dysphagia matters

Feeding, swallowing, speech, voice, and language are often treated as separate clinical domains, yet growing evidence points to shared sensorimotor pathways that connect them across the lifespan. Together with Prof David McFarland we discuss how early feeding difficulties may relate to later language development disorders, how cross-system thinking can enhance adult dysphagia care, and why moving beyond traditional clinical silos may improve assessment, intervention, and interdisciplinary collaboration. Literature that we discuss Martin-Harris et al. 2022: Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions.  McFarland & Tremblay, 2006: Clinical implications of cross-system interactions.  McFarland et al. 2020: Development and Preliminary Application of a Caregiver Directed Questionnaire to Identify Feeding-Swallowing Difficulties in Young Children. Poulin et al. 2026: Examining the Relationship Between Early Feeding Difficulties and Language Development: A Longitudinal Study

Tracheostomy care is a highly specialised clinical area, but when it comes to infants and children, the complexities multiply. Pediatric care requires a completely unique approach that accounts for anatomical differences, developmental milestones, and family dynamics. In this episode, Louise Edwards, Clinical Specialist Speech and Language Therapist and PhD candidate, joins us to explore the realities of pediatric tracheostomy care from an SLT perspective. Together, we examine the core clinical priorities, unpack the key differences between pediatric and adult management, and discuss the often-overlooked challenges of transitioning young people with complex needs from pediatric to adult services. Key takeaways: Pediatric vs. Adult Care: Understanding the critical physiological, anatomical, and developmental differences clinicians must recognize. SLT Clinical Priorities: Establishing communication, developmental feeding, and swallowing safety in infants and children with a tracheostomy. The “Trach” vs. The Underlying Condition: Teasing apart how much swallowing and feeding difficulties are caused by the tracheostomy tube itself versus the child’s broader medical and developmental profile. Transitions to Adulthood: Practical considerations for the multidisciplinary team to ensure young people and their families don’t feel lost when moving into adult services. The Future of Care: A forward-looking discussion on hoped-for advancements in family support and clinical care over the next five years. Networks: Global Tracheostomy Collaborative: not SLT specific, but they have a great website and provide research and webinars focused on supporting people living with a tracheostomy and their families across the age, as well as healthcare professionals. Royal College of Speech & Language Therapists Tracheostomy Clinical Excellence Network: UK based network of SLTs (and other HCPs) looking at tracheostomy across the age range. Often run virtual study days/webinars. Resources: National Tracheostomy Safety Project (NTSP): paediatric guidance and training References: Miles et al. (2025). Children with a tracheostomy: Global speech-language therapists’ practice. Streppel et al. (2019). Swallowing problems in children with a tracheostomy tube. Pullens & Streppel. (2021). Swallowing problems in children with a tracheostomy. Gupta et al. (2026). Impact of Tracheostomy on Dysphagia in Children. Lee et al. (2025). Incidence of Pediatric to Adult Transition Among Tracheotomy Patients. Ongkasuwan et al. (2014). The effect of a speaking valve on laryngeal aspiration and penetration in children with tracheotomies. Brooks et al. (2020). Passy muir valve tolerance in medically complex infants and children: Are there predictors for success?

When we think of Obstructive Sleep Apnea (OSA), we usually think of snoring, disrupted sleep, and daytime fatigue. But there is a critical link between OSA and dysphagia. In this episode, we sit down with Prof. Ankita Bhutada from Northwestern University to explore how upper airway collapse and chronic respiratory disruption can profoundly impact swallowing function. We cover: Understanding OSA: What is obstructive sleep apnea, its primary risk factors, and why it is a major public health concern. The link to dysphagia: Understanding the sensorimotor mechanisms and neuromuscular changes that connect sleep-disordered breathing to swallowing dysfunction. Clinical Presentation: How dysphagia typically manifests in individuals with OSA  Diagnostics: Why clinicians should consider routinely screening people with OSA for dysphagia and how to adapt existing assessment tools for this population. High-Risk Groups: Identifying which specific patient profiles within the OSA population face the highest risk for airway compromise. Management & Treatment: A look at current and emerging treatment approaches for dysphagia in people with OSA. Literature that we discuss: Bhutada et al. (2022). Predictors of Patient-Reported Dysphagia and Reflux Symptoms in Obstructive Sleep Apnea. Bhutada et al. (2020). Obstructive sleep apnea syndrome (OSAS) and swallowing function—A systematic review. Bhutada et al. (2025). Effects of Expiratory Muscle Strength Training on Oropharyngeal Swallow Physiology in Persons with Obstructive Sleep Apnea (OSA): A Preliminary Study.

What do you do when patients report severe swallowing difficulties, but all structural and neurological exams come back normal? In this episode, we talk to Prof. Anna Miles about her paper “Functional dysphagia: Developing a framework for assessment and treatment”. We explore why terms like “psychogenic dysphagia” or “phagophobia” are outdated, look into the neurobiological underpinnings of the condition, and discuss practical, biopsychosocial strategies for speech and language therapists. Key Takeaways: Language Matters: Why shifting from psychogenic to functional dysphagia reduces stigma and improves patient care. The Biopsychosocial Framework: Moving away from a diagnosis of exclusion toward a positive, holistic assessment. Neurobiology & Agency: How functional dysphagia relates to a real disruption in the voluntary control of swallowing (loss of agency). Hypervigilance: How past negative events (e.g., a choking incident) lock patients into a restrictive cycle. Clinical Crossovers: Applying techniques from voice therapy (e.g., laryngeal massage) and laryngeal hypersensitivity management (cough/gag reflex) to functional cases. Psychoeducation: Why explaining the underlying mechanisms to the patient is a highly effective therapeutic tool in itself.

What if a microphone and a few sensors placed on the neck could detect dysphagia; without access to FEES  or videofluoroscopy, maybe even without a dysphagia specialist in the room? In this episode, we sit down with Prof. Ervin Sejdic, a biomedical engineer at the university of Toronto, whose research is changing the way we think about dysphagia assessment. Ervin leads work on High-Resolution Cervical Auscultation (HRCA) – a method that captures the sounds and vibrations of swallowing using sensors on the throat, then analyses that data with signal processing algorithms and artificial intelligence to identify aspiration risk and characterise swallowing function. We talk about how to develop biomarkers for dysphagia, and how they could one day fill the gap of reliable swallowing assessment where FEES or videofluoroscopy may not be accessible; in hospitals, nursing homes, and community settings alike. We discuss: What a computational biomarker is and why it matters clinically What HRCA looks like in practice: setup, sensors, and data What the algorithms can detect today, and what’s still on the horizon The path from research lab to clinical routine

Dysphagia is an under-recognised but clinically important complication following cardiac surgery. In this episode, Prof. Cara Donohue discusses why dysphagia can occur despite surgery being anatomically distant from the swallowing mechanism. We explore the complexities of dysphagia in patients post cardiac surgery, highlighting risk factors, prevalence, assessment methods, and potential interventions. Cara shares her research findings and clinical perspectives, emphasising the importance of early detection and proactive management to reduce complications and improve patient outcomes. Topics covered Why dysphagia occurs after cardiac surgery Mechanisms contributing to postoperative swallowing impairment Prevalence and potential under-recognition of dysphagia in this population Typical clinical and instrumental findings Surgical and perioperative risk factors Consequences for recovery and patient outcomes The role of prehabilitation and respiratory strength training Identifying patients who may benefit from preoperative interventions Key clinical messages for SLTs in cardiothoracic settings

Preparing safe, enjoyable meals for people with dysphagia can be challenging but it does not have to mean sacrificing enjoyment of food, variety, and social connection. How can clinicians and caregivers help ensure meals remain safe and enjoyable? In this episode, we speak with Dr. Simone Howells from Griffith University, Australia, about the second edition of Beyond the Blender: Dysphagia Made Easier; a freely available cookbook featuring 30 recipes organised according to IDDSI Levels 2–6. We discuss: the inspiration behind creating the cookbook how recipes were developed, selected and adapted across IDDSI levels the challenges of modifying everyday meals while maintaining taste, texture, and visual appeal the broader responsibilities of SLTs beyond recommending modified diets practical strategies and resources to better support patients and families

Meta-analyses are powerful tools, but they can be challenging to interpret. In this episode, we explore how dysphagia clinicians can better understand and critically evaluate meta-analyses to support evidence-informed practice. We are joined by Prof. Kendrea Garand to talk about the article “How to Interpret and Evaluate a Meta-Analysis in the Field of Speech and Language Therapy: A Tutorial for Clinicians.” We discuss: What meta-analyses are and why they matter for dysphagia clinicians How to conduct a meta-analysis How to critically interpret and evaluate a meta-analysis Red flags in pooling studies in meta-analyses Rapid appraisal tips for clinical decision-making Integrating evidence with clinical expertise and patient values

In this episode, we talk to Dr. Raele Loy, a Speech and Language Therapist and research scientist at the Center for Health Disparities Research at the University of Wisconsin-Madison. We discuss a critical but often overlooked aspect of dysphagia care: health equity, or the lack thereof. Raele discusses what sparked her interest in health equity, and explains what ‘health disparities’ mean in clinical practice and research today. She discusses what is currently known about disparities in dysphagia assessment and management, and presents her conceptual framework which illustrates how disparities emerge and persist throughout the entire eating and swallowing care pathway in people with dementia.

Behind the tremor in Parkinson’s disease lies a complex neurodegenerative process that affects far more than movement. In this conversation, we are joined by Prof. emer. Werner Poewe, neurologist and one of the world’s leading experts in Parkinson’s disease. He unpacks the evolving understanding of Parkinson’s disease, from James Parkinson’s first observations to today’s insights into pathology, prodromal symptoms, diagnosis, and treatment. With a special focus on swallowing and dysphagia, we explore what clinicians need to know to support individuals with Parkinson’s disease across all stages of the disease.