequately gained enough knowledge to be clinically confident. Until next time, slow it down, over-articulate, and keep being heard.

Speaker0:
[32:52] Ah, great sign-off. So appropriate. it. Until next time.

Speaker1:
[32:57] Bye, guys. You've been listening to Speech Talk.

Speaker0:
[33:01] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker1:
[33:07] If you like this episode and you want to give us some love, please rate us on your favorite podcasting app. Leave a review and tell the world because as podcasters, our love language is in positive affirmations.

Speaker0:
[33:19] And if you like listening to us, you may like more podcasts from our network, Human Content, like How to Be Patient, Bendy Bodies, Knock Knock High with the Glock and Fleckens, and Psychiatry Bootcamp. If you have a research topic you want us to cover, or you have episode comments, clinical experience you want to share, or just want to send us some love letters, send us an email at hello at speechtalkpod.com.

Speaker1:
[33:43] If you want even more speech talk content, check out our website at speechtalkpod.com, where you can find all of our resources we made for you, copies of articles covered, and Eva's blog following these topics and more.

Speaker0:
[33:56] We're your hosts, Eva Johnson and Emily Brady.

Speaker1:
[33:59] Our editor and engineer is Andrew Sims.

Speaker0:
[34:01] Our music is by Omar Benzvi.

Speaker1:
[34:03] Our executive producers are Aaron Corney, Rob Goldman, and Shanti Brooke.

Speaker0:
[34:08] To learn about Speech Talk's program disclaimer and ethics policy, verification and licensing terms, and HIPAA release terms, you can go to speechtalkpod.com slash disclaimers.

Speaker1:
[34:20] Speech Talk is a proud member of the Human Content Podcast Network.