March 15, 2026 • 47 mins
In this episode, Theresa interviews Dr. Yvette McCoy, Assistant Professor at Moravian University, about her research on the connection between physical performance and swallowing function in older adults. Dr. McCoy discusses her dissertation, which found that upper body power strongly predicts swallowing-related measures, highlighting the value of integrating exercise science principles into dysphagia rehabilitation. The […]
The post 391 – From Exercise Science to Swallowing Success: A New Approach to Dysphagia Rehabilitation appeared first on Swallow Your Pride Podcast.
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(00:12):
Welcome to the Swallow Your Pride podcast. I'm
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders,
a mobile thieves business owner, and founder of
the MedSLP Collective.
This podcast is all about delivering the latest
evidence based practice to medical
SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
(00:33):
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
(00:54):
that, let's dive right in.
Just a quick disclaimer that all statements and
opinions expressed in this episode do not reflect
on the organizations associated with the speakers and
are their own opinions solely.
Alright. Good morning, Yvette.
Good morning,
Theresa.
Thank you so much for joining me. Oh
my goodness. I'm so excited to be here.
(01:14):
I I appreciate the invitation.
Yes. Yes. Of course. Alright. So for those
of you that don't know, this is doctor
Yvette McCoy. She's an assistant professor at Moravian
University and the author of two books, The
Adult Dysphagia Pocket Guide second edition and The
Clinical Process, both by Plural Publishing.
Her research interests include rehabilitation of the swallowing
mechanism via exercise, specifically in community dwelling elderly.
(01:38):
She also has a strong interest in interprofessional
education and collaboration.
So
welcome to the show, my dear friend. I
just love that we're doing this together. I
Yvette's been one of my
longest I was gonna say oldest friends in
the field, but you were definitely not my
oldest friend in the field. One of my
longest friends in the field. Yeah. Long time
friend. Yeah. Long time friend. And I and
(01:59):
I think what's so what I love is
we're at this point of in our career
where so many of us had talked about
getting PhDs and going on and getting more
involved into research. And now I'm at that
point in my career where, like, my friends
have actually done that, and I'm so close
to doing it too. But I'm so excited,
and and thank you for being here. Many,
many years later, you were one of the
first people on this this show, gosh, six,
(02:20):
seven years ago probably. So Yeah. And I
think what's so what's really is so great
about this is people always my students, whenever
I tell them, you know, that I know
Teresa Richard, they get all excited. They can't
believe
they're like, you know her. And I say,
oh, my goodness. I knew her before she
was the MetSLP
club. I know. Before she was anybody.
But I knew her when we were trying
(02:42):
to figure out what we were gonna do
with our careers being frustrated together and Yeah.
You know, if we were gonna take this
PhD journey. So just to see, I I
think our careers have sort of followed a
similar trajectory, although we've gone different, you know,
directions. I I just think it's so great
that we have sort of both come full
circle, and I'm just so
grateful that you asked me to chat with
(03:03):
you today. Yeah. Yeah. So so, yeah, Yvette
and I, you know, both she started her
PhD journey first, and and then I started
mine. And, you know, it's it's interesting the
way that the PhD
journey takes you because it's where you thought
you were gonna be is really never where
it ends up, and there's a million you
know, it's like that meme you see online
with the million spirals in between. And, you
know, I know that my topic is somewhat
(03:24):
the same, but it's just been
rolled over forwards and backwards a million times
before we arrived here. Yeah. So I I'd
love if you could just share a little
bit about what your dissertation topic was, Yvette,
because it's such a fascinating
and really, really well needed body of work.
And yeah. So go ahead if you can
share with us what it is and where
(03:44):
you got to it. Well, the if the
formal,
title of my dissertation
is physical performance measures
as predictors
of swallowing related
measures in community dwelling elderly. And I think
and, you know, before I get to talking,
because I'll you know, I'm quite verbose. So
before I start talking, I cannot I would
(04:06):
be remiss if I did not thank my
committee.
Doctor Jason Winchester
out of
Concordia University of Chicago,
who was my dissertation chair,
Sonya Molfinter,
from New York University, NYU,
and,
doctor
Deb Souter
from the, University of Kentucky. So the my
(04:30):
committee,
it was
incredible in terms of mentorship and guidance, and
I I don't I know for sure that
I would not be here,
without them. This has been
quite a journey. But I think part of
the reason why I became so interested in
this topic, it was it started out as
being more personal than professional, really.
I've worked for so many years in outpatient
(04:53):
rehab
alongside physical therapists and occupational therapists, and I
just I've really watched
how they use the principle of exercise to
rehabilitate their patients. And, you know, I as
I'm watching them, I'm thinking they're just not
doing therapy. That what they're doing is really
taking these principles
of exercise science and applying them, right? Progressive
(05:15):
overload, they measure strength, they track endurance,
they think about dosage and frequency and intensity
and
all of that, And as a result, over
time, what we began to see with their
patients is this meaningful measurable change in what?
In gait speed,
in grip strength, and how they transfer,
you know, their overall mobility. And so
(05:37):
I I started asking myself, if
if swallowing is a neuromuscular task, and if
swallowing decline
sort of mirrors a systemic physical decline,
why wouldn't we approach it the same way?
Why wouldn't we use these exercise
principles?
And, you know, I mean, that just started
me down a complete rabbit hole, and and
granted, we're talking about sort of large limb
(05:59):
muscles, right, versus our tiny swallowing muscles.
But I don't know. I just started thinking
more and more about this, and I thought
muscle mass declines with age, neuromuscular
integrity declines with age.
And so then maybe swallowing reflects that broader
decline. And if it does,
then maybe we should be thinking beyond compensation.
(06:22):
Now I I should say that please do
not come away from this discussion saying that
that Yvette said we shouldn't use compensation.
I'm not suggesting that compensation and diet modifications
and all those things are not necessary in
some cases. I mean, albeit temporarily,
but and specifically in our critically ill, we
do need diet modifications.
(06:44):
We do need
short term solutions
to protect the airway, right, and improve bolus
efficiency.
But,
you know,
I started thinking that maybe we should also
be thinking about, you know,
rehabilitation
that is grounded
in exercise science, specifically after our patients
(07:06):
move past that stage
of,
critical illness. And so that shift, I think,
for me
was really seeing swallowing
not seeing swallowing as just sort of this
isolated function. Right?
But to sort of look at it as
part of a larger
(07:26):
system, and that's what really motivated me to
to look into this. Before I reflect on
my findings before you know, and I don't
wanna get too,
quote, unquote scientific.
I do wanna talk briefly about the findings,
but even before I get to that,
you know, I I
think we have to consider the science that
even got us to this point. Right?
(07:49):
And we we've known for years that if
a patient has reduced cough peak flow, that
that could potentially
manifest itself in in difficulties
in swallowing. And we knew that lingual strength
and endurance and swallowing reserve and all of
those things,
can impact swallowing performance.
(08:12):
What else do we know? We all we
already knew about frailty and sarcopenia
and all of that sort of co occurring
with dysphasia.
But what hadn't been done and what hadn't
been really studied was to
systematically look at a broader physical
performance profile. Right? One that would include,
(08:33):
upper body power. So, you know, looking from
sort of a whole body perspective
and really ask the question, do these fitness
measures or do these,
physical performance measures predict
swallowing outcomes in in healthy older adults who
really aren't necessarily complaining about swallowing?
(08:54):
And that's one of the reasons that I
chose the demographic of community dwelling elderly because,
you know, these are people that are in
assisted living facilities or people that are living
independently at home.
They're 65.
They're probably experiencing some of the normal age
related changes that we see in swallowing, but,
(09:14):
you know, they're all they're they're
sometimes overlooked. Right? Or,
just,
you know, we don't think about them much
because of their perceived
independence.
Right? But we know that they
are going to experience,
like, some of these age related
(09:36):
changes.
And so I wanted to just take that
demographic and look at them, you know, healthy,
elderly people.
And so
what did what did we do? What did
I do? Well, I looked at
five physical
performance
measures. K? So
I,
(09:56):
I examined gait speed,
via the ten minute 10 meter walk test,
aerobic capacity and endurance
via the six minute walk test,
upper body strength and power
via a seated med ball throw.
Lower body strength and endurance was also assessed
via the thirty second sit to stand test,
(10:18):
and also hand grip strength.
And then for our swallowing,
performance measures, I use the E10 and the
Yale swallow protocol,
lingual pressures via the IOPI.
We also looked at the,
a mastication assessment. Right? The test of mastication
and swallowing of solids,
as well as cough peak flow. So our
(10:41):
measurement tools consisted of five swallowing measures and
five physical performance measures. Now I could talk
about this for hours, but Can I yeah?
Can I can I stop you and back
you up a second? Sure.
Talk to me about when you were coming
up with this with this topic. I'm assuming
you had to recruit a PT to be
on your committee. No. You did not. Okay.
No. No. And I'm just wondering No. Yeah.
(11:02):
Did anyone think you were absolutely crazy in
left field? Is this the most bizarre study
that's ever been done on swallowing? Talk to
me more a little bit about how that
process fleshed out.
So it's funny that you asked that because
so my doctorate,
I didn't did not get a PhD in
communication sciences disorders and speech pathology.
(11:22):
My doctorate was,
in
health and human performance
with an with an emphasis in exercise science.
And so my committee chair, my mentor,
he's an exercise physiology guy. So,
you know, when I did my doctoral work
and I got to this point of looking
(11:42):
for a mentor, I asked probably 13 faculty
in the department,
and they all said no
because,
I don't know how you're going to
you know, you wanna look at swallowing and
exercise? Well, there's how how and why? And
I don't have any experience that I could
even guide you in this. And so,
(12:04):
thankfully, one person said yes, and that was
doctor Jason Winchester, as I said.
And he was really intrigued by it because,
of some personal
swallowing problems that had occurred in his family,
and he was really intrigued by what he
was seeing being done. And so he enthusiastically
said, sure. Let's take this on.
(12:27):
And and that is how we started.
That's how I started. So I didn't recruit
any PT, but but because of my,
my actual,
doctoral
major, you know, in health and human performance,
I had to
recruit some faculty who were already in that
field of exercise. And so that's how how
(12:49):
we got started.
And I will tell you and you know
this,
being
a person who is just sort of in
the throes of this doctoral work, that
when you,
start this,
you don't really you're you do your literature
(13:09):
review. Right? And you think you're going one
direction, and that literature review takes you in
a completely different direction.
Yep. And before you know it, you're doing
something completely different than what you'd initially set
out to do. Yep. Initially,
I wanted to do something
that
looked at
SEMG
(13:31):
and the utility of SEMG
and biofeedback
and, you know, and and there I went
through the litter and there had been already
so much done on that.
Boy. And then I came across a paper
as I started doing my literature review,
and it just blew the world wide open
(13:51):
for me.
When I came across doctor Van Ravenhorst Bell,
boy, I came across her
papers, and that just sort of took me
down a completely different path. And I can
remember even saying to my
chair, have you seen this paper about weightlifters'
tongue
strength and runners'
endurance in their tongue. Have you seen this?
(14:12):
Somebody's looking at this.
And so that's really how we we started,
you know, just looking more and more
into,
physical performance and how it ties in. It
started off as just oral function, looking at
just the tongue, but, again, as we started
diving more and more into the literature, it
was just,
(14:32):
amazing what we found.
So I don't did that answer your question
or not? Yeah. Do you wanna dive into
those papers now? Let's let's give people a
little bit more of an idea of those.
But in her 2016 study, doctor Van Ravenhorst
Bell,
she assessed tongue strength and endurance in 48
subjects. Right? And she found that the and
they were elderly. She did, she looked at
(14:54):
people in their sixties
and people in their twenties, I believe.
And what she found was that those who
classified as highly active
scored higher
on their tongue measures than their sedentary peers,
and that effect was more pronounced in people
in their 60s than people in their 20s.
And so what that suggests then that regular
(15:16):
exercise
can sort of help stave off the the
the usual age related decline that we see
in lingual muscle performance. And so, again,
sort of this overarching idea that being physically
active or engaging in physical exercise
might slow
age related tongue muscle performance decline.
(15:39):
And I think the other thing that I
wanna say about this is there's I think
we need to define something
clearly because the terms
physical activity and physical exercise
are often really used interchangeably, and they're not
the
same. And so in physical activity, we're looking
at any bodily movement
(16:00):
that is produced by skeletal muscles that's gonna
result in energy expenditure. Right? That's physical activity.
Anything that we do that's gonna result in
energy expenditure. That could be walking to the
mailbox. Right? That could be standing up from
a chair,
climbing upstairs, doing laundry even,
or transferring from the bed to the chair.
(16:21):
It's really this broad sort of spectrum of
things,
and it's cumulative.
It reflects how much somebody moves
across their day, right, and essentially across their
their lives. But exercise is is distinctly different.
Okay? It's a subset
of physical activity. I think it's important to
(16:42):
make that distinction because
physical exercise is planned,
it's it's structured,
it's repetitive, it's intentional,
and it's performed
with the objective
of improving
physical fitness or at maybe at some point
even maintaining it. Right? So all exercise
(17:03):
is physical activity. We could say that pretty
broadly,
but not all physical activity
is exercise. And I think that distinction
matters. It matters a lot because
exercise reflects intervention.
Right? A targeted
a targeted stimulus
that is applied with a specific training goal.
(17:24):
Right? And so when we're talking about,
swallowing decline or frailty or rehab, we have
to be clear
about what we're actually
discussing.
And I know that, you know, sometimes as
speech pathologists, we,
talk about physical activity,
and and we might think we're talking about
(17:45):
physical
exercise,
but but we're not. Okay? And so what
we need to ask ourselves, are we talking
about
structured
swallowing
exercises that are going to improve
a specific function,
or are we asking about whether a person's
overall
physical activity level, right, influencing
their
(18:06):
swallowing capacity? And I think that those are
two very different
questions. And so in my research, I'm looking
more
at physical
exercise and not just physical
activity. And even more importantly, I'm looking at
the entire body.
Right? I'm concerned about whole body Yeah. Exercise
and intervention.
(18:27):
And often people have asked me, you know,
why did you choose
the five
physical performance measures? That's the next question out
of my mouth. So yeah.
Why did you choose those? Well,
you know, if we're looking at gait speed,
we cannot just look at the look at
the timed up and go test. The timed
(18:49):
up and go test is not a true,
true, true measure
of gait speed. Right? If we're looking at
a true measure
of gait of a person's gait speed, we
don't wanna stop them by, you know, having
them
sit down and then stand up. That might
be a really good measure of of functional,
(19:10):
their functional physical
performance, but I wanted to measure,
gait speed. And to order to truly,
measure gait speed, we need to look at
the 10 meter walk test.
If I want if I'm measuring endurance,
right, and aerobic capacity,
the best way to do that is via
(19:30):
the six minute walk test. And these are
things that I don't expect us as speech
and language pathologists to know. You know? I'm
just weird and I don't you know, I'm
not thinking that we should learn all this,
but I'm just weird and find it intriguing.
Upper body strength and power.
You know, if I'm looking at the entire
body, I've gotta look at upper body and
(19:51):
lower body, you know, individually. So we we
chose the seated med ball throw where,
you know, patients are sitting and they they've
got a three to four pound,
like a three pound medicine ball, which is
which is the
recommended weight for,
elderly community dwelling, elderly 65 and older. So
we're looking at how far they can throw
(20:13):
that. Lower body strength, we're gonna see and
endurance, how many times they can sit sit
to stand in thirty seconds. And, of course,
hand grip strength, which is something that, you
know, has been in the literature for many,
many years as being,
this surrogate to lingual strength as well.
And so those
five were chosen
(20:34):
because of the fact that they reflect the
entire
body,
and we're looking at true measures
of gait speed, upper body power, lower body
strength,
and endurance as well. Yeah. I I wanna
I wanna ask you, So you figured out
all of these physical therapy or exercise physiology
components or of exercise that you wanted to
(20:55):
add in. How did how did you now
bring those over to your swallowing mentors and
say, hey. Would you guys be interested in
doing this project with me? Because we're gonna
look at all of these different exercise physiology
components.
Well, it was great because, initially, I was
only looking at lingual pressures
and
chewing.
(21:16):
And so my amazing mentors, when I brought
this
to them, the first thought was, okay.
These are all great, but let's look at
what what is the literature
telling us, you know, for the logistic regression,
what ended up happening was we dichotomized
the Yale swallow protocol
(21:38):
to assess dysphagia risk. Right?
And so and we used the e 10.
And
so what we ended up doing
was so the e 10, we know that's
an ordinal variable. Right? But for descriptive purposes,
we reported the mean and the standard deviation
as a sum score, and so we treated
(21:58):
it as a continuous
variable. But then when we went and did
the
logistic regression,
we dichotomized greater than,
three and above three to assess dysphasia risk,
which made it,
sort of binary. So and then we again,
we know that the,
cough peak flow
(22:20):
we we there's lots of literature to suggest
that reduced cough peak flow,
you know, can impact
swallowing
function. We we know that.
And so why don't we use cough peak
flow
as one of the swallowing performance variables? So
I hadn't I hadn't considered,
(22:42):
you know, a self reported measure like the
e 10.
I hadn't considered
thinking about the Yale swallow protocol in this
process or cough peak flow. And so I
think
that, for me,
was really
the way we married the two, and it
really wasn't until doctor Molfentor and doctor Souter
(23:03):
came into
the conversation
that I began to think a little bit
differently about it. And it again, it speak
to me, it speaks to the beauty of
interprofessional
Yeah.
Collaboration,
which, you know, again, I could talk about
that
for a while too.
But it wasn't until because, you know, my
(23:26):
my chair wasn't thinking along those lines. And
I don't know that
I you know, for the last three years,
my head was in
exercise, and so I needed somebody to sort
of bring me out of that and see
how we could marry the two.
And,
you know, I I think that is what
the my swallowing mentors
(23:47):
brought to the table.
Yeah. Yeah. Alright. Do you wanna dive into
findings?
Well, I can.
I think, again,
the big takeaway here is that when when
I examined all five of these physical performance
measures
in healthy community dwelling elderly,
The the biggest surprise to me was that
(24:10):
all five
all five of these physical performance measures showed
significant correlations with cough peak flow. Interesting.
Here's what was novel, and then and we
didn't find this out until we did the
stepwise,
progression to, you know, to figure out which
one was most predictive.
And upper body power was the strongest
(24:32):
predictor
among all of them, and and that hadn't
been shown before.
And so when we looked at swallowing outcomes
directly,
upper body power consistently
predicted lingual pressures,
lingual endurance,
cough pee flow,
and swallowing
reserve. K?
(24:52):
And so what this tell told me is
that this isn't, like, just one
measure. This was sort of a multidimensional
pattern that we were seeing here,
consistently
correlating and and being more predictive of upper
body power. And so
what I think the big piece to this
is I think it's important because it extends
(25:12):
what we already know
about cough, peak, flow, and swallowing. Yeah. But
it but it adds upper body
power
as maybe a new, you know, clinical
flag.
Now
am I suggesting that speech language pathologists
become
exercise scientists and start testing upper body power?
(25:34):
No. That's not what
I am suggesting
at all.
But what I am thinking about
is
clinically because I get asked this question too.
What what does this all mean clinically? Yep.
When I think about this
clinically,
I'm thinking about
PT and OT, sort of changing
(25:57):
the culture
of,
you know, how we communicate
with PT and OT. You know, I know
a lot of people are thinking, oh, this
is great in theory.
But how do you actually get PT and
OT to think about swallowing? And the the
the honest answer really for me is I
don't
know. We don't have a system for it,
and I think that that's part of the
(26:18):
gap.
But
I think that if we look at what
the literature
on interprofessional
practice
practice talks to us about,
I think we could start
with shared language. Right? So, I mean, think
about it from this perspective. PT and OT,
they already measure gait speed. Right? They already
measure grip strength for
(26:40):
for upper body. They already
look at other areas of upper body power
and functional performance, and so we're not only
asking them to learn something new. We're not
asking them to
learn all about swallowing. I'm not asking speech
pathologists to learn all about physical performance,
But what I am asking, I think, is
to think about maybe a connection
(27:01):
that
we haven't made
before
together. Right? And so
sort of if if we could think about
maybe embedding it into all of into our
already existing workflows. Right?
So
for example, if PT is already measuring upper
body power and gait speed,
what if a low score became
(27:24):
sort of a red flag referral for speech
therapy?
Right? That's just, like, a minimal
behavior change to shift our thinking, like, from
reactive
to proactive.
And then the other question that I always
get, well, who's gonna pay for this? Because
insurance doesn't pay for preventative care for us.
Well, I don't know. They didn't pay for
(27:45):
preventative mammogram screens or colonoscopy screens at first.
Right? They didn't pay for any of that
preventative care until the science was there to
back it. So I think I think we
have to start somewhere. Conversation has to start
somewhere. Yeah. I do. I do think that,
and I think that,
you know,
there's not a a complete answer to all
(28:06):
of those questions.
Right?
I think
that if we can just start talking about
it, and we do that here at Moravian.
We are,
we have,
huge interprofessional
care,
education, and not only,
do we all of our students learn together
(28:26):
here, PTOT,
speech athletic training,
they all have classes together. We all learn
here. We have interprofessional
education sessions every single Friday,
so that we're starting
the students early, so that they understand the
language
of PT SLPs,
and that they understand the language of OT,
(28:48):
and so on and so forth. And so
I think,
you know, if we sort of change the
culture
between our communication,
and maybe PT and OT can start thinking,
maybe I need to refer for a swallow
screening,
based on the fact that I'm seeing
(29:08):
this specific
physical performance indicator. Right? Right. Right. We all
we already have a payment model for screening.
So as SLPs, we're not asking for anything
particularly new. Right?
We are just offering
or I'm asking maybe to think about a
different justification,
you know,
and that could go both ways. You know,
(29:30):
that could lead us back to referring to
PT for evaluating and potentially treating a patient,
that we see has impaired strength,
weakness,
just sort of overall that sort of generalized,
deconditioning
that may be impacting their swallowing. We see
that all the time. So can we refer
(29:50):
them back to PT
for a prescriptive,
sort of exercise program
to help them build up their strength and
their, you know, overall functional reserve, which might
help improve their swallowing reserve? I mean, there's
so many different ways
to think about that. Right?
We're we're not I'm not asking SLPs to
become PTs or OTs. Just, again, thinking about
(30:13):
changing the discourse
about it with our exercise colleagues and really
begin true interdisciplinary
care from a cross systems
approach.
Does does that make sense? Yeah. Yeah. Yeah.
Yeah. Very well so. Very beautifully said. Can
I ask you just a few clarifying questions?
Yes. Of course. Tell me again exactly how
(30:35):
you measured upper body power.
We measured upper body power via the seated
med ball throw. Seated med ball throw. Okay.
Was there a specific
weight that everyone had to do? Like, how
was that calculated? Yes. So so in the
seated med ball throw, the patients are seated,
in the chair, their arms at their sides.
They're holding a three
(30:55):
pound
medicine ball. I wish we were on video
because I got one. I got this three
like, I'm the only speech pathologist that has
the date walk the the med ball in
my office. So and so patients are asked
I mean, the subjects were asked to throw
it. K? Just signature and throw it as
far as they can. Okay. K? And that
and then we measured that.
(31:17):
And so that's how we measured upper body
power. Okay.
Alright. Fascinating. And it's so fascinating that that
was what you said
always correlated to
tongue pressure.
And cough peak flow. And cough peak flow.
Cough peak flow.
But think about it. We need we in
order for us to cough effectively,
(31:38):
to have a really strong productive cough, we've
gotta have
good upper body power. Right? I mean, it
makes it makes so much sense to us.
Yeah. Yeah. Makes Yes. Oh, and, you know,
I think that's you know, where we I
think we got sidetracked because I was talking
about doctor Van Ravenhorst Bell's study
and sort of,
(31:59):
you know, what
made me just sort of think about this
all differently. Because
in her study,
she,
in her 2016
study that she was looking at
tongue measures in
48 people. She was looking at, tongue pressures
(32:22):
and exercise. Right? But the one that just
really blew my mind was her study in
2018
where she recruited 21 weightlifters
and 23 runners. K?
And so the findings of that study
were that weightlifters
produced it produced significantly greater tongue strengths than
runners, particularly in the anterior region of the
(32:44):
tongue.
But then runners
produce significantly
greater
tongue endurance
than weightlifters.
That, I mean, that just blew me away.
And what she and she each of these
runners and weightlifters
engaged in their preferred
exercise program at least four times a week.
(33:04):
And this study was the first to investigate
sort of the indirect effects of physical exercise,
on tongue muscle.
And I thought this is amazing.
And the it it really did, I think,
or it it's paving the way for future
research
to invest investigate more approaches to this
(33:26):
age related decline on tongue muscle performance,
right, that can maybe,
prevent
the decline
of,
you know,
swallowing function. I mean, that's a big,
leap to say that, but I think that
it just
is paving the way for us to think
about
(33:46):
physical
exercise, not physical activity, but physical exercise,
in a different way, and what are the
broader implications
then for swallowing. And I have to tell
you about this fangirl moment. So let me
just tell you about doctor Van Raven Horst
She's at the University of Wichita.
Let me just tell you this.
(34:07):
So here I am, unicorn speech pathologist,
you know, holding my med ball.
I
love this med ball.
I'm I'm unicorn speech pathologist getting a doctorate
in,
health and human performance
and an emphasis in exercise science. So I'm
reading these papers by doctor Van Ravenhorst Bell,
(34:28):
and I met ASHA
in 2024.
Right?
Doctor Molfinster says, Jevan, you've gotta come you
gotta come over here. We're in the posters.
You gotta come over here. You're not gonna
believe who's here. And I'm like, who's here?
Who's here? And she says,
doctor Van Ravenhorst Bell, and she was just
at your poster. I'm like, you gotta be
kidding me.
And I was, you know, I'm fangirly. I'm
(34:50):
like, oh my god. I'm gonna meet her.
I'm gonna meet her. I'm gonna meet her.
She doctor Van Ravenhorst Bell is an exercise
scientist. She's an exercise physiologist
who happened to get a doctorate in communication
sciences and disorders. And so I thought, oh,
this person
is somebody who gets me. She's Oh, that's
so funny. Yeah. Isn't it so funny? She's
(35:11):
the one person in the world who understands
me. And so subsequently
she and I have had, oh my word,
some wonderful
conversations,
and I mean I could just talk to
her for hours.
She's really quite remarkable.
But, yeah, we did just the opposite. So
she's an exercise,
(35:31):
physiologist who wanted to learn more about communication
sciences and disorders, and then I did just
the opposite. So we have lots of great,
great conversation, she and I. Oh, I love
that. Thank you for sharing that. Love when
love when you find your unicorn besties in
totally different fields. Yeah. Oh, good. I love
that. Yeah. But
yeah. My my brain was just thinking this
(35:52):
whole time as you were talking about, you
know, how does this become part of screening
and who pays for it and all you
know? And I love the analogy you gave
about, you know, breast cancer screenings and colonoscopies
and things like that. And I think where
my brain went was,
you know, I know there's different researchers working
on sort of these
swallowing algorithms. Right? Like, these algorithms for
(36:12):
determining
aspiration risk or patients that are really at
risk of having
swallowing impairments that can cause all these down
the line
real medical complications. Right? And so I think
that's what I was thinking. This is part
of that big play. Like, this is part
of that big
screening for, you know, at risk older adults
or at risk adults that have some of
(36:34):
these conditions that we know impact swallowing.
You know, is this something that is a
screening in and of itself, or is this
packaged in
one of those algorithms? I think, you know,
there's there's so much opportunity for this information
to to find its
home. Yeah. I agree with you, and I,
I
yes. I have the utmost respect,
(36:56):
for all of our researchers who are working
to improve the lives of those with swallowing
problems. But I think
often when we think about
swallowing problems in aging, we do just focus
on
sort of our little
throat.
Right? We we focus on our little area
right here.
(37:17):
And in reality, I think it may be
a much bigger picture than that. I mean,
you know, as we get older, we don't
just lose strength in one area.
Right?
Skeletal muscle mass declines across the entire body.
You know, neuromuscular
integrity, though, that communication between nerves and muscles,
that also deteriorates
(37:39):
globally.
So I think, you know, thinking about it
out of the box a little bit, the
same processes that slow gait speed,
that reduce grip strength,
and affect mobility,
maybe
it also has the potential
I mean, it could be plausible that it
could impact swallowing. Right?
I mean, you know, in that sense, we
(38:00):
think about
if we think about swallowing as maybe not
being this isolated
dysfunction,
think about it as reflecting,
you know, this broader sort of systemic
aging that it could have the potential to
mirror overall physical
decline sort of, you know, as this cross
system
deterioration that goes beyond what we traditionally
(38:23):
label as purely,
a swallowing problem. You know? And I think
if we can think a little bit
about swallowing,
not just as a stand alone problem,
that if we can start thinking it of
it as an expression of, you know, sort
of our whole body neuromuscular
(38:44):
health,
you know, such that when the body declines,
guess what? Swallowing might decline with it. And
I, you know, I recognize that what I'm
saying is
probably,
you know, for some people, they're like, what
is she talking
but I do recognize that there's limitations to
what I'm do what I've done and what
(39:05):
I'm doing. And, again, all of what I've
done is cross sectional data. Right? I can
show that upper body power and swallowing measures
are associated. Right?
There's correlated, but it maybe what's the the
causal factors are not there. And I can't
definitively say that improving upper body power will
improve
swallowing. Right? So it's important distinction.
(39:27):
But I think instead of seeing it as
a as a weakness, we can maybe use
it as a road map
to take us to the next step. There's
so
much more work to be done.
The next logical step, in in my opinion,
would be a perspective more longitudinal
design and sort of that we look at
the same people over time to see if
(39:49):
changes in their fitness program
predict swallowing changes.
We need instrumental assessments like MBS and FEES
to confirm these predictive relationships
just beyond, you know, the the clinical
measurements. And then I think, ultimately,
really, we need to,
you know,
sort of test
(40:10):
whether fitness based rehabilitation
protocols can actually move the needle on swaddled
outcome. You know? I don't know.
I just I I don't think that the
limitations
undermine the findings. I think they
really define what needs to happen next. And
I think, you know, I mean, I how
how much time we got? I can talk
about this for hours. But I but I
(40:31):
think, you know, I think there needs to
be a call to action. And I think
if I had to describe what my call
to action
would be,
I would say,
let's look at what we're doing now. Are
we truly interprofessional?
Are we
multidisciplinary,
or are we interdisciplinary?
(40:52):
And I remember, I love interprofessional care education,
so I'm always, you know,
doing a webinar or listening to a talk
on something about interprofessional education. And I was
listening to someone say
that if we imagine
sort
of the layers of a yogurt parfait. Right?
We've got we get up. We make our
(41:13):
yogurt parfait in the morning. We've got our
we've got our yogurt, then we've got our
strawberries or blueberries, then we've got our, you
know, other fruit, and then we've got our
granola,
and then we might have another layer of
yogurt and granola, whatever, but they're each stacked
sort of separately. Right? So that each
ingredient is maintaining its own identity. And I
(41:34):
think that's what
really represents a multidisciplinary
approach where we've got different professionals. We've got
SLP, PT, OT,
nurses, physicians.
We've got everybody on the multidisciplinary
team contributing their expertise,
but we're working
parallel.
Right?
(41:54):
Our roles are distinctly
and clearly separated
even though
we're all in the same parfait, we're serving
the same patient.
Right? But we're distinctly
separated.
Now if you think about that same parfait,
and this is what really you know, when
I heard the speaker say this, and I
can't remember where I heard it, but it's
what really sort of shifted my thinking. You
(42:15):
think about that same parfait
blended up. Now it's a smoothie. Right? The
ingredients are all blended together in one uniform
drink,
and you can't really distinguish the individual components
anymore. Right?
That to me really represents sort of our
interprofessional
or interdisciplinary
approach, right, where we
(42:36):
are collaborating
closely, we're integrated,
we've got shared decision making, and we work
together as a cohesive unit. That that plan
of care is now
cocreated
rather than sort of layered
separately.
And so,
you know, I guess what I'm saying is
that multidisciplinary
is just sort of this layered collaboration where
(42:57):
we're doing sort of these side by side
parallel contributions,
But interdisciplinary
is really that blended,
collaborations
where we're integrated and we have this
shared approach. And so we we have evidence
that tells us that there are some physical
performance measures that are correlated with swallowing performance
(43:17):
measures.
That is not new. But I think this
is another reason. And, again, I I feel
like the work that I've done just sort
of adds to that already,
and it's just another reason why we should
all be playing in the sandbox together. So
if that if, you know, if there was
a call to action,
that would be it for me. Yeah. Yeah.
(43:39):
Talk to me about what's next, Yvette. Where
obviously, that is your call to action, but
where do you personally
see taking this now? You know, do you
wanna test it in different specific populations? Are
you wishing for just
Well, I don't I don't know. I mean,
I think I think that there's
a lot.
But like I said earlier, I think the
(44:00):
logical next step is a perspective longitudinal
design. So I'd like to follow the same
people,
community dwelling elderly. I just have a heart
for them. I love them so much,
just because they don't
get a lot attention
attention. They're overlooked because of their, like I
said, perceived independence. Yeah.
But I think swallowing the following the same
(44:21):
people
over time,
to see if changes in fitness
actually predict changes in swallowing. And so,
instrumental assessments
to confirm
these predictive relationships
and intervention study,
maybe not first, but leading up to that.
(44:42):
Yeah. Yeah. Lots to think about. Yeah. I'm
get I'm getting old though, you know, so
I I don't know if I'm gonna have
time to do all of this. Of course
you are. But What what else are you
gonna do with your time?
I feel like you're not gonna just sit
around and think about swallowing all the time.
You're full of it. Yeah. Well, you know.
So yeah. I mean, I I don't know,
but there's there's so many conversations
(45:05):
to be had.
And right now, I really want to focus
on changing
the culture,
you know, just among
our colleagues and really thinking more
interprofessionally
rather than multi
professional
or multidisciplinary.
Yep. Good. I love it. Thank you so
(45:26):
much for sharing this. This is awesome work,
and I'm I'm so happy. I've been hearing
bits and pieces for years of what you
were doing, so thank you for explaining it
directly from your mouth. I just love to
hear it. Any final thoughts? Anything else you'd
like to share with the people?
No. I mean, I don't I don't have
anything that is I feel like, you know,
just glaring. I think I've talked about it
(45:47):
so much. I I could talk about this
for hours, though.
So I've tried to condense it and not
bore the people with my
with my interest in exercise.
But, yeah, I know. I don't I think
that we just need to start having
different conversations.
And,
I I really don't want people to go
(46:08):
away thinking that I'm suggesting that we become
physical therapists or occupational therapists and start testing
upper body strength and hand grip strength and
gait speed. That is not at all what
I'm suggesting.
Yeah.
And and yeah. Again, I don't wanna
have people come away thinking that that lady
said on Teresa's podcast,
we shouldn't be doing any sort of compensations
(46:30):
or diet modifications. They're just gonna be throwing
med ball all day.
That's right. Yep. They heard it here first,
everyone.
All those med balls and you're swallowing the
food. That's it. That's not what I'm suggesting.
But just, you know, a more broad conversation
Yeah.
About
the the principles of exercise, and maybe we
(46:50):
should start thinking about this
more from an interdisciplinary
perspective.
And that's a wrap for this episode.
As always, thank you so much for listening.
If you'd like to download the show notes
from this episode, please visit swallowyourpridepodcast.com.
There you can also sign up for our
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episode.
If you do like what you hear, then
(47:12):
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If you'd like to be a guest, share
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on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
catch you next week.
Welcome to the Swallow Your Pride podcast. I'm
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders,
a mobile thieves business owner, and founder of
the MedSLP Collective.
This podcast is all about delivering the latest
evidence based practice to medical
SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
(00:33):
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
(00:54):
that, let's dive right in.
Just a quick disclaimer that all statements and
opinions expressed in this episode do not reflect
on the organizations associated with the speakers and
are their own opinions solely.
Alright. Good morning, Yvette.
Good morning,
Theresa.
Thank you so much for joining me. Oh
my goodness. I'm so excited to be here.
(01:14):
I I appreciate the invitation.
Yes. Yes. Of course. Alright. So for those
of you that don't know, this is doctor
Yvette McCoy. She's an assistant professor at Moravian
University and the author of two books, The
Adult Dysphagia Pocket Guide second edition and The
Clinical Process, both by Plural Publishing.
Her research interests include rehabilitation of the swallowing
mechanism via exercise, specifically in community dwelling elderly.
(01:38):
She also has a strong interest in interprofessional
education and collaboration.
So
welcome to the show, my dear friend. I
just love that we're doing this together. I
Yvette's been one of my
longest I was gonna say oldest friends in
the field, but you were definitely not my
oldest friend in the field. One of my
longest friends in the field. Yeah. Long time
friend. Yeah. Long time friend. And I and
(01:59):
I think what's so what I love is
we're at this point of in our career
where so many of us had talked about
getting PhDs and going on and getting more
involved into research. And now I'm at that
point in my career where, like, my friends
have actually done that, and I'm so close
to doing it too. But I'm so excited,
and and thank you for being here. Many,
many years later, you were one of the
first people on this this show, gosh, six,
(02:20):
seven years ago probably. So Yeah. And I
think what's so what's really is so great
about this is people always my students, whenever
I tell them, you know, that I know
Teresa Richard, they get all excited. They can't
believe
they're like, you know her. And I say,
oh, my goodness. I knew her before she
was the MetSLP
club. I know. Before she was anybody.
But I knew her when we were trying
(02:42):
to figure out what we were gonna do
with our careers being frustrated together and Yeah.
You know, if we were gonna take this
PhD journey. So just to see, I I
think our careers have sort of followed a
similar trajectory, although we've gone different, you know,
directions. I I just think it's so great
that we have sort of both come full
circle, and I'm just so
grateful that you asked me to chat with
(03:03):
you today. Yeah. Yeah. So so, yeah, Yvette
and I, you know, both she started her
PhD journey first, and and then I started
mine. And, you know, it's it's interesting the
way that the PhD
journey takes you because it's where you thought
you were gonna be is really never where
it ends up, and there's a million you
know, it's like that meme you see online
with the million spirals in between. And, you
know, I know that my topic is somewhat
(03:24):
the same, but it's just been
rolled over forwards and backwards a million times
before we arrived here. Yeah. So I I'd
love if you could just share a little
bit about what your dissertation topic was, Yvette,
because it's such a fascinating
and really, really well needed body of work.
And yeah. So go ahead if you can
share with us what it is and where
(03:44):
you got to it. Well, the if the
formal,
title of my dissertation
is physical performance measures
as predictors
of swallowing related
measures in community dwelling elderly. And I think
and, you know, before I get to talking,
because I'll you know, I'm quite verbose. So
before I start talking, I cannot I would
(04:06):
be remiss if I did not thank my
committee.
Doctor Jason Winchester
out of
Concordia University of Chicago,
who was my dissertation chair,
Sonya Molfinter,
from New York University, NYU,
and,
doctor
Deb Souter
from the, University of Kentucky. So the my
(04:30):
committee,
it was
incredible in terms of mentorship and guidance, and
I I don't I know for sure that
I would not be here,
without them. This has been
quite a journey. But I think part of
the reason why I became so interested in
this topic, it was it started out as
being more personal than professional, really.
I've worked for so many years in outpatient
(04:53):
rehab
alongside physical therapists and occupational therapists, and I
just I've really watched
how they use the principle of exercise to
rehabilitate their patients. And, you know, I as
I'm watching them, I'm thinking they're just not
doing therapy. That what they're doing is really
taking these principles
of exercise science and applying them, right? Progressive
(05:15):
overload, they measure strength, they track endurance,
they think about dosage and frequency and intensity
and
all of that, And as a result, over
time, what we began to see with their
patients is this meaningful measurable change in what?
In gait speed,
in grip strength, and how they transfer,
you know, their overall mobility. And so
(05:37):
I I started asking myself, if
if swallowing is a neuromuscular task, and if
swallowing decline
sort of mirrors a systemic physical decline,
why wouldn't we approach it the same way?
Why wouldn't we use these exercise
principles?
And, you know, I mean, that just started
me down a complete rabbit hole, and and
granted, we're talking about sort of large limb
(05:59):
muscles, right, versus our tiny swallowing muscles.
But I don't know. I just started thinking
more and more about this, and I thought
muscle mass declines with age, neuromuscular
integrity declines with age.
And so then maybe swallowing reflects that broader
decline. And if it does,
then maybe we should be thinking beyond compensation.
(06:22):
Now I I should say that please do
not come away from this discussion saying that
that Yvette said we shouldn't use compensation.
I'm not suggesting that compensation and diet modifications
and all those things are not necessary in
some cases. I mean, albeit temporarily,
but and specifically in our critically ill, we
do need diet modifications.
(06:44):
We do need
short term solutions
to protect the airway, right, and improve bolus
efficiency.
But,
you know,
I started thinking that maybe we should also
be thinking about, you know,
rehabilitation
that is grounded
in exercise science, specifically after our patients
(07:06):
move past that stage
of,
critical illness. And so that shift, I think,
for me
was really seeing swallowing
not seeing swallowing as just sort of this
isolated function. Right?
But to sort of look at it as
part of a larger
(07:26):
system, and that's what really motivated me to
to look into this. Before I reflect on
my findings before you know, and I don't
wanna get too,
quote, unquote scientific.
I do wanna talk briefly about the findings,
but even before I get to that,
you know, I I
think we have to consider the science that
even got us to this point. Right?
(07:49):
And we we've known for years that if
a patient has reduced cough peak flow, that
that could potentially
manifest itself in in difficulties
in swallowing. And we knew that lingual strength
and endurance and swallowing reserve and all of
those things,
can impact swallowing performance.
(08:12):
What else do we know? We all we
already knew about frailty and sarcopenia
and all of that sort of co occurring
with dysphasia.
But what hadn't been done and what hadn't
been really studied was to
systematically look at a broader physical
performance profile. Right? One that would include,
(08:33):
upper body power. So, you know, looking from
sort of a whole body perspective
and really ask the question, do these fitness
measures or do these,
physical performance measures predict
swallowing outcomes in in healthy older adults who
really aren't necessarily complaining about swallowing?
(08:54):
And that's one of the reasons that I
chose the demographic of community dwelling elderly because,
you know, these are people that are in
assisted living facilities or people that are living
independently at home.
They're 65.
They're probably experiencing some of the normal age
related changes that we see in swallowing, but,
(09:14):
you know, they're all they're they're
sometimes overlooked. Right? Or,
just,
you know, we don't think about them much
because of their perceived
independence.
Right? But we know that they
are going to experience,
like, some of these age related
(09:36):
changes.
And so I wanted to just take that
demographic and look at them, you know, healthy,
elderly people.
And so
what did what did we do? What did
I do? Well, I looked at
five physical
performance
measures. K? So
I,
(09:56):
I examined gait speed,
via the ten minute 10 meter walk test,
aerobic capacity and endurance
via the six minute walk test,
upper body strength and power
via a seated med ball throw.
Lower body strength and endurance was also assessed
via the thirty second sit to stand test,
(10:18):
and also hand grip strength.
And then for our swallowing,
performance measures, I use the E10 and the
Yale swallow protocol,
lingual pressures via the IOPI.
We also looked at the,
a mastication assessment. Right? The test of mastication
and swallowing of solids,
as well as cough peak flow. So our
(10:41):
measurement tools consisted of five swallowing measures and
five physical performance measures. Now I could talk
about this for hours, but Can I yeah?
Can I can I stop you and back
you up a second? Sure.
Talk to me about when you were coming
up with this with this topic. I'm assuming
you had to recruit a PT to be
on your committee. No. You did not. Okay.
No. No. And I'm just wondering No. Yeah.
(11:02):
Did anyone think you were absolutely crazy in
left field? Is this the most bizarre study
that's ever been done on swallowing? Talk to
me more a little bit about how that
process fleshed out.
So it's funny that you asked that because
so my doctorate,
I didn't did not get a PhD in
communication sciences disorders and speech pathology.
(11:22):
My doctorate was,
in
health and human performance
with an with an emphasis in exercise science.
And so my committee chair, my mentor,
he's an exercise physiology guy. So,
you know, when I did my doctoral work
and I got to this point of looking
(11:42):
for a mentor, I asked probably 13 faculty
in the department,
and they all said no
because,
I don't know how you're going to
you know, you wanna look at swallowing and
exercise? Well, there's how how and why? And
I don't have any experience that I could
even guide you in this. And so,
(12:04):
thankfully, one person said yes, and that was
doctor Jason Winchester, as I said.
And he was really intrigued by it because,
of some personal
swallowing problems that had occurred in his family,
and he was really intrigued by what he
was seeing being done. And so he enthusiastically
said, sure. Let's take this on.
(12:27):
And and that is how we started.
That's how I started. So I didn't recruit
any PT, but but because of my,
my actual,
doctoral
major, you know, in health and human performance,
I had to
recruit some faculty who were already in that
field of exercise. And so that's how how
(12:49):
we got started.
And I will tell you and you know
this,
being
a person who is just sort of in
the throes of this doctoral work, that
when you,
start this,
you don't really you're you do your literature
(13:09):
review. Right? And you think you're going one
direction, and that literature review takes you in
a completely different direction.
Yep. And before you know it, you're doing
something completely different than what you'd initially set
out to do. Yep. Initially,
I wanted to do something
that
looked at
SEMG
(13:31):
and the utility of SEMG
and biofeedback
and, you know, and and there I went
through the litter and there had been already
so much done on that.
Boy. And then I came across a paper
as I started doing my literature review,
and it just blew the world wide open
(13:51):
for me.
When I came across doctor Van Ravenhorst Bell,
boy, I came across her
papers, and that just sort of took me
down a completely different path. And I can
remember even saying to my
chair, have you seen this paper about weightlifters'
tongue
strength and runners'
endurance in their tongue. Have you seen this?
(14:12):
Somebody's looking at this.
And so that's really how we we started,
you know, just looking more and more
into,
physical performance and how it ties in. It
started off as just oral function, looking at
just the tongue, but, again, as we started
diving more and more into the literature, it
was just,
(14:32):
amazing what we found.
So I don't did that answer your question
or not? Yeah. Do you wanna dive into
those papers now? Let's let's give people a
little bit more of an idea of those.
But in her 2016 study, doctor Van Ravenhorst
Bell,
she assessed tongue strength and endurance in 48
subjects. Right? And she found that the and
they were elderly. She did, she looked at
(14:54):
people in their sixties
and people in their twenties, I believe.
And what she found was that those who
classified as highly active
scored higher
on their tongue measures than their sedentary peers,
and that effect was more pronounced in people
in their 60s than people in their 20s.
And so what that suggests then that regular
(15:16):
exercise
can sort of help stave off the the
the usual age related decline that we see
in lingual muscle performance. And so, again,
sort of this overarching idea that being physically
active or engaging in physical exercise
might slow
age related tongue muscle performance decline.
(15:39):
And I think the other thing that I
wanna say about this is there's I think
we need to define something
clearly because the terms
physical activity and physical exercise
are often really used interchangeably, and they're not
the
same. And so in physical activity, we're looking
at any bodily movement
(16:00):
that is produced by skeletal muscles that's gonna
result in energy expenditure. Right? That's physical activity.
Anything that we do that's gonna result in
energy expenditure. That could be walking to the
mailbox. Right? That could be standing up from
a chair,
climbing upstairs, doing laundry even,
or transferring from the bed to the chair.
(16:21):
It's really this broad sort of spectrum of
things,
and it's cumulative.
It reflects how much somebody moves
across their day, right, and essentially across their
their lives. But exercise is is distinctly different.
Okay? It's a subset
of physical activity. I think it's important to
(16:42):
make that distinction because
physical exercise is planned,
it's it's structured,
it's repetitive, it's intentional,
and it's performed
with the objective
of improving
physical fitness or at maybe at some point
even maintaining it. Right? So all exercise
(17:03):
is physical activity. We could say that pretty
broadly,
but not all physical activity
is exercise. And I think that distinction
matters. It matters a lot because
exercise reflects intervention.
Right? A targeted
a targeted stimulus
that is applied with a specific training goal.
(17:24):
Right? And so when we're talking about,
swallowing decline or frailty or rehab, we have
to be clear
about what we're actually
discussing.
And I know that, you know, sometimes as
speech pathologists, we,
talk about physical activity,
and and we might think we're talking about
(17:45):
physical
exercise,
but but we're not. Okay? And so what
we need to ask ourselves, are we talking
about
structured
swallowing
exercises that are going to improve
a specific function,
or are we asking about whether a person's
overall
physical activity level, right, influencing
their
(18:06):
swallowing capacity? And I think that those are
two very different
questions. And so in my research, I'm looking
more
at physical
exercise and not just physical
activity. And even more importantly, I'm looking at
the entire body.
Right? I'm concerned about whole body Yeah. Exercise
and intervention.
(18:27):
And often people have asked me, you know,
why did you choose
the five
physical performance measures? That's the next question out
of my mouth. So yeah.
Why did you choose those? Well,
you know, if we're looking at gait speed,
we cannot just look at the look at
the timed up and go test. The timed
(18:49):
up and go test is not a true,
true, true measure
of gait speed. Right? If we're looking at
a true measure
of gait of a person's gait speed, we
don't wanna stop them by, you know, having
them
sit down and then stand up. That might
be a really good measure of of functional,
(19:10):
their functional physical
performance, but I wanted to measure,
gait speed. And to order to truly,
measure gait speed, we need to look at
the 10 meter walk test.
If I want if I'm measuring endurance,
right, and aerobic capacity,
the best way to do that is via
(19:30):
the six minute walk test. And these are
things that I don't expect us as speech
and language pathologists to know. You know? I'm
just weird and I don't you know, I'm
not thinking that we should learn all this,
but I'm just weird and find it intriguing.
Upper body strength and power.
You know, if I'm looking at the entire
body, I've gotta look at upper body and
(19:51):
lower body, you know, individually. So we we
chose the seated med ball throw where,
you know, patients are sitting and they they've
got a three to four pound,
like a three pound medicine ball, which is
which is the
recommended weight for,
elderly community dwelling, elderly 65 and older. So
we're looking at how far they can throw
(20:13):
that. Lower body strength, we're gonna see and
endurance, how many times they can sit sit
to stand in thirty seconds. And, of course,
hand grip strength, which is something that, you
know, has been in the literature for many,
many years as being,
this surrogate to lingual strength as well.
And so those
five were chosen
(20:34):
because of the fact that they reflect the
entire
body,
and we're looking at true measures
of gait speed, upper body power, lower body
strength,
and endurance as well. Yeah. I I wanna
I wanna ask you, So you figured out
all of these physical therapy or exercise physiology
components or of exercise that you wanted to
(20:55):
add in. How did how did you now
bring those over to your swallowing mentors and
say, hey. Would you guys be interested in
doing this project with me? Because we're gonna
look at all of these different exercise physiology
components.
Well, it was great because, initially, I was
only looking at lingual pressures
and
chewing.
(21:16):
And so my amazing mentors, when I brought
this
to them, the first thought was, okay.
These are all great, but let's look at
what what is the literature
telling us, you know, for the logistic regression,
what ended up happening was we dichotomized
the Yale swallow protocol
(21:38):
to assess dysphagia risk. Right?
And so and we used the e 10.
And
so what we ended up doing
was so the e 10, we know that's
an ordinal variable. Right? But for descriptive purposes,
we reported the mean and the standard deviation
as a sum score, and so we treated
(21:58):
it as a continuous
variable. But then when we went and did
the
logistic regression,
we dichotomized greater than,
three and above three to assess dysphasia risk,
which made it,
sort of binary. So and then we again,
we know that the,
cough peak flow
(22:20):
we we there's lots of literature to suggest
that reduced cough peak flow,
you know, can impact
swallowing
function. We we know that.
And so why don't we use cough peak
flow
as one of the swallowing performance variables? So
I hadn't I hadn't considered,
(22:42):
you know, a self reported measure like the
e 10.
I hadn't considered
thinking about the Yale swallow protocol in this
process or cough peak flow. And so I
think
that, for me,
was really
the way we married the two, and it
really wasn't until doctor Molfentor and doctor Souter
(23:03):
came into
the conversation
that I began to think a little bit
differently about it. And it again, it speak
to me, it speaks to the beauty of
interprofessional
Yeah.
Collaboration,
which, you know, again, I could talk about
that
for a while too.
But it wasn't until because, you know, my
(23:26):
my chair wasn't thinking along those lines. And
I don't know that
I you know, for the last three years,
my head was in
exercise, and so I needed somebody to sort
of bring me out of that and see
how we could marry the two.
And,
you know, I I think that is what
the my swallowing mentors
(23:47):
brought to the table.
Yeah. Yeah. Alright. Do you wanna dive into
findings?
Well, I can.
I think, again,
the big takeaway here is that when when
I examined all five of these physical performance
measures
in healthy community dwelling elderly,
The the biggest surprise to me was that
(24:10):
all five
all five of these physical performance measures showed
significant correlations with cough peak flow. Interesting.
Here's what was novel, and then and we
didn't find this out until we did the
stepwise,
progression to, you know, to figure out which
one was most predictive.
And upper body power was the strongest
(24:32):
predictor
among all of them, and and that hadn't
been shown before.
And so when we looked at swallowing outcomes
directly,
upper body power consistently
predicted lingual pressures,
lingual endurance,
cough pee flow,
and swallowing
reserve. K?
(24:52):
And so what this tell told me is
that this isn't, like, just one
measure. This was sort of a multidimensional
pattern that we were seeing here,
consistently
correlating and and being more predictive of upper
body power. And so
what I think the big piece to this
is I think it's important because it extends
(25:12):
what we already know
about cough, peak, flow, and swallowing. Yeah. But
it but it adds upper body
power
as maybe a new, you know, clinical
flag.
Now
am I suggesting that speech language pathologists
become
exercise scientists and start testing upper body power?
(25:34):
No. That's not what
I am suggesting
at all.
But what I am thinking about
is
clinically because I get asked this question too.
What what does this all mean clinically? Yep.
When I think about this
clinically,
I'm thinking about
PT and OT, sort of changing
(25:57):
the culture
of,
you know, how we communicate
with PT and OT. You know, I know
a lot of people are thinking, oh, this
is great in theory.
But how do you actually get PT and
OT to think about swallowing? And the the
the honest answer really for me is I
don't
know. We don't have a system for it,
and I think that that's part of the
(26:18):
gap.
But
I think that if we look at what
the literature
on interprofessional
practice
practice talks to us about,
I think we could start
with shared language. Right? So, I mean, think
about it from this perspective. PT and OT,
they already measure gait speed. Right? They already
measure grip strength for
(26:40):
for upper body. They already
look at other areas of upper body power
and functional performance, and so we're not only
asking them to learn something new. We're not
asking them to
learn all about swallowing. I'm not asking speech
pathologists to learn all about physical performance,
But what I am asking, I think, is
to think about maybe a connection
(27:01):
that
we haven't made
before
together. Right? And so
sort of if if we could think about
maybe embedding it into all of into our
already existing workflows. Right?
So
for example, if PT is already measuring upper
body power and gait speed,
what if a low score became
(27:24):
sort of a red flag referral for speech
therapy?
Right? That's just, like, a minimal
behavior change to shift our thinking, like, from
reactive
to proactive.
And then the other question that I always
get, well, who's gonna pay for this? Because
insurance doesn't pay for preventative care for us.
Well, I don't know. They didn't pay for
(27:45):
preventative mammogram screens or colonoscopy screens at first.
Right? They didn't pay for any of that
preventative care until the science was there to
back it. So I think I think we
have to start somewhere. Conversation has to start
somewhere. Yeah. I do. I do think that,
and I think that,
you know,
there's not a a complete answer to all
(28:06):
of those questions.
Right?
I think
that if we can just start talking about
it, and we do that here at Moravian.
We are,
we have,
huge interprofessional
care,
education, and not only,
do we all of our students learn together
(28:26):
here, PTOT,
speech athletic training,
they all have classes together. We all learn
here. We have interprofessional
education sessions every single Friday,
so that we're starting
the students early, so that they understand the
language
of PT SLPs,
and that they understand the language of OT,
(28:48):
and so on and so forth. And so
I think,
you know, if we sort of change the
culture
between our communication,
and maybe PT and OT can start thinking,
maybe I need to refer for a swallow
screening,
based on the fact that I'm seeing
(29:08):
this specific
physical performance indicator. Right? Right. Right. We all
we already have a payment model for screening.
So as SLPs, we're not asking for anything
particularly new. Right?
We are just offering
or I'm asking maybe to think about a
different justification,
you know,
and that could go both ways. You know,
(29:30):
that could lead us back to referring to
PT for evaluating and potentially treating a patient,
that we see has impaired strength,
weakness,
just sort of overall that sort of generalized,
deconditioning
that may be impacting their swallowing. We see
that all the time. So can we refer
(29:50):
them back to PT
for a prescriptive,
sort of exercise program
to help them build up their strength and
their, you know, overall functional reserve, which might
help improve their swallowing reserve? I mean, there's
so many different ways
to think about that. Right?
We're we're not I'm not asking SLPs to
become PTs or OTs. Just, again, thinking about
(30:13):
changing the discourse
about it with our exercise colleagues and really
begin true interdisciplinary
care from a cross systems
approach.
Does does that make sense? Yeah. Yeah. Yeah.
Yeah. Very well so. Very beautifully said. Can
I ask you just a few clarifying questions?
Yes. Of course. Tell me again exactly how
(30:35):
you measured upper body power.
We measured upper body power via the seated
med ball throw. Seated med ball throw. Okay.
Was there a specific
weight that everyone had to do? Like, how
was that calculated? Yes. So so in the
seated med ball throw, the patients are seated,
in the chair, their arms at their sides.
They're holding a three
(30:55):
pound
medicine ball. I wish we were on video
because I got one. I got this three
like, I'm the only speech pathologist that has
the date walk the the med ball in
my office. So and so patients are asked
I mean, the subjects were asked to throw
it. K? Just signature and throw it as
far as they can. Okay. K? And that
and then we measured that.
(31:17):
And so that's how we measured upper body
power. Okay.
Alright. Fascinating. And it's so fascinating that that
was what you said
always correlated to
tongue pressure.
And cough peak flow. And cough peak flow.
Cough peak flow.
But think about it. We need we in
order for us to cough effectively,
(31:38):
to have a really strong productive cough, we've
gotta have
good upper body power. Right? I mean, it
makes it makes so much sense to us.
Yeah. Yeah. Makes Yes. Oh, and, you know,
I think that's you know, where we I
think we got sidetracked because I was talking
about doctor Van Ravenhorst Bell's study
and sort of,
(31:59):
you know, what
made me just sort of think about this
all differently. Because
in her study,
she,
in her 2016
study that she was looking at
tongue measures in
48 people. She was looking at, tongue pressures
(32:22):
and exercise. Right? But the one that just
really blew my mind was her study in
2018
where she recruited 21 weightlifters
and 23 runners. K?
And so the findings of that study
were that weightlifters
produced it produced significantly greater tongue strengths than
runners, particularly in the anterior region of the
(32:44):
tongue.
But then runners
produce significantly
greater
tongue endurance
than weightlifters.
That, I mean, that just blew me away.
And what she and she each of these
runners and weightlifters
engaged in their preferred
exercise program at least four times a week.
(33:04):
And this study was the first to investigate
sort of the indirect effects of physical exercise,
on tongue muscle.
And I thought this is amazing.
And the it it really did, I think,
or it it's paving the way for future
research
to invest investigate more approaches to this
(33:26):
age related decline on tongue muscle performance,
right, that can maybe,
prevent
the decline
of,
you know,
swallowing function. I mean, that's a big,
leap to say that, but I think that
it just
is paving the way for us to think
about
(33:46):
physical
exercise, not physical activity, but physical exercise,
in a different way, and what are the
broader implications
then for swallowing. And I have to tell
you about this fangirl moment. So let me
just tell you about doctor Van Raven Horst
She's at the University of Wichita.
Let me just tell you this.
(34:07):
So here I am, unicorn speech pathologist,
you know, holding my med ball.
I
love this med ball.
I'm I'm unicorn speech pathologist getting a doctorate
in,
health and human performance
and an emphasis in exercise science. So I'm
reading these papers by doctor Van Ravenhorst Bell,
(34:28):
and I met ASHA
in 2024.
Right?
Doctor Molfinster says, Jevan, you've gotta come you
gotta come over here. We're in the posters.
You gotta come over here. You're not gonna
believe who's here. And I'm like, who's here?
Who's here? And she says,
doctor Van Ravenhorst Bell, and she was just
at your poster. I'm like, you gotta be
kidding me.
And I was, you know, I'm fangirly. I'm
(34:50):
like, oh my god. I'm gonna meet her.
I'm gonna meet her. I'm gonna meet her.
She doctor Van Ravenhorst Bell is an exercise
scientist. She's an exercise physiologist
who happened to get a doctorate in communication
sciences and disorders. And so I thought, oh,
this person
is somebody who gets me. She's Oh, that's
so funny. Yeah. Isn't it so funny? She's
(35:11):
the one person in the world who understands
me. And so subsequently
she and I have had, oh my word,
some wonderful
conversations,
and I mean I could just talk to
her for hours.
She's really quite remarkable.
But, yeah, we did just the opposite. So
she's an exercise,
(35:31):
physiologist who wanted to learn more about communication
sciences and disorders, and then I did just
the opposite. So we have lots of great,
great conversation, she and I. Oh, I love
that. Thank you for sharing that. Love when
love when you find your unicorn besties in
totally different fields. Yeah. Oh, good. I love
that. Yeah. But
yeah. My my brain was just thinking this
(35:52):
whole time as you were talking about, you
know, how does this become part of screening
and who pays for it and all you
know? And I love the analogy you gave
about, you know, breast cancer screenings and colonoscopies
and things like that. And I think where
my brain went was,
you know, I know there's different researchers working
on sort of these
swallowing algorithms. Right? Like, these algorithms for
(36:12):
determining
aspiration risk or patients that are really at
risk of having
swallowing impairments that can cause all these down
the line
real medical complications. Right? And so I think
that's what I was thinking. This is part
of that big play. Like, this is part
of that big
screening for, you know, at risk older adults
or at risk adults that have some of
(36:34):
these conditions that we know impact swallowing.
You know, is this something that is a
screening in and of itself, or is this
packaged in
one of those algorithms? I think, you know,
there's there's so much opportunity for this information
to to find its
home. Yeah. I agree with you, and I,
I
yes. I have the utmost respect,
(36:56):
for all of our researchers who are working
to improve the lives of those with swallowing
problems. But I think
often when we think about
swallowing problems in aging, we do just focus
on
sort of our little
throat.
Right? We we focus on our little area
right here.
(37:17):
And in reality, I think it may be
a much bigger picture than that. I mean,
you know, as we get older, we don't
just lose strength in one area.
Right?
Skeletal muscle mass declines across the entire body.
You know, neuromuscular
integrity, though, that communication between nerves and muscles,
that also deteriorates
(37:39):
globally.
So I think, you know, thinking about it
out of the box a little bit, the
same processes that slow gait speed,
that reduce grip strength,
and affect mobility,
maybe
it also has the potential
I mean, it could be plausible that it
could impact swallowing. Right?
I mean, you know, in that sense, we
(38:00):
think about
if we think about swallowing as maybe not
being this isolated
dysfunction,
think about it as reflecting,
you know, this broader sort of systemic
aging that it could have the potential to
mirror overall physical
decline sort of, you know, as this cross
system
deterioration that goes beyond what we traditionally
(38:23):
label as purely,
a swallowing problem. You know? And I think
if we can think a little bit
about swallowing,
not just as a stand alone problem,
that if we can start thinking it of
it as an expression of, you know, sort
of our whole body neuromuscular
(38:44):
health,
you know, such that when the body declines,
guess what? Swallowing might decline with it. And
I, you know, I recognize that what I'm
saying is
probably,
you know, for some people, they're like, what
is she talking
but I do recognize that there's limitations to
what I'm do what I've done and what
(39:05):
I'm doing. And, again, all of what I've
done is cross sectional data. Right? I can
show that upper body power and swallowing measures
are associated. Right?
There's correlated, but it maybe what's the the
causal factors are not there. And I can't
definitively say that improving upper body power will
improve
swallowing. Right? So it's important distinction.
(39:27):
But I think instead of seeing it as
a as a weakness, we can maybe use
it as a road map
to take us to the next step. There's
so
much more work to be done.
The next logical step, in in my opinion,
would be a perspective more longitudinal
design and sort of that we look at
the same people over time to see if
(39:49):
changes in their fitness program
predict swallowing changes.
We need instrumental assessments like MBS and FEES
to confirm these predictive relationships
just beyond, you know, the the clinical
measurements. And then I think, ultimately,
really, we need to,
you know,
sort of test
(40:10):
whether fitness based rehabilitation
protocols can actually move the needle on swaddled
outcome. You know? I don't know.
I just I I don't think that the
limitations
undermine the findings. I think they
really define what needs to happen next. And
I think, you know, I mean, I how
how much time we got? I can talk
about this for hours. But I but I
(40:31):
think, you know, I think there needs to
be a call to action. And I think
if I had to describe what my call
to action
would be,
I would say,
let's look at what we're doing now. Are
we truly interprofessional?
Are we
multidisciplinary,
or are we interdisciplinary?
(40:52):
And I remember, I love interprofessional care education,
so I'm always, you know,
doing a webinar or listening to a talk
on something about interprofessional education. And I was
listening to someone say
that if we imagine
sort
of the layers of a yogurt parfait. Right?
We've got we get up. We make our
(41:13):
yogurt parfait in the morning. We've got our
we've got our yogurt, then we've got our
strawberries or blueberries, then we've got our, you
know, other fruit, and then we've got our
granola,
and then we might have another layer of
yogurt and granola, whatever, but they're each stacked
sort of separately. Right? So that each
ingredient is maintaining its own identity. And I
(41:34):
think that's what
really represents a multidisciplinary
approach where we've got different professionals. We've got
SLP, PT, OT,
nurses, physicians.
We've got everybody on the multidisciplinary
team contributing their expertise,
but we're working
parallel.
Right?
(41:54):
Our roles are distinctly
and clearly separated
even though
we're all in the same parfait, we're serving
the same patient.
Right? But we're distinctly
separated.
Now if you think about that same parfait,
and this is what really you know, when
I heard the speaker say this, and I
can't remember where I heard it, but it's
what really sort of shifted my thinking. You
(42:15):
think about that same parfait
blended up. Now it's a smoothie. Right? The
ingredients are all blended together in one uniform
drink,
and you can't really distinguish the individual components
anymore. Right?
That to me really represents sort of our
interprofessional
or interdisciplinary
approach, right, where we
(42:36):
are collaborating
closely, we're integrated,
we've got shared decision making, and we work
together as a cohesive unit. That that plan
of care is now
cocreated
rather than sort of layered
separately.
And so,
you know, I guess what I'm saying is
that multidisciplinary
is just sort of this layered collaboration where
(42:57):
we're doing sort of these side by side
parallel contributions,
But interdisciplinary
is really that blended,
collaborations
where we're integrated and we have this
shared approach. And so we we have evidence
that tells us that there are some physical
performance measures that are correlated with swallowing performance
(43:17):
measures.
That is not new. But I think this
is another reason. And, again, I I feel
like the work that I've done just sort
of adds to that already,
and it's just another reason why we should
all be playing in the sandbox together. So
if that if, you know, if there was
a call to action,
that would be it for me. Yeah. Yeah.
(43:39):
Talk to me about what's next, Yvette. Where
obviously, that is your call to action, but
where do you personally
see taking this now? You know, do you
wanna test it in different specific populations? Are
you wishing for just
Well, I don't I don't know. I mean,
I think I think that there's
a lot.
But like I said earlier, I think the
(44:00):
logical next step is a perspective longitudinal
design. So I'd like to follow the same
people,
community dwelling elderly. I just have a heart
for them. I love them so much,
just because they don't
get a lot attention
attention. They're overlooked because of their, like I
said, perceived independence. Yeah.
But I think swallowing the following the same
(44:21):
people
over time,
to see if changes in fitness
actually predict changes in swallowing. And so,
instrumental assessments
to confirm
these predictive relationships
and intervention study,
maybe not first, but leading up to that.
(44:42):
Yeah. Yeah. Lots to think about. Yeah. I'm
get I'm getting old though, you know, so
I I don't know if I'm gonna have
time to do all of this. Of course
you are. But What what else are you
gonna do with your time?
I feel like you're not gonna just sit
around and think about swallowing all the time.
You're full of it. Yeah. Well, you know.
So yeah. I mean, I I don't know,
but there's there's so many conversations
(45:05):
to be had.
And right now, I really want to focus
on changing
the culture,
you know, just among
our colleagues and really thinking more
interprofessionally
rather than multi
professional
or multidisciplinary.
Yep. Good. I love it. Thank you so
(45:26):
much for sharing this. This is awesome work,
and I'm I'm so happy. I've been hearing
bits and pieces for years of what you
were doing, so thank you for explaining it
directly from your mouth. I just love to
hear it. Any final thoughts? Anything else you'd
like to share with the people?
No. I mean, I don't I don't have
anything that is I feel like, you know,
just glaring. I think I've talked about it
(45:47):
so much. I I could talk about this
for hours, though.
So I've tried to condense it and not
bore the people with my
with my interest in exercise.
But, yeah, I know. I don't I think
that we just need to start having
different conversations.
And,
I I really don't want people to go
(46:08):
away thinking that I'm suggesting that we become
physical therapists or occupational therapists and start testing
upper body strength and hand grip strength and
gait speed. That is not at all what
I'm suggesting.
Yeah.
And and yeah. Again, I don't wanna
have people come away thinking that that lady
said on Teresa's podcast,
we shouldn't be doing any sort of compensations
(46:30):
or diet modifications. They're just gonna be throwing
med ball all day.
That's right. Yep. They heard it here first,
everyone.
All those med balls and you're swallowing the
food. That's it. That's not what I'm suggesting.
But just, you know, a more broad conversation
Yeah.
About
the the principles of exercise, and maybe we
(46:50):
should start thinking about this
more from an interdisciplinary
perspective.
And that's a wrap for this episode.
As always, thank you so much for listening.
If you'd like to download the show notes
from this episode, please visit swallowyourpridepodcast.com.
There you can also sign up for our
email list so that you'll never miss another
episode.
If you do like what you hear, then
(47:12):
please subscribe and leave a review on iTunes
or share it on social media with your
friends and colleagues because that is what keeps
these episodes coming.
If you'd like to be a guest, share
feedback, or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
catch you next week.
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