Can You Hear Yourself Talking?

Speaker0:
[0:15] Hi, everyone. I'm Emily.

Speaker1:
[0:18] And this is Aoife.

Speaker0:
[0:19] And you're listening to Speech Talk.

Speaker1:
[0:22] We're your research book club so you can do evidence-based practice in practice.

Speaker0:
[0:26] So let's start talking.

Speaker1:
[0:28] And let's start talking with what was fun this week, Emily? What happened?

Speaker0:
[0:32] So this week was my oldest birthday. You turned eight. And it was such a good day. I made a homemade ice cream cake.

Speaker1:
[0:44] Which I wish you know was possible. I thought that was like factory magic.

Speaker0:
[0:48] Yeah, Eva said, how long do you bake it for?

Speaker1:
[0:54] Just out here asking the important questions.

Speaker0:
[0:58] And I took him to the mall and holy cow, he is not allowed within like a hundred miles of a mall and like my credit card. That boy went wild, but it was fun. And so it's crazy to see your biggest grow up. How was your week?

Speaker1:
[1:15] My sister-in-law works in schools and she's out of school now. So we had a great time. I was like, oh my gosh, how come we don't hang out like this more? And then I remembered the last time we hung out like this was also last summer when she doesn't have work. So we've been hanging out a ton. We've been watching the World Cup, having a good time. And, yeah, man, it's been summer vibes. Like, it's been awesome.

Speaker0:
[1:43] I love that. I actually, I think that it's nice in the sniff world because we end up, for whatever reason, having a lesser caseload in the summer. And I think it's because everybody is summer vibing. So when you get those days that it's just short and you get to enjoy the weather and be with your friends, it's so nice. Yeah, man.

Speaker1:
[2:04] Hot girl summer is like actually keeping people well.

Speaker0:
[2:10] It does. It's like they just lay out. That's why you get those old bitties that look like leather.

Speaker1:
[2:16] You're like, okay, we see that sunscreen hadn't been invented. Let's talk about covering up now. And please stop going into the courtyard for cigarettes. All right.

Speaker1:
[2:28] Moving on. So last episode, I hope it was last episode, we introduced the idea of doing some speech headlines. So here are our headlines. First, a study coming out of Archives of Gerontology and Geriatrics, that is, study of aging, by the way, found that dysphagia independently predicted institutional discharge from hospitals. So that means when you're getting discharged, you're not going home, you're going to skilled nursing or a different institution. And even after they controlled for stroke severity and dementia. So this means that dysphagia is a leading indicator of where patients are going to end up after the hospital.

Speaker0:
[3:07] That's actually a super interesting one because recently I had a patient, like I went to UR, it was my first ever UR, and the admissions director was like.

Speaker1:
[3:18] So what about this? Is that like undercover reporting? What is UR?

Speaker0:
[3:22] Oh, I actually don't know what it stands for. It's like the meeting where they talk about clinically all the patients and what they're going to be doing. Like a team. Yeah, stand up. That's like a weekly meeting and they're like, can this person go home? They're on your caseload for dysphagia. And I'm like, oh no, they had a GI diet. I'm just making sure. Like send them on their way.

Speaker1:
[3:46] Oh, that's so cool. I love going to stand-up. It doesn't happen often, but I feel like you really get this holistic picture of what's happening with the patient and what it means for them to be able to go home or to their next level of care.

Speaker0:
[3:57] Yeah, that's interesting, guys. I always think that our stuff doesn't keep people, so I'm going to have to read that one, Viva.

Speaker1:
[4:04] There you go.

Speaker0:
[4:05] And in NeuroImage Clinical, a new study on post-stroke aphasia found that the pattern of brain damage, not just the location, predicts what language skills are affected and how well someone recovers. Big idea is that aphasia isn't just about the particular location that was affected by the stroke. It's about how the communication networks is disconnected. And we'll put those links in the show notes.

Speaker1:
[4:33] Yeah, I always think about that, that like, when I'm doing these little drawings about what a stroke actually looks like, because in lieu of having the MRI image to show patients, I'm like, look at my little line drawing of your brain. It looks kind of like a misshapen bunny. and then I show where the stroke is and then how the kind of watershed of impaired tissue is within the initial line drawing and I'm always kind of showing how things are disconnected and then through therapy we're trying to reconnect lines in different ways so I really like that it's not just about you know right side left side frontal parietal lobe it's Where are we seeing this pattern of disconnection between neurons? So if you love getting to these types of little quick research updates, then you're going to want to check out Medlines. It's a brand new show from our network, Human Content, and is produced in partnership with the New England Journal of Medicine. It's medical headlines keeping you up to date faster than you can write your session notes.

Speaker0:
[5:34] And Eva is actually going to be a co-host. It's so exciting. So you'll be hearing her voice over there, too. um go find it wherever you get

Speaker0:
[5:44] your podcasts and do not worry eva's not leaving us just yet for her other big adventures.

Speaker1:
[5:52] Just get a double dose blushing okay let's let's move on to something more comfortable like today's topic episode um okay so this week's topic came from something that has been just literally staring me in the face like across the session table staring me at the face um We talk a lot about aphasia and what it looks like and how we treat it, but we don't always talk about the feedback loop and why it's broken in aphasia. So Emily, can you please explain what a broken feedback loop is and if you've worked with patients who have this?

Speaker0:
[6:27] I might be wrong.

Speaker1:
[6:30] Let's find out. Pop quiz.

Speaker0:
[6:32] I know. So what I'm thinking it is, is that when they're giving or getting information, they're not processing that information correctly. So they're not able to alter or make changes to that communication or understand when something has gone wrong. So then they can't fix it. Am I close?

Speaker1:
[6:53] You're like, you are very much in the ballpark.

Speaker0:
[6:56] So dang it, that's not right.

Speaker1:
[6:58] It is that it is that idea of correction, but it's specifically with when somebody is talking, they are not hearing themselves. It's not information they're getting from somebody else. It's the information that is coming out of their mouths. And normally what happens is we hear a broken word or an impaired word, right? I mean to say, of course, I'm like, I have to say a word and can't think of any. God, what is a word? Okay, I go to say banana. Right. I go to say banana instead I say banana. Immediately my brain goes, that was not right. Let's try again. And you correct to banana. So that is the feedback loop. You hear it. You go, oh, that was wrong. You correct it. A broken feedback loop is when our patients are saying, and they keep going and they're not hearing that what they're saying doesn't make sense. They're using the wrong words. It's not like intelligible language at all. And it's really hard to get that across because they're not hearing it.

Speaker0:
[7:59] I have actually seen that quite a few times. And I don't know if I'm supposed to just be commenting on this. But whenever I see it, I always end up saying like, you know, you said X. Did you mean X? Like you said, did you mean to say?

Speaker1:
[8:16] I feel like we just I was like, I think we sound like the adults in Charlie Brown.

Speaker0:
[8:23] But oh don't say that that's copyrighted is it copyrighted to mention them.

Speaker1:
[8:27] Can we reference i think we can reference charlie brown's name right charlie brown

Speaker0:
[8:33] They can want me.

Speaker1:
[8:35] I will ignore you but only gently um yeah so when you have to you start to have to provide that interruption you have to start to bring their attention to it so this paper that we're covering today gets into exactly that. It's called Impairment of Speech Auditory Feedback Error Detection and Motor Connection in Post-Stroke Aphasia from Beresma and colleagues out of the University of South Carolina. It was published in 2021, so a few years back now. And the question they're asking is, can people with post-stroke officia accurately detect errors in their own speech feedback? And if not, what does that mean for how they communicate? So, Emily, let's talk a little bit more about the feedback loop for context.

Speaker0:
[9:19] Yeah, okay. So when you speak, your brain is not just sending a command to your mouth. It's doing something much more sophisticated. It generates a prediction, a preview of what your speech should sound like before the sound even reaches your ears.

Speaker1:
[9:34] So you should already know what your words should sound like.

Speaker0:
[9:38] Right. And when you hear the words come out of your mouth, your brain checks what it heard against what you predicted. That is the feedback loop.

Speaker1:
[9:46] This is how we know when we've said something incorrectly. And our brain does this crazy fast, like in milliseconds. Our automatic correction response kicks in at around 100 to 200 milliseconds after the error.

Speaker0:
[10:00] It's so crazy to think that our brain operates that fast. And I know that it can, you know, because like you slam on your brakes, but it's weird to think about that as even in speech.

Speaker1:
[10:11] Yeah, I literally can't think that fast. Like our brains are thinking faster than we're thinking. The brain is a wild place. Anyways, so that's exactly right, though. It's happening below the level of conscious thought. And this whole system is predominantly on the left side. It's left lateralized. And a series of brain segments that are called the dorsal stream work together for this auditory-motor integration that's happening. So what happens, Emily, when somebody has a left-sided stroke? And... They're now, this whole process is impaired.

Speaker0:
[10:47] Yeah, that is our language center. Your language center is on that left side, so we're going to see all of those auditory breakdowns. They're not going to have the feedback loop. They're going to have an aphasia. They're going to be burp, burp, burp.

Speaker1:
[11:01] Yeah, and apraxia. I think, I keep laughing because I'm like, it sounds so terrible that we're saying burp, burp, burp, but it's really hard to fake a jargon word or a neologism, which are these sounds that people with some more severe aphasias say that are nonsensical strings of sounds sometimes, it's very hard to make one up on the spot. So brr-brr-brr is sort of what we've apparently come up with. And I think part of what's so hard is that they are already struggling so much with the aphasia component, right? Like they're not getting the right word out. What's coming out is like letter soup. And on top of that, you have to provide this feedback to get them to recognize or their ability to recognize it is, you know, been deteriorated. It's so hard. Like we take speaking for granted so much of the time and we tend to take our errors for granted. We go, oh yeah, I know I made a mistake. I said a two instead of a five. You know, we can self-correct. And for them, they can't. So they're just kind of saying nothing and have no idea it's going on a lot of the time.

Speaker1:
[12:12] Okay, and we'll get back to you with how the researchers came up with a way to evaluate this after the break.

Speaker0:
[12:21] Okay, study design. They recruited 34 individuals with chronic left hemispheric strokes. And I want to emphasize chronic. They mean time post-stroke was about five and a half years. So these are not just people who had a stroke. There were 25 neurologically intact age-matched controls. So Eva, tell us how they set up that study.

Speaker1:
[12:49] Yeah. So before I get into it, I just want to say that in terms of the age match, basically they, just a quick summary, they took the folks who had the chronic left hemisphere stroke, and then they went and they said, okay, we're going to try and find a bunch of people who have not had a stroke and try and make sure that our age demographics are as closely linked as possible. So they use this research paradigm called the Altered Auditory Feedback or AAF because speech therapy loves acronyms. And here's how they set it up. You are sitting in a soundproof booth. You have earphones in and a microphone and you're hearing your own voice fed back through the earphones in real time. So it's kind of like having a live monitor of yourself. And then during that live feedback, either while you are talking or while you're listening to a playback, the researchers, they get in there and they sneak in a brief pitch shift. So, Your voice has been recorded. They alter your voice just a tiny bit in pitch. And then suddenly your voice sounds higher or lower than it actually is.

Speaker0:
[13:56] That's crazy. They're just like throwing you off.

Speaker1:
[14:00] Yeah, I it would drive me crazy. I was recently doing a recording and I could hear my voice in other people's computers while I was trying to read. And I could not. I was like everything about my ability to talk completely broke down while hearing my own voice. I was so upset. I was like, everybody's back. Yeah. Anyway, so then after each trial, you press a green button. Yes, I heard the change or red button. No, I didn't hear the change.

Speaker0:
[14:28] So you're consciously reporting whether or not you notice that error.

Speaker1:
[14:32] Yeah, exactly. And then they also ran a control trial where there was no pitch shift because it's really important to see, like, can people identify if there's no change so that we're verifying that they can understand the presence of change and no change.

Speaker0:
[14:47] They measured something else too. It was the actual acoustic speech signal during vocalization. How much did your fundamental frequency actually shift in response to the pitch shift? That gives you the motor correction behavior, which is different from the conscious did you notice it behavior.

Speaker1:
[15:04] Right, exactly. So what they're kind of teasing apart there is the first thing you do is, did I notice a change? Yes or no. And if I did notice a change, And so they say they shifted your voice up a little bit. The next time you do the recording, they're saying, did you shift your voice down to kind of correct for that change? And so that's what they're calling the motor correction behavior. Like, how much did you actually attempt to correct the pitch shift?

Speaker0:
[15:33] It seems like I think if that was happening to... Like normal people, right? You might like almost be like a jump scare. Like, oh, I sound so, I sound like high pitched or I sound like low pitched all of a sudden, you know?

Speaker1:
[15:48] And then literally every time I hear how we talk, like every time I listen to one of our episodes, I'm like, oh my God, that's what I sound like in real life. It just blows my mind.

Speaker0:
[16:02] I know. In my own ears, my voice already sounds a lot deeper than it does on our podcast. And I listen back and I'm like, oh, that's it. I'm kind of annoying.

Speaker1:
[16:14] I don't think you're annoying. I love listening to your voice.

Speaker0:
[16:18] So what did they find? I got jump scares. What did they see?

Speaker1:
[16:22] So the main idea that they found was that stroke participants were significantly less accurate at both detecting and rejecting pitch shift errors compared to their control counterparts. And this was true regardless of whether they were vocalizing or just listening to the playback.

Speaker0:
[16:37] Wait, really? Both tasks?

Speaker1:
[16:39] Yeah, yeah, for both. And the second part is key because when they're just listening, there's no voice production, no motor output. The error detection is still worse. So even if they don't have the added component of vocalizing again, they're still struggling.

Speaker0:
[16:57] So it's not just that they can't control their voice. They can't accurately hear the error in the first place.

Speaker1:
[17:02] Right, exactly, which gets back to that auditory feedback loop. It's not just a motor problem. It's like the whole auditory system itself. The part that's supposed to be flagging those incoming errors of going, hey, I have, that was an impaired production. Let me try that again. And it's less sensitive after the left hemisphere stroke.

Speaker0:
[17:22] I feel like this is interesting and it makes me happy that this is something that I kind of just did and I, you know, kind of felt bad about doing, you know, like people will tell me, and I say, is that what you mean to say? And I say it back to them just to clarify. So it makes me feel better, at least like in my own practice, that I'm, you know, going back and trying to highlight it. Maybe it's, you know, not the same because they're still not hearing it based on this research. But I don't know, maybe they hear it better from somebody else's perspective, too.

Speaker1:
[18:00] Yeah. And I think that part of what you're saying is so integral to the speech therapist experience, which is that sometimes you just start noticing that the techniques you're using are effective, whether or not you remember having learned it or whether you were trained in it. You're just kind of sitting there recognizing, hey, this person is talking to me and they do not appear to be aware of what's going on. So I'm going to start providing that feedback, whether it's auditory, visual or tactile. Like you can tap them. I sometimes have just held a mirror up to people. I have... Done exactly what you're talking about, where you interrupt them and you let them know. And sometimes they go, oh, no, and they look completely bewildered. They have no idea that what came out of their mouth is actually what they said. And that's kind of that interruption that we have to initiate. We have to start getting in there and like make kind of helping to rehab that feedback loop.

Speaker0:
[19:02] When they were talking about the compensation part, did they actually start to compensate? Maybe just like less?

Speaker1:
[19:11] Yeah, the stroke population did eventually start to compensate on those errors. They just did it less, exactly. So it was less strong in the early window of those iterations. But here's the interesting part. After about 200 milliseconds, which again is so short, I can't even contemplate it, the later compensation was comparable between groups. So the stroke group is beginning to keep up at the later stages.

Speaker0:
[19:41] So what does that mean?

Speaker1:
[19:44] So they interpreted it as the fast automatic like reflex level feedback is impaired, but the slower, like more deliberate, the voluntary adjustments, those intentional adjustments that you and I are just talking about are relatively preserved. So again, it starts to get a little complex, but the late motor system can still do its job. The fast reflex part, not so much, but that doesn't mean that the learning and the correction isn't occurring. It's just not the fast reaction. It's the early subconscious part that's broken. And if we keep promoting that feedback, they can start to make the adjustments more independently.

Speaker0:
[20:28] So there's something left to work with that voluntary layer.

Speaker1:
[20:31] Right, exactly. That's where we step in as clinicians, right? And they found that the lower error detection accuracy during the listening task correlated significantly with smaller early compensation response during vocalization.

Speaker0:
[20:44] So the worse you are at hearing the error, the worse your early automatic correction is?

Speaker1:
[20:50] Yeah, exactly. So if you are particularly bad at hearing that there is a problem, your ability to do that initial correction is also pretty bad.

Speaker0:
[21:01] Yeah, that makes sense. If you are already heavily impaired, if you're not hearing the error, it would make sense that you're not going to attempt to correct it. That needs more work.

Speaker1:
[21:14] Right, exactly. And so there's like a direct mechanism link there. The error signal drives the correction, I think is what you're getting at. So if the signal isn't coming through clearly that, hey, we got to make it that there was an error, then we're not going to start that secondary part of, hey, we need to make a correction. So this kind of reminds me of a session I was having today with a patient who has pretty severe aphasia and some apraxia. It's really hard to kind of pull apart because her aphasia has a lot of neologisms and jargon, and we're doing the session in Spanish. And so it's just very linguistically complicated. But we started matching...

Speaker1:
[22:00] Uno cards just by color and as we were labeling them and saying them initially they were not at all the right color names like she was not saying like brojo verde amarillo she was saying these jargony words and then every once in a while i would as i would say hey that's not it and i would say the word again the more times we did the activity in these kind of weird jargon sentences, I would hear a random rojo, I would hear a random amarillo. I was like, oh, the words are becoming salient. Like she's getting the words. And the more we stop and we provide that interruption and awareness, the more it's coming through. And it was kind of crazy to see it slowly happen across the episode. I mean, not the episode, across our session. Because even though she wasn't saying the words like 100% right. It went from practically zero times to maybe like four out of 10. And that was awesome.

Speaker0:
[23:07] Yeah, any progress always feels like, you know, huge wins, especially when you're doing language treatments outside of your native language, Eva, kudos for that session. That sounded like it was a particularly challenging one.

Speaker1:
[23:25] Yeah, I had an actual interpreter in a different session for a patient. And it's one of those things where I always talk to the interpreters afterwards. I'm like, I just want to make sure we all heard the same thing, because this can be like, I think my Spanish is pretty good. But you start adding in aphasia and apraxia and I'm suddenly like, I don't necessarily know I'm keeping up anymore. So it's always nice to have the interpreter there for backup.

Speaker0:
[23:55] I need you to connect this aphasia as a language disorder because I keep thinking, I mean, we're talking about pitch and vocal sounds, not words, not sentences. What does this have to do with what our patients are struggling with every day?

Speaker1:
[24:12] Yeah, and I think that's kind of a good pushback. Like, in the article, they're adjusting vowel sounds. They're not really adjusting full words. They're just tuning pitch up a little bit, a little bit up and a little bit down. So, you know, how does that affect people when they're actually trying to produce, like, full words and full sentences?

Speaker1:
[24:34] I think this is kind of my favorite part, the practical aspect. This is important. They're looking at it as a language disorder, right? So they're taking a look at whether error detection performance is related to the WAB or the Western aphasia battery and how patients performed taking this test, which is an aphasia battery. Patients are asked a series of questions, and based on how they score, it helps clinicians understand in what ways their language might be impaired. And they found a significant correlation specifically with the repetition subtest. So the subtest within the Western aphasia battery that patients are literally just repeating words or phrases.

Speaker0:
[25:15] So not comprehension, not fluency, repetition.

Speaker1:
[25:20] Yeah, repetition. And I feel like that really makes sense in the context of this conversation because we're taking a look at that feedback loop, right? So if they're hearing you and they're trying to say something and it's erred, it kind of mirrors that concept of the feedback loop, right?

Speaker0:
[25:34] Now that we understand that... You know, we can help people with repetition, that there is this auditory feedback loop that we need to be targeting. How do we do this? How are we going to do this?

Speaker1:
[25:50] Yeah, so I think a few things for me. First, it gives us a mechanism for why repetition is so hard, even with patients whose comprehension is pretty good. That monitoring loop that is driving their self-correction is kind of broken down a little bit. It's not just about their output. They may not be getting like a clean feedback into their own productions.

Speaker0:
[26:15] Yeah, and I always notice too when my patients start to notice their feedback, I always get excited. And that's when I feel like patients are the most frustrated. Don't you see that? They're like, oh, and they'll like grunt or growl or like say something. And I'm like, no, but it's good because you weren't recognizing before and now you're seeing it now you're with me so it's good and they're just angry.

Speaker1:
[26:42] Yeah that is such a good like um emotional distinction you're drawing because when they have no idea that they're all these errors there's kind of like happily talking along at you and as the person listening you're like i have no idea what's going on and but for them there's no frustration because there's no recognition and then they start to recognize it And there is this transitional difficulty. I think you really hit the nail on the head where they're starting to be like, oh my God, I'm saying it wrong and I can't get it out right. And so there's this, yeah, there's this anger sometimes, frustration. I do a lot of deep breathing with my patients. Like when they start to get to that point, I'm like, okay, hey, hey, hey, let's take a deep breath.

Speaker0:
[27:26] Ah like no and it's always so funny because they're like, getting angry and i'm like that's so good and they're like what's wrong with you what are you talking about and i'm like no this is a good sign and they're, like what the heck like i'm mad and you're happy get out like i'm done.

Speaker1:
[27:45] Uh yeah just another way in which we're torturing people

Speaker0:
[27:49] The list goes on but second the late voluntary compensation was relatively preserved is really interesting because it suggests that the conscious layer is still accessible. If you build in tasks that ask patients to deliberately monitor and categorize their own productions, did that sound right? You might be engaging in a compensatory pathway.

Speaker1:
[28:17] Yeah, those compensatory pathways I think are It's like habitual, right? That's what we're trying to tell people. It's like, it's not just about can you react right away? It's can you build the habit of noticing? And that's where we get into like, can you use your phone to record their correct production and their impaired production? Can they hear the difference between those? When they're watching themselves in the mirror, can they see if they're doing like mouth groping where they're kind of making these gestures with their mouth in an attempt to say the word versus when they just go ahead and say, are they noticing these differences? How can we draw their attention to it? And so it's, yeah, it's so good to know that that conscious layer is still intact.

Speaker0:
[29:01] Yeah, which is kind of the point of those cueing hierarchies, but like way more intentionally. I think that sometimes when it comes to therapy or these tasks, I definitely can be quick to say, okay, let's give you some homework. I want you to work on these, but it is important to have a therapist to help them go back through the process. What are they missing? What is going wrong? How can we rebuild that?

Speaker1:
[29:31] Right, exactly. Which brings us to our third point, that if that internal feedback signal is degraded, then that clinician feedback is even more important because now we are their feedback loop, right? We're not just giving them feedback on the results of how they did because, like, it's good practice. We are literally substituting their own detection system. So, I don't know, that's pretty cool. Like, clap for all y'all clinicians doing this. I have a patient right now who has aphasia and apraxia and a broken feedback loop. And he's getting to that stage that you were just describing with frustration. And if you think I get into my jazz voice when we're talking, I have to use like 70% jazz voice with him to help keep him sort of...

Speaker1:
[30:26] Emotionally regulated because when we're joking or we're going back and forth the faster he goes the more errors he has and so he not only needs help with the feedback loop aspect but also just the pacing of it and so I fully go into my smooth jazz radio voice and then he starts to monitor like mirror my pace he mirrors my softness and then he starts trying again with all the appropriate strategies and I just I like leave the session feeling very calm and relaxed because I feel like I've meditated myself

Speaker0:
[31:07] I always forget like how great modeling can even be for a treatment strategy that, like sometimes it's so quick to to want to over explain or overdue and sometimes like the comprehension, is just not there for a variety of reasons whether it's, sometimes our dementia people or sometimes it's like just information overload or they're like this not processing the things that they're hearing the same way, so just i mean showing people what you expect instead of telling them what you want is such like a good way to, get your message through without without saying it.

Speaker1:
[31:54] Yeah i mean it's funny you say that because i was working with one of my patients today who she was really struggling with the neologism which is kind of like these invented speechy sounds they're not real words she just could not get the beginning of her words right. She was just starting all over the place. And so I was trying to visually prompt her, hey, let's just get into the right position. So I opened my mouth like in an ah sound and I was waiting for her to do what I was doing. I was like, okay, we're just going to start here together. And then I just held my mouth open for like two straight minutes while she tried to approximate the same shape.

Speaker0:
[32:36] And I was like.

Speaker1:
[32:37] This is so wild. Like, here I am kind of going, she can't hear it. She can't correct it. And then just to watch her really struggle to make an ah shape with her mouth, I was like, God, this is so much work for her.

Speaker1:
[32:51] It was just such a clear way to see how much effort she's putting in, you know?

Speaker0:
[32:57] Yeah. Yeah, this is a cool episode. I've been recording some script trainings. And script training is just when you're practicing the same thing over and over and over. And they're good for people with aphasia, but mostly apraxia where you're just practicing and watching that model. And the more you practice, the easier it gets.

Speaker1:
[33:24] Yeah. And to the point about modeling, when you're leveraging those mirror neurons, when you watch somebody do something, your brain starts to go, oh, I'm going to try to recreate that motor pattern, right? So these, I'm always so amazed by your dedication as a clinician. I love that you're recording like scripts for your patients. So whether you are a clinician, we hope you have enjoyed learning a little bit more about feedback loop error and maybe some strategies for how to approach that in session. And if you're not a clinician, you're just listening, maybe because you're my uncle, then I hope you learned something. And maybe if you know somebody who's in the hospital doing speech therapy, you got a little insight to what we do. Anyways, we'll see you guys next time.

Speaker0:
[34:11] Thanks, everyone. You've been listening to Speech Talk.

Speaker1:
[34:16] Thank you, everyone, for coming to listen to our research book club. Until next time, keep learning and leading with research.

Speaker0:
[34:22] 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.

Speaker1:
[34:34] 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.

Speaker0:
[34:58] 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.

Speaker1:
[35:11] We're your hosts, Eva Johnson and Emily Brady.

Speaker0:
[35:14] Our editor and engineer is Andrew Sims.

Speaker1:
[35:16] Our music is by Omar Benzvi.

Speaker0:
[35:18] Our executive producers are Aaron Corney, Rob Goldman, and Shanti Brooke.

Speaker1:
[35:23] 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.

Speaker0:
[35:35] Speech Talk is a proud member of the Human Content Podcast Network.