May 25, 2025 • 23 mins
05/25/25
The Healthy Matters Podcast
S04_E16 - We're Talkin' Speech-Language Pathology
With Special Guest: Adam Terrell, MS
When it comes to the field of Speech Pathology, we might tend to think it's all about helping people with the challenges of a stutter or helping kids get out a proper "R" sound - but it turns out there's a lot more to it! Communication is a 2-way street, and there can be a lot to manage when it comes to speaking, listening and retaining information. From a child struggling to say their first words, to stroke survivors, a Speech-Language Pathologist (SLP) can be essential to opening up the doors of language and communication.
But it turns out there's even more to it - and joining us on Episode 16 of our show is Adam Terrel (MS). He's a SLP at Hennepin Healthcare and he'll walk us though what the job is really like in a hospital setting and the variety of patients helped by the work of SLPs. We'll cover everything, from diagnosing swallowing issues to therapies and outcomes for those looking to regain their voice. Communication is an essential part of our lives and whether you're a parent, a patient or just curious about the world of Speech-Language Pathology, you've come to the right place. Let's get talking!
American Speech-Language-Hearing Association I ASHA.org
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 01 (00:01):
And now, here's our host...
Speaker 03 (00:17):
Hey there, welcome to the Healthy Matters podcast.
I'm pediatric nursepractitioner Shayonda Beecher, a
previous guest of the show, andI'll be sitting in for Dr.
Hilden for this episode.
Today we're going to dive intothe wide world of speech
pathology.
So I see a fair amount of thisin my field, pediatrics, but
today we're going to be joinedby Adam Terrell, who is an
expert in the subject.
(00:37):
He's been a big help to many,so Adam, welcome to the podcast.
Thanks
Speaker 00 (00:41):
for
Speaker 03 (00:41):
having me.
So let's start with the basics.
Speech-language pathology.
What is it?
Speaker 00 (00:46):
Yeah.
So speech-language pathologyencompasses a lot.
Speech kind of refers to moreof the muscles, lips, voice box,
and how that impacts verbalcommunication, where language is
going to be more thatunderlying system of how
sentences are structured,grammar, reading comprehension,
written comprehension, thingslike that.
(01:08):
So speech-language pathologistswork to help people with their
speech, their language,cognition, and swallowing kind
of throughout the continuum ofhealthcare and the lifespan.
Speaker 03 (01:17):
So it's not just speech therapy.
It's a lot more than that.
There's a list of disordershere that's kind of long, so I'm
wondering if you can help usdefine and distinguish between
the following.
So for example, what's thedifference between a speech
disorder and a languagedisorder?
Speaker 00 (01:30):
So speech disorder, like I said, is going to be
those lips, tongues, and voicemovement.
What people might traditionallythink of when they think of
speech therapy, producingcertain sounds clearly or
working with people who stutterto reduce that just language
disorders are going to be morethat underlying system so
difficulties expressing thoughtsunderstanding what people say
might show up with difficultycomprehension finding your words
(01:52):
and expressing full andcomplete thoughts
Speaker 03 (01:54):
so how does that play along with like a
communication disorder or ifsomething's related to your
voice like a voice disorder
Speaker 00 (02:00):
so voice disorders are typically going to be
related to the voice box or thelarynx itself so difficulties
how your vocal folds move openor close too much or too little
movement or any damage thathappens to the vocal folds that
might impact how that voice isproduced.
Communication disorders canoverlap with language disorders,
but can also refer todifficulties with like social
(02:22):
interaction, what we callpragmatics or how you do kind of
navigating those hidden partsof language, how close to say to
someone, how much eye contact,too much eye contact, things
like that.
Speaker 03 (02:33):
So you mentioned vocal folds.
And for those of us who may notknow what that is, can you
break that down a little bitfurther for us?
Speaker 00 (02:39):
Yeah.
So you have kind of two piecesof of like tissue and muscle
that sit right behind yourAdam's apple in a V shape.
And it's open when we'rebreathing.
But then when we turn our voiceon, those vocal folds squeeze
together, vibrate, and that'show you produce your voice.
And then that whole system ispart of what we call the larynx.
Speaker 03 (02:59):
Excellent.
Okay.
So keeping with like the areaof the mouth that we're talking
about here, do you ever workwith swallowing disorders?
Speaker 00 (03:05):
Yeah, a ton.
That's a lot of what SLPs do inthe hospital.
Someone might have a swallowingdisorder for a lot lot of
different reasons, and whetherthat's difficulty with chewing,
moving the food around in themouth, or getting that safely to
the stomach rather than theairway.
Speaker 03 (03:20):
So you think about swallowing disorders, speech
disorders, voice disorders, andall of that's controlled by the
brain.
Do you ever work with cognitiondisorders?
Speaker 00 (03:28):
Yeah, that's primarily where I practice.
So working with people afterstroke or traumatic brain injury
to help support or find ways tokind of work with changes in
attention, memory, planning,speed of thinking, organization,
things like that.
Speaker 03 (03:42):
Can you give me an example of that?
I'm just curious.
Yeah.
What a cognition disorder lookslike when you first meet with
somebody and then what do you doto help improve their outlook?
Speaker 00 (03:50):
Yeah.
So that might look like a lotof distractibility or kind of
forgetting things, whetherthat's where they put their keys
earlier in the day or like whatday it is.
So it can really look like alot of different things
depending on the severity.
What we'll kind of come and dois find ways that people can
structure their environment orset up the day so that they're
(04:11):
better able to focus kind ofwith where their attention might
be.
Coming up with like differentstrategies or tools to support
their memory, maybe writingthings down, getting a notebook
or a calendar system in placethat they can consistently refer
back to.
Speaker 03 (04:24):
So wow, that's really more than just speech
therapy.
Speaker 00 (04:27):
Yeah.
Speaker 03 (04:27):
So you spoke a little bit about folks that had
maybe a traumatic brain injuryor stroke.
Do you ever work with kids withdevelopmental delays?
Speaker 00 (04:35):
I personally don't, but...
SLPs as a whole absolutely do.
We have a great pediatricprogram here, and then SLPs are
also really involved in earlychildhood or working in the
schools with pediatrics as well.
Speaker 03 (04:47):
And for the adult population, you mentioned
stroke, brain injuries.
What about folks with dementiaor Parkinson's or ALS?
What kind of support do theyget from SLPs?
Speaker 00 (04:56):
Yeah, absolutely.
So a lot of those moreprogressive diseases, we're
really focusing on how tosupport swallowing and nutrition
as the disease progresses, butalso looking at what effective
communication the looks like asour way of understanding or
expressing changes over time,finding ways to really focus on
expressing and understandingthose things that are important.
(05:16):
With like ALS, for example, assome of those speech systems
deteriorate, working on comingup with other ways to
communicate.
So whether that's what we callvoice banking, where you might
record someone's voice early onin the process so that we're
able to kind of synthesize it ormimic it over time, or using
what we call AAC or alternativeand augmented communication to
(05:38):
develop like a tablet or iPadkind of picture or sentence
communication where you're ableto type or write out what you're
thinking.
Speaker 03 (05:46):
So I'm thinking Stephen Hawking,
Speaker 00 (05:48):
right?
Yeah, great example.
Speaker 03 (05:49):
So is that sort of what happens in clinic too or
Speaker 00 (05:51):
with our patients?
Yep, so we have, especially inour ALS clinic, that's a lot of
that alternative andaugmentative communication.
So setting up a device, gettingit to track someone's eyes so
that they're able to expresstheir thoughts just through
looking.
Speaker 03 (06:04):
That's pretty
Speaker 00 (06:04):
cool.
Speaker 03 (06:04):
Yeah.
What about folks with cancerWe're seeing a lot more head and
neck cancers.
Speaker 00 (06:08):
Yeah.
So it can look, again, verydifferent depending on where
someone's at with their cancerdiagnosis.
But looking at adaptive ways tofeed, there's different
utensils that can be used tokind of help bypass the tongue
or work around the tongue,determining what foods might be
kind of safe to eat, ways tostrengthen or like manage the
(06:30):
tissues after radiation can be areally big way that speech
pathologists are involved withhead and neck cancer.
And then looking at to voicechanges as well.
If someone has a totallaryngectomy where their entire
voice box is removed, how can westill effectively communicate
without the ability to producevoice?
Speaker 03 (06:47):
My kid's going through puberty.
His voice is changing.
Speaker 00 (06:50):
Do you guys do anything for that?
Unfortunately, no.
Speaker 03 (06:54):
Speaking of my kids, we are very familiar with
sports injuries.
We see a lot of our favoriteathletes getting PT or courtside
or after the season's over.
But there's people that usetheir voices a lot too, singers
or teachers.
Do you ever work with folksthat have voice disorders
because of overuse of theirprofession?
Speaker 00 (07:12):
Yeah, yeah.
So singers, teachers, publicspeakers, religious leaders,
like very high risk for voicestrain, voice overuse.
So yeah, absolutely work withthem to kind of establish good
vocal hygiene That's what wecall.
So what sort of things can yoube doing day to day?
Are you getting enough water?
Are you having times whereyou're not using your voice to
kind of protect that mechanism?
(07:32):
And then different exercisesand relaxation techniques to
help kind of reduce some of thatstrain as well.
Speaker 03 (07:37):
So are you telling me that Taylor Swift and Beyonce
both have an SLP?
Speaker 00 (07:40):
Most likely.
Speaker 03 (07:42):
Okay.
So you're not with Taylor Swiftor Beyonce, but you work here
as a speech languagepathologist.
What do you do in a day to day?
Speaker 00 (07:47):
So I work in our outpatient TBI program.
So primarily I'm working withpeople after mild to severe
trauma.
traumatic brain injury.
Seeing patients for about anhour, working on different ways
to manage their cognitive skillsprimarily, but then also some
communication intervention aswell.
But we have SLPs all throughoutthe hospital.
We have a team that works ininpatient rehab, kind of really
(08:10):
helping people gethigh-intensity therapy
throughout their stay.
We have people in acute care.
We have our pediatricsoutpatient and inpatient as
well.
So we're all throughout theclinics and hospitals.
Speaker 03 (08:21):
So you see a patient following a stoke, and you're
working with them hour a day.
What's your trajectory in timespent with them?
Is it based on their severity?
What does the progression looklike from the first day you meet
them to graduation?
Speaker 00 (08:35):
Yeah, yeah.
So again, yeah, really going todepend on patient by patient
and severity, really want tokind of do an in-depth
assessment on how thosecognitive communication and
swallowing skills are working.
So we'll do a clinical exam ofthe swallow where we have them
eat and drink and we look atkind of mouth and motor
movement, see how those nervesand muscles are working.
(08:56):
And then if needed, we might doa more in-depth assessment of
the swallow where we either takesome x-rays or some pictures to
see how food and liquid aremoving, making sure those are
going down safely.
And if not, what can we doabout it?
But then also really trying toestablish kind of what thinking
and communication skills lookat.
Does the person have betterverbal output than they do
(09:17):
comprehension?
So are they better able toexpress their thoughts than
they're able to understand?
Is their understanding reallygood, but they're having a tough
time expressing their thoughts?
And then what can we do tosupport that?
Using like a picturecommunication board, writing
things out, using more simplesentences, things like that.
We really want to see wheretheir strengths, where their
weaknesses are, and reallyestablish what we want to be
working on.
Speaker 03 (09:37):
So I can imagine that you're meeting this person
for the first time.
You may not Do you pull infamily or others to help
evaluate?
Speaker 00 (09:46):
Absolutely.
Yeah.
Yeah.
Family, friends, whoever'snearby.
Such great input for not onlytelling us what that baseline
is, but what sort of things areimportant to communicate about
so that that way we can reallytailor our therapy to what's
important to the patient.
Speaker 03 (10:00):
You mentioned x-rays and imaging to get a sense for
swallowing, but are there othertechnology or devices that you
would use in your assessment orevaluation of the progress?
Speaker 00 (10:10):
Yeah, so the two big ones for swallowing do what we
call a modified barium swallowstudy, which is an x-ray of the
swallow.
And then we can also do what wecall a flexible endoscopic
evaluation of the swallow, wherewe take a camera down the nose
and look at the swallow fromkind of the top down.
Other...
Technology we might use ifsomeone's having any difficulty
(10:30):
breathing, they have atracheostomy or a tube just
below their Adam's apple to helpthem breathe, we'll use, it's
called a speaking valve, wherewe can kind of create a one-way
valve to help them turn on theirvoice, essentially, and that
has some really profound impactson the swallowing communication
as well.
Speaker 03 (10:46):
I know that you're focused on individuals who have
had a stroke and helping themrecover after a brain injury,
but it sounds like theprofession itself is seeing
everybody from baby to
Speaker 00 (10:57):
elderly.
Yeah, all throughout thelifespan.
Speaker 03 (10:59):
So how does that look from when you're training
to be an SLP?
Do you have to understand howeverything works for every
single age group?
Speaker 00 (11:07):
Yeah, yeah.
So the practicum forundergraduate and graduate
school is across the lifespan.
I know some programs aregetting a little more tailored
these days to kind of have youpick a little earlier on in your
career path if you think youwant to go more pediatrics or
more adults, more medical ormore school.
But at least when I wentthrough it, it was
Speaker 03 (11:25):
everything.
And so tell me, because we'rereaching graduation season or we
are in graduation season,there's probably a couple folks
out there who are trying tofigure out what they want to be
when they grow up.
How does one become a speechpathologist?
Speaker 00 (11:39):
Typically, it's a four-year undergraduate program
for speech-language pathology,and then you do two years of
graduate school on top of that.
After that, you'll have about anine-month fellowship program,
and then you're a fully licensedspeech therapist.
Speaker 03 (11:51):
And that fellowship, is that then defined to the
population you want to workwith?
Speaker 00 (11:55):
Yeah.
So at that point, you'reworking full-time.
You're just not fullycertified.
Got it.
Speaker 03 (12:00):
Okay.
We're talking with AdamTerrell, who is a
speech-language pathologist.
We're going to take a quickbreak, and when we come back,
we're going to dive in a bitdeeper into the wide world of
speech pathology.
Stay with us.
We'll be right back.
Speaker 02 (12:15):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life.
and all that it brings.
Hennepin HealthCare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(12:36):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin HealthCare is here foryou and here for life.
Speaker 03 (12:51):
And we're back talking to Adam Terrell of
Hennepin Healthcare about speechpathology.
So Adam, how did you personallyget into this field?
Speaker 00 (12:59):
Yeah, so it's kind of in the family business.
My mom's actually aspeech-language pathologist.
Does she work here?
No, she's back in Wisconsin.
She works primarily in theschools and is now teaching at a
university.
But so I've kind of alwaysknown about it and been
fascinated by language and theway it kind of shapes people.
the way we think about thingsand how we determine what's
(13:20):
important to us, who's close tous.
And then, yeah, once I reallyfound out about the whole brain
side of speech-languagepathology, that had me sold.
I love seeing how the brainworks, how language is so just
embedded throughout the brain.
And then once I learned moreabout speech pathology, finding
out ways that you can not onlysee how language plays out in
(13:40):
the brain, but how you can helpand support language, yeah, I
was sold.
Speaker 03 (13:44):
Very cool.
Can I ask a question?
I'm going to jump on a tangenthere.
You spoke a bit about languageand development and cognition.
At Hennepin, we see a lot ofpatients who do not have English
as your preferred language ofchoice.
When you have somebody thatspeaks Spanish, Somali, Hmong,
how does that work.
How do you as an Englishspeaker navigate language
(14:05):
differences when you're tryingto tackle language?
Speaker 00 (14:07):
Yeah, great question.
So, I mean, we're incrediblylucky to have a phenomenal
interpreter department here.
So, we work really closely withthem to kind of help bridge
some of those culturaldifferences to help figure out
how children or adults might beusing their language.
So, there are certainmilestones or ways that we use
language kind of across theboard.
(14:28):
And then there's a lot ofcultural nuance.
So, we really lean on theinterpreters for that cultural
nuance.
piece, but then we're lookingat like kind of those root
foundations of language.
How are you using language toexpress wants and needs?
How are you using it tomaintain social closeness,
exchange information?
That's where we kind of fit in.
And that's the system oflanguage rather than the
language that's being spoken orused.
Speaker 03 (14:50):
Good clarification.
I appreciate that.
Thank you.
So we've got the basics down.
I want to dive into why thework in speech pathology is so
important.
Speaker 00 (14:59):
So I think communication is hopefully
relatively straightforward.
That's how we build closenesswith people.
Relationships, exchangeinformation, you know, it's a
pretty day-to-day function.
For the majority of people, notall, but speech is going to be
the primary way that thatcommunication is exchanged.
We also use that reading,writing.
So any challenges there aregoing to have huge impacts on
(15:22):
safety, independence,well-being, but also ability to
advocate and navigate resourcesand the community.
I think swallowing is a big onetoo, just because so much of
our social time is spent arounda table.
And so if there's a change tohow you communicate, interact
with meals, that's going to havehuge social and emotional
repercussions.
And so being able to step inand help with that is huge.
Speaker 03 (15:45):
I love how you say much of our time is spent around
a table and that significancethat plays to social
interactions.
We've heard a lot aboutloneliness and the pandemic in
recent years.
And I wonder what roles docognition and communication play
when it comes to mental healthissues like isolation and
quality of life?
Speaker 00 (16:03):
Yeah, absolutely.
I think cognition is acognitive resources we need to
even have a conversation isreally easy to overlook.
The amount of attention we needto not just pay attention to
what we're saying, but listenwell, be able to plan what we
want to say and listen, be ableto understand, perspective take,
(16:23):
all huge parts of cognition andcommunication.
So when we see changes withthat, it becomes harder to
engage in good quality socialinteraction and communication.
When something's hard, we tendto not want to do it.
This feedback loop of it'sdifficult to do, so we don't do
it, so we do it less, so itbecomes more difficult, really,
really drives that socialisolation.
Speaker 03 (16:45):
So let's talk about the swallowing disorders.
What are some of the seriouscomplications they can lead to?
Speaker 00 (16:50):
The big two that we see with changes in swallowing
are malnutrition and lunginfection, predominantly
aspiration pneumonia.
So When eating is difficult orimpacted, not being able to meet
your nutrition and hydrationneeds is huge.
Unintentional weight loss willjust kind of have huge impacts
(17:11):
on the whole body.
And then as well, if that foodand liquid isn't going down the
right tube, it's going into yourlungs rather than your stomach,
that's going to lead toinfection.
If your body's kind of alreadyat a weak point because of that
malnutrition, that infection isgoing to be a lot harder to
fight off.
Speaker 03 (17:28):
So you're saying that when you identify something
as aspiration pneumonia, that'swhen the food goes down the
wrong tube.
Speaker 00 (17:33):
Yeah, yeah.
So aspiration is just the termwe use when food goes past your
vocal folds into your lungswhere we don't want it to be.
Speaker 03 (17:40):
Correct, yeah.
So it sounds like you'vetouched upon a lot of different
symptoms and disorders that Iknow that I've seen in my
community and even in my family.
And I'm sure some of ourlisteners are wondering the same
thing I am.
How does someone get help ifthey think that they have it?
Yeah.
or their relative has it.
Speaker 00 (17:58):
So if you're seeing any of these signs, that's a
good time to talk with yourprimary care provider.
Speaker 03 (18:03):
And when do you know when it's time?
Like, how do you know it's timeto see the speech-language
pathologist?
Speaker 00 (18:08):
Yeah, so it really depends on a lot of different
factors and where you're seeingthat.
I would say, like, withpediatric populations, if
they're not hitting theirdevelopmental milestones,
initiating communication, youknow, establishing good eye
contact, things like that.
Speaker 03 (18:22):
So you're saying establishing good eye contact
and communication, that's wellbefore they start saying their
first few words.
Speaker 00 (18:27):
Yeah, yeah.
So that's attention, being ableto kind of attend to what the
parents are looking at, saying,things like that.
Huge developmental milestonesfor communication.
Speaker 03 (18:38):
And what about for our elderly?
Speaker 00 (18:40):
Yeah, so changes in swallowing.
If you're coughing, choking,feeling like foods are stuck
during meals throughout the day,that's a really good time to
potentially look at getting theswallow checked out.
But then also changes incommunication or thinking, you
know, difficulty finding words,understanding more frequent
distractions, misplacing items,anything like that, as well as
(19:02):
like obviously any medicalevent, a stroke, TBI, yeah,
probably good to get looked atby a speech pathologist.
Speaker 03 (19:08):
So it sounds like the first thing to do is see
your primary care provider, getthat referral.
And then are we all looking fora speech-language pathologist
here at Hennepin?
Are there community resourcesthat can help provide education
on this?
Speaker 00 (19:20):
Yeah, absolutely.
So typically more pediatricfocus is going to be through the
schools.
Not always, but we know therapyworks best in the environment
that the person's in since kidsare Most often in school, that's
going to be the kind of thebest place to provide therapy.
Other community resources, Iwould say our national
organization, the AmericanSpeech Language and Hearing
(19:43):
Association, or ASHA, is a greatresource that you can look up
when it might be time to talk toa primary care provider about a
referral.
They have great resources forhow to kind of initiate and talk
through that with PCP as well.
Speaker 03 (19:56):
Before we wrap up here, I just had a couple more
questions for you.
What surprised you the mostabout your career?
Speaker 00 (20:02):
I think the variety.
I think there is this, forbetter or worse, commonly held
idea that speech therapy is justworking on ours.
And that's absolutely part ofit, and that is meaningful and
great.
But I think being able to justsee the variety within the field
and what that means to eachperson that...
Like working on ours is just asimportant as working on
(20:24):
swallowing and being really ableto see how people are using
their communication and whatthat means to gain that back and
effectively communicate.
Speaker 03 (20:33):
So it sounds like it's really gratifying work.
Are there any patients who youor your colleagues have helped
out and that stand out to you?
Speaker 00 (20:40):
Yeah, I think working with people to get them
back to work is always a reallyfun and rewarding experience,
especially after a significantlife event, having to take that
time off and being able torebuild those skills.
There's several people thatcome to mind that worked with
for over the course of monthsand really being able to walk
through that process, see themget back to part-time work,
(21:02):
full-time work, and then getback to where they were before
their injury is incrediblyrewarding.
Being able to help someone findtheir voice in a really
vulnerable and scary time issuch a privilege.
And so there are a lot ofdifferent stories that come to
mind of whether it's being therewith someone when they first
(21:22):
put on a speaking valve and heartheir voice for the first time
after a long period of time.
That's just such a cool momentto be a part of.
Speaker 03 (21:31):
Wonderful.
So are there any final thoughtsto leave our listeners with?
Speaker 00 (21:34):
Yeah, there is help.
We see really good outcomesfrom speech therapy, that if
people are experiencing anydifficulties with communicating,
swallowing, understanding, areferral is well worth it and
that we do see really goodimprovement.
Speaker 03 (21:49):
So we've been talking today with Adam Terrell,
who is a speech pathologist atHennepin Healthcare.
He's one of several speechpathologists here and can help
you or a loved one strugglingwith these conditions.
I want to give a huge thank youto Adam for joining us.
Speaker 00 (22:02):
Thanks for having me.
Speaker 03 (22:03):
Thanks for listening.
My name is Shayanga Beecher,standing in for David Hilden,
who will be back in two weeks.
And until then, be healthy andbe well.
Speaker 01 (22:13):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(22:34):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(22:56):
Until next time, be healthy andbe well.
And now, here's our host...
Speaker 03 (00:17):
Hey there, welcome to the Healthy Matters podcast.
I'm pediatric nursepractitioner Shayonda Beecher, a
previous guest of the show, andI'll be sitting in for Dr.
Hilden for this episode.
Today we're going to dive intothe wide world of speech
pathology.
So I see a fair amount of thisin my field, pediatrics, but
today we're going to be joinedby Adam Terrell, who is an
expert in the subject.
(00:37):
He's been a big help to many,so Adam, welcome to the podcast.
Thanks
Speaker 00 (00:41):
for
Speaker 03 (00:41):
having me.
So let's start with the basics.
Speech-language pathology.
What is it?
Speaker 00 (00:46):
Yeah.
So speech-language pathologyencompasses a lot.
Speech kind of refers to moreof the muscles, lips, voice box,
and how that impacts verbalcommunication, where language is
going to be more thatunderlying system of how
sentences are structured,grammar, reading comprehension,
written comprehension, thingslike that.
(01:08):
So speech-language pathologistswork to help people with their
speech, their language,cognition, and swallowing kind
of throughout the continuum ofhealthcare and the lifespan.
Speaker 03 (01:17):
So it's not just speech therapy.
It's a lot more than that.
There's a list of disordershere that's kind of long, so I'm
wondering if you can help usdefine and distinguish between
the following.
So for example, what's thedifference between a speech
disorder and a languagedisorder?
Speaker 00 (01:30):
So speech disorder, like I said, is going to be
those lips, tongues, and voicemovement.
What people might traditionallythink of when they think of
speech therapy, producingcertain sounds clearly or
working with people who stutterto reduce that just language
disorders are going to be morethat underlying system so
difficulties expressing thoughtsunderstanding what people say
might show up with difficultycomprehension finding your words
(01:52):
and expressing full andcomplete thoughts
Speaker 03 (01:54):
so how does that play along with like a
communication disorder or ifsomething's related to your
voice like a voice disorder
Speaker 00 (02:00):
so voice disorders are typically going to be
related to the voice box or thelarynx itself so difficulties
how your vocal folds move openor close too much or too little
movement or any damage thathappens to the vocal folds that
might impact how that voice isproduced.
Communication disorders canoverlap with language disorders,
but can also refer todifficulties with like social
(02:22):
interaction, what we callpragmatics or how you do kind of
navigating those hidden partsof language, how close to say to
someone, how much eye contact,too much eye contact, things
like that.
Speaker 03 (02:33):
So you mentioned vocal folds.
And for those of us who may notknow what that is, can you
break that down a little bitfurther for us?
Speaker 00 (02:39):
Yeah.
So you have kind of two piecesof of like tissue and muscle
that sit right behind yourAdam's apple in a V shape.
And it's open when we'rebreathing.
But then when we turn our voiceon, those vocal folds squeeze
together, vibrate, and that'show you produce your voice.
And then that whole system ispart of what we call the larynx.
Speaker 03 (02:59):
Excellent.
Okay.
So keeping with like the areaof the mouth that we're talking
about here, do you ever workwith swallowing disorders?
Speaker 00 (03:05):
Yeah, a ton.
That's a lot of what SLPs do inthe hospital.
Someone might have a swallowingdisorder for a lot lot of
different reasons, and whetherthat's difficulty with chewing,
moving the food around in themouth, or getting that safely to
the stomach rather than theairway.
Speaker 03 (03:20):
So you think about swallowing disorders, speech
disorders, voice disorders, andall of that's controlled by the
brain.
Do you ever work with cognitiondisorders?
Speaker 00 (03:28):
Yeah, that's primarily where I practice.
So working with people afterstroke or traumatic brain injury
to help support or find ways tokind of work with changes in
attention, memory, planning,speed of thinking, organization,
things like that.
Speaker 03 (03:42):
Can you give me an example of that?
I'm just curious.
Yeah.
What a cognition disorder lookslike when you first meet with
somebody and then what do you doto help improve their outlook?
Speaker 00 (03:50):
Yeah.
So that might look like a lotof distractibility or kind of
forgetting things, whetherthat's where they put their keys
earlier in the day or like whatday it is.
So it can really look like alot of different things
depending on the severity.
What we'll kind of come and dois find ways that people can
structure their environment orset up the day so that they're
(04:11):
better able to focus kind ofwith where their attention might
be.
Coming up with like differentstrategies or tools to support
their memory, maybe writingthings down, getting a notebook
or a calendar system in placethat they can consistently refer
back to.
Speaker 03 (04:24):
So wow, that's really more than just speech
therapy.
Speaker 00 (04:27):
Yeah.
Speaker 03 (04:27):
So you spoke a little bit about folks that had
maybe a traumatic brain injuryor stroke.
Do you ever work with kids withdevelopmental delays?
Speaker 00 (04:35):
I personally don't, but...
SLPs as a whole absolutely do.
We have a great pediatricprogram here, and then SLPs are
also really involved in earlychildhood or working in the
schools with pediatrics as well.
Speaker 03 (04:47):
And for the adult population, you mentioned
stroke, brain injuries.
What about folks with dementiaor Parkinson's or ALS?
What kind of support do theyget from SLPs?
Speaker 00 (04:56):
Yeah, absolutely.
So a lot of those moreprogressive diseases, we're
really focusing on how tosupport swallowing and nutrition
as the disease progresses, butalso looking at what effective
communication the looks like asour way of understanding or
expressing changes over time,finding ways to really focus on
expressing and understandingthose things that are important.
(05:16):
With like ALS, for example, assome of those speech systems
deteriorate, working on comingup with other ways to
communicate.
So whether that's what we callvoice banking, where you might
record someone's voice early onin the process so that we're
able to kind of synthesize it ormimic it over time, or using
what we call AAC or alternativeand augmented communication to
(05:38):
develop like a tablet or iPadkind of picture or sentence
communication where you're ableto type or write out what you're
thinking.
Speaker 03 (05:46):
So I'm thinking Stephen Hawking,
Speaker 00 (05:48):
right?
Yeah, great example.
Speaker 03 (05:49):
So is that sort of what happens in clinic too or
Speaker 00 (05:51):
with our patients?
Yep, so we have, especially inour ALS clinic, that's a lot of
that alternative andaugmentative communication.
So setting up a device, gettingit to track someone's eyes so
that they're able to expresstheir thoughts just through
looking.
Speaker 03 (06:04):
That's pretty
Speaker 00 (06:04):
cool.
Speaker 03 (06:04):
Yeah.
What about folks with cancerWe're seeing a lot more head and
neck cancers.
Speaker 00 (06:08):
Yeah.
So it can look, again, verydifferent depending on where
someone's at with their cancerdiagnosis.
But looking at adaptive ways tofeed, there's different
utensils that can be used tokind of help bypass the tongue
or work around the tongue,determining what foods might be
kind of safe to eat, ways tostrengthen or like manage the
(06:30):
tissues after radiation can be areally big way that speech
pathologists are involved withhead and neck cancer.
And then looking at to voicechanges as well.
If someone has a totallaryngectomy where their entire
voice box is removed, how can westill effectively communicate
without the ability to producevoice?
Speaker 03 (06:47):
My kid's going through puberty.
His voice is changing.
Speaker 00 (06:50):
Do you guys do anything for that?
Unfortunately, no.
Speaker 03 (06:54):
Speaking of my kids, we are very familiar with
sports injuries.
We see a lot of our favoriteathletes getting PT or courtside
or after the season's over.
But there's people that usetheir voices a lot too, singers
or teachers.
Do you ever work with folksthat have voice disorders
because of overuse of theirprofession?
Speaker 00 (07:12):
Yeah, yeah.
So singers, teachers, publicspeakers, religious leaders,
like very high risk for voicestrain, voice overuse.
So yeah, absolutely work withthem to kind of establish good
vocal hygiene That's what wecall.
So what sort of things can yoube doing day to day?
Are you getting enough water?
Are you having times whereyou're not using your voice to
kind of protect that mechanism?
(07:32):
And then different exercisesand relaxation techniques to
help kind of reduce some of thatstrain as well.
Speaker 03 (07:37):
So are you telling me that Taylor Swift and Beyonce
both have an SLP?
Speaker 00 (07:40):
Most likely.
Speaker 03 (07:42):
Okay.
So you're not with Taylor Swiftor Beyonce, but you work here
as a speech languagepathologist.
What do you do in a day to day?
Speaker 00 (07:47):
So I work in our outpatient TBI program.
So primarily I'm working withpeople after mild to severe
trauma.
traumatic brain injury.
Seeing patients for about anhour, working on different ways
to manage their cognitive skillsprimarily, but then also some
communication intervention aswell.
But we have SLPs all throughoutthe hospital.
We have a team that works ininpatient rehab, kind of really
(08:10):
helping people gethigh-intensity therapy
throughout their stay.
We have people in acute care.
We have our pediatricsoutpatient and inpatient as
well.
So we're all throughout theclinics and hospitals.
Speaker 03 (08:21):
So you see a patient following a stoke, and you're
working with them hour a day.
What's your trajectory in timespent with them?
Is it based on their severity?
What does the progression looklike from the first day you meet
them to graduation?
Speaker 00 (08:35):
Yeah, yeah.
So again, yeah, really going todepend on patient by patient
and severity, really want tokind of do an in-depth
assessment on how thosecognitive communication and
swallowing skills are working.
So we'll do a clinical exam ofthe swallow where we have them
eat and drink and we look atkind of mouth and motor
movement, see how those nervesand muscles are working.
(08:56):
And then if needed, we might doa more in-depth assessment of
the swallow where we either takesome x-rays or some pictures to
see how food and liquid aremoving, making sure those are
going down safely.
And if not, what can we doabout it?
But then also really trying toestablish kind of what thinking
and communication skills lookat.
Does the person have betterverbal output than they do
(09:17):
comprehension?
So are they better able toexpress their thoughts than
they're able to understand?
Is their understanding reallygood, but they're having a tough
time expressing their thoughts?
And then what can we do tosupport that?
Using like a picturecommunication board, writing
things out, using more simplesentences, things like that.
We really want to see wheretheir strengths, where their
weaknesses are, and reallyestablish what we want to be
working on.
Speaker 03 (09:37):
So I can imagine that you're meeting this person
for the first time.
You may not Do you pull infamily or others to help
evaluate?
Speaker 00 (09:46):
Absolutely.
Yeah.
Yeah.
Family, friends, whoever'snearby.
Such great input for not onlytelling us what that baseline
is, but what sort of things areimportant to communicate about
so that that way we can reallytailor our therapy to what's
important to the patient.
Speaker 03 (10:00):
You mentioned x-rays and imaging to get a sense for
swallowing, but are there othertechnology or devices that you
would use in your assessment orevaluation of the progress?
Speaker 00 (10:10):
Yeah, so the two big ones for swallowing do what we
call a modified barium swallowstudy, which is an x-ray of the
swallow.
And then we can also do what wecall a flexible endoscopic
evaluation of the swallow, wherewe take a camera down the nose
and look at the swallow fromkind of the top down.
Other...
Technology we might use ifsomeone's having any difficulty
(10:30):
breathing, they have atracheostomy or a tube just
below their Adam's apple to helpthem breathe, we'll use, it's
called a speaking valve, wherewe can kind of create a one-way
valve to help them turn on theirvoice, essentially, and that
has some really profound impactson the swallowing communication
as well.
Speaker 03 (10:46):
I know that you're focused on individuals who have
had a stroke and helping themrecover after a brain injury,
but it sounds like theprofession itself is seeing
everybody from baby to
Speaker 00 (10:57):
elderly.
Yeah, all throughout thelifespan.
Speaker 03 (10:59):
So how does that look from when you're training
to be an SLP?
Do you have to understand howeverything works for every
single age group?
Speaker 00 (11:07):
Yeah, yeah.
So the practicum forundergraduate and graduate
school is across the lifespan.
I know some programs aregetting a little more tailored
these days to kind of have youpick a little earlier on in your
career path if you think youwant to go more pediatrics or
more adults, more medical ormore school.
But at least when I wentthrough it, it was
Speaker 03 (11:25):
everything.
And so tell me, because we'rereaching graduation season or we
are in graduation season,there's probably a couple folks
out there who are trying tofigure out what they want to be
when they grow up.
How does one become a speechpathologist?
Speaker 00 (11:39):
Typically, it's a four-year undergraduate program
for speech-language pathology,and then you do two years of
graduate school on top of that.
After that, you'll have about anine-month fellowship program,
and then you're a fully licensedspeech therapist.
Speaker 03 (11:51):
And that fellowship, is that then defined to the
population you want to workwith?
Speaker 00 (11:55):
Yeah.
So at that point, you'reworking full-time.
You're just not fullycertified.
Got it.
Speaker 03 (12:00):
Okay.
We're talking with AdamTerrell, who is a
speech-language pathologist.
We're going to take a quickbreak, and when we come back,
we're going to dive in a bitdeeper into the wide world of
speech pathology.
Stay with us.
We'll be right back.
Speaker 02 (12:15):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life.
and all that it brings.
Hennepin HealthCare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(12:36):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin HealthCare is here foryou and here for life.
Speaker 03 (12:51):
And we're back talking to Adam Terrell of
Hennepin Healthcare about speechpathology.
So Adam, how did you personallyget into this field?
Speaker 00 (12:59):
Yeah, so it's kind of in the family business.
My mom's actually aspeech-language pathologist.
Does she work here?
No, she's back in Wisconsin.
She works primarily in theschools and is now teaching at a
university.
But so I've kind of alwaysknown about it and been
fascinated by language and theway it kind of shapes people.
the way we think about thingsand how we determine what's
(13:20):
important to us, who's close tous.
And then, yeah, once I reallyfound out about the whole brain
side of speech-languagepathology, that had me sold.
I love seeing how the brainworks, how language is so just
embedded throughout the brain.
And then once I learned moreabout speech pathology, finding
out ways that you can not onlysee how language plays out in
(13:40):
the brain, but how you can helpand support language, yeah, I
was sold.
Speaker 03 (13:44):
Very cool.
Can I ask a question?
I'm going to jump on a tangenthere.
You spoke a bit about languageand development and cognition.
At Hennepin, we see a lot ofpatients who do not have English
as your preferred language ofchoice.
When you have somebody thatspeaks Spanish, Somali, Hmong,
how does that work.
How do you as an Englishspeaker navigate language
(14:05):
differences when you're tryingto tackle language?
Speaker 00 (14:07):
Yeah, great question.
So, I mean, we're incrediblylucky to have a phenomenal
interpreter department here.
So, we work really closely withthem to kind of help bridge
some of those culturaldifferences to help figure out
how children or adults might beusing their language.
So, there are certainmilestones or ways that we use
language kind of across theboard.
(14:28):
And then there's a lot ofcultural nuance.
So, we really lean on theinterpreters for that cultural
nuance.
piece, but then we're lookingat like kind of those root
foundations of language.
How are you using language toexpress wants and needs?
How are you using it tomaintain social closeness,
exchange information?
That's where we kind of fit in.
And that's the system oflanguage rather than the
language that's being spoken orused.
Speaker 03 (14:50):
Good clarification.
I appreciate that.
Thank you.
So we've got the basics down.
I want to dive into why thework in speech pathology is so
important.
Speaker 00 (14:59):
So I think communication is hopefully
relatively straightforward.
That's how we build closenesswith people.
Relationships, exchangeinformation, you know, it's a
pretty day-to-day function.
For the majority of people, notall, but speech is going to be
the primary way that thatcommunication is exchanged.
We also use that reading,writing.
So any challenges there aregoing to have huge impacts on
(15:22):
safety, independence,well-being, but also ability to
advocate and navigate resourcesand the community.
I think swallowing is a big onetoo, just because so much of
our social time is spent arounda table.
And so if there's a change tohow you communicate, interact
with meals, that's going to havehuge social and emotional
repercussions.
And so being able to step inand help with that is huge.
Speaker 03 (15:45):
I love how you say much of our time is spent around
a table and that significancethat plays to social
interactions.
We've heard a lot aboutloneliness and the pandemic in
recent years.
And I wonder what roles docognition and communication play
when it comes to mental healthissues like isolation and
quality of life?
Speaker 00 (16:03):
Yeah, absolutely.
I think cognition is acognitive resources we need to
even have a conversation isreally easy to overlook.
The amount of attention we needto not just pay attention to
what we're saying, but listenwell, be able to plan what we
want to say and listen, be ableto understand, perspective take,
(16:23):
all huge parts of cognition andcommunication.
So when we see changes withthat, it becomes harder to
engage in good quality socialinteraction and communication.
When something's hard, we tendto not want to do it.
This feedback loop of it'sdifficult to do, so we don't do
it, so we do it less, so itbecomes more difficult, really,
really drives that socialisolation.
Speaker 03 (16:45):
So let's talk about the swallowing disorders.
What are some of the seriouscomplications they can lead to?
Speaker 00 (16:50):
The big two that we see with changes in swallowing
are malnutrition and lunginfection, predominantly
aspiration pneumonia.
So When eating is difficult orimpacted, not being able to meet
your nutrition and hydrationneeds is huge.
Unintentional weight loss willjust kind of have huge impacts
(17:11):
on the whole body.
And then as well, if that foodand liquid isn't going down the
right tube, it's going into yourlungs rather than your stomach,
that's going to lead toinfection.
If your body's kind of alreadyat a weak point because of that
malnutrition, that infection isgoing to be a lot harder to
fight off.
Speaker 03 (17:28):
So you're saying that when you identify something
as aspiration pneumonia, that'swhen the food goes down the
wrong tube.
Speaker 00 (17:33):
Yeah, yeah.
So aspiration is just the termwe use when food goes past your
vocal folds into your lungswhere we don't want it to be.
Speaker 03 (17:40):
Correct, yeah.
So it sounds like you'vetouched upon a lot of different
symptoms and disorders that Iknow that I've seen in my
community and even in my family.
And I'm sure some of ourlisteners are wondering the same
thing I am.
How does someone get help ifthey think that they have it?
Yeah.
or their relative has it.
Speaker 00 (17:58):
So if you're seeing any of these signs, that's a
good time to talk with yourprimary care provider.
Speaker 03 (18:03):
And when do you know when it's time?
Like, how do you know it's timeto see the speech-language
pathologist?
Speaker 00 (18:08):
Yeah, so it really depends on a lot of different
factors and where you're seeingthat.
I would say, like, withpediatric populations, if
they're not hitting theirdevelopmental milestones,
initiating communication, youknow, establishing good eye
contact, things like that.
Speaker 03 (18:22):
So you're saying establishing good eye contact
and communication, that's wellbefore they start saying their
first few words.
Speaker 00 (18:27):
Yeah, yeah.
So that's attention, being ableto kind of attend to what the
parents are looking at, saying,things like that.
Huge developmental milestonesfor communication.
Speaker 03 (18:38):
And what about for our elderly?
Speaker 00 (18:40):
Yeah, so changes in swallowing.
If you're coughing, choking,feeling like foods are stuck
during meals throughout the day,that's a really good time to
potentially look at getting theswallow checked out.
But then also changes incommunication or thinking, you
know, difficulty finding words,understanding more frequent
distractions, misplacing items,anything like that, as well as
(19:02):
like obviously any medicalevent, a stroke, TBI, yeah,
probably good to get looked atby a speech pathologist.
Speaker 03 (19:08):
So it sounds like the first thing to do is see
your primary care provider, getthat referral.
And then are we all looking fora speech-language pathologist
here at Hennepin?
Are there community resourcesthat can help provide education
on this?
Speaker 00 (19:20):
Yeah, absolutely.
So typically more pediatricfocus is going to be through the
schools.
Not always, but we know therapyworks best in the environment
that the person's in since kidsare Most often in school, that's
going to be the kind of thebest place to provide therapy.
Other community resources, Iwould say our national
organization, the AmericanSpeech Language and Hearing
(19:43):
Association, or ASHA, is a greatresource that you can look up
when it might be time to talk toa primary care provider about a
referral.
They have great resources forhow to kind of initiate and talk
through that with PCP as well.
Speaker 03 (19:56):
Before we wrap up here, I just had a couple more
questions for you.
What surprised you the mostabout your career?
Speaker 00 (20:02):
I think the variety.
I think there is this, forbetter or worse, commonly held
idea that speech therapy is justworking on ours.
And that's absolutely part ofit, and that is meaningful and
great.
But I think being able to justsee the variety within the field
and what that means to eachperson that...
Like working on ours is just asimportant as working on
(20:24):
swallowing and being really ableto see how people are using
their communication and whatthat means to gain that back and
effectively communicate.
Speaker 03 (20:33):
So it sounds like it's really gratifying work.
Are there any patients who youor your colleagues have helped
out and that stand out to you?
Speaker 00 (20:40):
Yeah, I think working with people to get them
back to work is always a reallyfun and rewarding experience,
especially after a significantlife event, having to take that
time off and being able torebuild those skills.
There's several people thatcome to mind that worked with
for over the course of monthsand really being able to walk
through that process, see themget back to part-time work,
(21:02):
full-time work, and then getback to where they were before
their injury is incrediblyrewarding.
Being able to help someone findtheir voice in a really
vulnerable and scary time issuch a privilege.
And so there are a lot ofdifferent stories that come to
mind of whether it's being therewith someone when they first
(21:22):
put on a speaking valve and heartheir voice for the first time
after a long period of time.
That's just such a cool momentto be a part of.
Speaker 03 (21:31):
Wonderful.
So are there any final thoughtsto leave our listeners with?
Speaker 00 (21:34):
Yeah, there is help.
We see really good outcomesfrom speech therapy, that if
people are experiencing anydifficulties with communicating,
swallowing, understanding, areferral is well worth it and
that we do see really goodimprovement.
Speaker 03 (21:49):
So we've been talking today with Adam Terrell,
who is a speech pathologist atHennepin Healthcare.
He's one of several speechpathologists here and can help
you or a loved one strugglingwith these conditions.
I want to give a huge thank youto Adam for joining us.
Speaker 00 (22:02):
Thanks for having me.
Speaker 03 (22:03):
Thanks for listening.
My name is Shayanga Beecher,standing in for David Hilden,
who will be back in two weeks.
And until then, be healthy andbe well.
Speaker 01 (22:13):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(22:34):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(22:56):
Until next time, be healthy andbe well.
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