EPISODE 275
[INTRO]

[00:00:13] MD: Hi, folks, and welcome to First Bite: Fed, Fun, and Functional, a speech therapy podcast sponsored by SpeechTherapyPD.com. I am your host on this nerd venture, Michelle Dawson, MS, CCC-SLP, CLC, the all-things peds SLP. I am a colleague in the trenches of home health and early intervention right there with you. I run my own private practice at HeartWood Speech Therapy, here in Cola Town, South Carolina and I guest lecture nationwide on best practices for early intervention for the medically complex and fragile child.

First BiteÕs mission is short and sweet, to bring light, hope, knowledge, and joy to the pediatric clinician, parent, or advocate. 

[00:01:01] EF: By way of a nerdy conversation, so thereÕs plenty of laughter, too. 

[00:01:05] MD: In this podcast, we cover everything from AAC to breastfeeding. 

[00:01:09] EF: Ethics on how to run a private practice. 

[00:01:12] MD: Pediatric dysphagia to clinical supervision. 

[00:01:15] EF: And all other topics in the world of pediatric speech pathology. Our goal is to bring evidence-based practice straight to you by interviewing subject matter experts. 

[00:01:24] MD: To break down the communication barriers so that we can access the knowledge of their fields. 

[00:01:30] EF: Or as a close friend says, to build the bridge. 

[00:01:34] MD: By bringing other professionals and experts in our field together, we hope to spark advocacy, joy, and passion for continuing to grow and advance care for our little ones.

[00:01:45] EF: Every fourth episode, I join in. IÕm Erin Forward, MSP, CCC-SLP, the Yankee by way of Rochester, New York transplant who actually inspired this journey. I bring a different perspective that of a new-ish clinician when experience in early intervention, pediatric acute care, and non-profit pediatric outpatient settings. 

[00:02:05] MD: So sit back, relax, and watch out for all hearthÕs growth, and enjoy this geeky gig brought to you by SpeechTherapyPD.com. 

[DISCLAIMER]

[00:02:20] MD: Hey, this is Michelle Dawson, and I need to update my disclosure statements, so my nonfinancial disclosures. I actively volunteer with Feeding Matters, National Foundation of Swallowing Disorders, NFOSD, Dysphagia Outreach Project, DOP. I am a former treasurer with the Council Estate Association Presidency, CESAP. 

A past president of the South Carolina Speech Language and Hearing Association, SCSHA, a current board of trustees member with the Communication Disorders Foundation of Virginia. I am a current member of ASHA, ASHA SIG 13, SCSHA, The Speech Language Hearing Association of Virginia, SHAV, a member of The National Black Speech Language Hearing Association, NBASLH, and Dysphagia Research Society, DRS.

My financial disclosures include receiving compensation for First Bite Podcast from SpeechTherapyPD.com, as well as from additional webinars and for webinars associated with understanding dysphagia, which is also a podcast with SpeechTherapyPD.com. I currently receive a salary from the University of South Carolina in my work as adjunct professor and Student Services Coordinator. 

I receive royalties from the sale of my book, Chasing the Swallow: Truth, Science, and Hope for Pediatric Feeding and Swallowing Disorders, as well as compensation for the CEUs associated with it from SpeechTherapyPD.com. So those are my current disclosure statements. Thanks, guys. 

[00:04:06] EF: Hi, this is Erin Forward, and these are my disclosure statements. I receive a salary from Cincinnati ChildrenÕs Hospital Medical Center. I receive royalties from SpeechTherapyPD for my work with First Bite Podcast and other presentations. I also receive payment for sales from the First Bite Boutique, which I have with Michelle Dawson. 

For nonfinancial disclosures, I am a member of ASHA and a member of Special Interest Group 13. I also am a volunteer for Feeding Matters. I am a contributor for the book, Chasing the Swallow, with Michelle Dawson, which I receive no financial gain. I also am a member of the South Carolina Coalition Committee with ICLDI at full-time.

The views and opinions expressed in todayÕs podcast do not reflect the organizationÕs associated with the speakers and are their views and opinions solely. 

[INTERVIEW]

[00:04:54] MD: All right, everybody. I am kind of geeking out and fangirling a little because we have none other than the Dr. Martin Brodsky, who is an ASHA fellow and one of the nicest humans you're ever going to meet. Bio is profound, and it's always amazing to me when you read something of this. He's an associate editor for Dysphagia. He's a section editor for the Archives of Physical Medicine and Rehab. He's the section head for Speech-Language Pathology in the Integrated Surgical Institute at Cleveland Clinic. He's an adjunct associate professor of Physical Medicine and Rehab and Pulmonary and Critical care at John Hopkins and, and, and, and, and. 

When I say he's one of the kindest humans, I have read his work. Just you sit back and you stand in awe of the great center field that lead with compassion. At ASHA this past year, there I was standing, trying to read a map to figure out where the party was at one of the gala events for a colleague who had just gotten her ASHA fellow. There he was standing at the map, completely lost. This nice man walks over and was like, ÒCan I help you?Ó Then lo and behold, it was Dr. Martin Brodsky, and I was like, ÒYes.Ó It was just that. Those little moments speak volume of the kindness that is still found in our profession. So with a whole heart, thank you so much for coming on and hi. 

[00:06:26] MB: Hi. That is a very kind introduction. I really appreciate that. Yes, it was shocking that however small we think this world of Dysphagia to be, I've had a little bit of a fanboy in me, I guess you could say, in trying to find you. It's been, what, a decade, trying to find each other. Lo and behold, we find each other, trying to find our way at ASHA. So it was a moment. 

[00:06:53] MD: Thank you. Y'all, I normally Ð what's really funny is I run into most people and meet most people in the ladies bathroom. YouÕd be surprised how I met Joan Arvedson running into the bathroom because I almost ran into Joan Arvedson, which would have been like the end of me as a human. But it's nice to meet you [inaudible 00:07:10]. 

[00:07:12] MB: I'm glad I didn't meet you in the restroom. 

[00:07:15] MD: Also, a couple of ASHAs ago, when we were out at LA, oh, I had to pee so bad, and I was waiting in line for forever. I was like, ÒWhy is this line for this bathroom taking so long?Ó I thought it was like one of those universal bathrooms. It was the elevator. I just misread the sign, so that was Ð I swear I'm smart. But sometimes, I'm not. 

[00:07:38] MB: We all have those moments. We all have those moments. 

[00:07:43] MD: Okay. I love getting every guest backstory. Y'all, before we got started, just so you know, he is also a fan of the Oxford comma and also double spaces after the period before the start of the next sentence. So we do have those little bitty nerd loves that are true and dear, and I just can't ever get rid of either one of those. But how, how did you find out about our field of speech pathology? We want to know that walk. Then what made you get into adult dysphagia research? That's kind of a tiny weird little niche kind of like PFD. 

[00:08:20] MB: I have to say it was quite the journey and definitely not my intention, at least initially. It would obviously became an intention after some period of time. But I came into Michigan State University at my undergrad wanting to do premed and move down the physiology route. I started full tilt boogie on that and me being a freshman and the mindset that I was, probably not as mature as I wanted to be. Truth told, physiology was definitely not going to be for me, mostly from the standpoint that they required two years of foreign language. I decided Ð I placed into 190 for Spanish, and that was after four years of high school. What I realized very quickly is that living in northwest suburbs of Detroit, you can't learn Spanish very well. 

Lo and behold, I passed in the course that was effectively the review course after 101, 102, 103. I had four years and I said enough of that. I'm not doing it. So I moved into psychology as a second love and stayed with that for a while, while taking pre-med courses. I went through a year of biological science, chemistry. Organic chemistry was in my second year. I went through two out of three courses, three out of four courses. We were on the quarter system in organic chemistry. I just said, ÒYou know what? I'm really not enjoying this.Ó 

At the same time, at the beginning of my sophomore year, I took an intro to communication disorders course. Interestingly enough, the person who normally taught the course was on sabbatical, and the person who took over that course ultimately turned out to be my greatest influence in the field, and that was Paul Cook. I can't even tell you. I probably did on the order of six to seven independent and dependent studies with him as an undergrad. I did several other courses with him at the graduate level. He was my thesis advisor at the master's level. He and I go a long, long, long way, and hands down the single greatest influence of me getting into the field. 

My master's thesis, for those of you who have never read it, it's probably buried somewhere, and you're never going to find it. But it was the influences of getting into speech-language pathology and audiology. What was the decision-making? How did you end up getting there? It's published in a counseling journal somewhere that's put out quarterly. That was my master's thesis. Shortly after that, I did my clinical fellowship. After leaving my clinical fellowship, obviously, I got some work and spent a total of four years doing work, the last two and a half in a major Detroit medical center, level one trauma. I was actually the only SLP in the entire building. It was 179 beds. Most of the work that I did was in the neurotrauma unit. Following that, I headed off to the University of Pittsburgh for my Ph.D. About three and a half years into that, I finished the necessary requirements in order to get me out of there. 

[00:11:49] MD: That's an intense three and a half years, by the way. 

[00:11:53] MB: When I say requirements to get me out of there, I didn't use the term graduate. I just physically left Pittsburgh. I went down to South Carolina to work with Bonnie Martin-Harris in December 2001 and stayed there until April 2008, finishing up my degree after eight very long years. I spent I think, what was it, a year and a half, give or take, maybe closer to two years after I graduated until I left there as an assistant professor working simultaneously in the end with the VA in Charleston, as well as Medical University of South Carolina. 

From there, I went to Johns Hopkins initially to work with Dr. Jeffrey Palmer. Things changed wildly in the first six months that I was there, and I got into the area of the stuff that I'm doing now in post-extubation ICU and all the research, which actually was my intention during my doctoral degree. I just never had the funding, the support, the opportunity, the patient population, and everything else. For those of you who talk about tenacity, this was a good 10-year journey to get back to where I wanted to be from 1998 when I entered my doctoral degree until 2008 when I entered Johns Hopkins. I spent almost 15 years there. Now, I am, as you said, section head at the Cleveland Clinic and enjoying it all the while. It's a great place. 

[00:13:39] MD: I think it's very humbling how many overlaps when you're sitting there talking about it. I know Dr. Bonnie Martin-Harris through an email when I was a CF working at a rural country hospital. They were prophylactically G-tubing and NPO-ing all of our head and neck cancer patients. If you had head and neck cancer, you got Ð the oncology suite everybody NPO and just put in a G-tube. I was like, ÒThis is not how we do things.Ó I was SLP of the department of one. Her work was coming out on head and neck cancer because this would have been Õ08, Õ09. 

January of Ô10 is when I started there, so right there Õ09 and Õ10. It was pre-MBSImP like that, yÕall. They must have been working on the research then. She was so gracious enough to send me resources, in addition to Ð this is back when you took a CEU class online, they mailed you the CD. That is tucked away in the filing cabinet behind me. It's just to be able to pursue knowledge and to serve those that we've been called to serve better but to be surrounded by this overlapping community where people truly just want to lift you up. It's one of my favorite things about our profession. If I sit back and watch all the nastiness that rolls out on social media, it can make you think we chose the wrong profession. But at the end of the day, that's not who we are. I think that needs to be stressed enough. 

[00:15:17] MB: Yes. In rehab, very different from I think Ð I don't even want to say rehab. Allied health. I think 100% and without exception anywhere in the medical community, we all want people to do well. We want people to be better. I think the approach is different from a physicianÕs standpoint in general and this broad brushstroke here. It's from the standpoint of if you can give them a medicine, if you can give them a position, if you can give them something to make them better, it's Òthe quick fix that may be the right fix.Ó 

We don't have medical degrees. The best that we can do is behavioral therapy. Behavior for anybody, whether you're training a dog or you're training a human, it really takes time and effort on both sides. I think it's one of those things. Whether you're in acute care with the half-hour touch or an-hour touch that may last twice in the patient's life, or you're in an outpatient type setting where you're spending perhaps weeks to months with the person who has a cognitive disorder, a language disorder, a speech disorder that takes that long to rehab, you really build the relationship. 

We really are Ð and I hate the term, but I haven't come up with a better one. We are the cheerleaders in their lives to push them to do better in a guided way. There's nothing negative about that. There can't be. There's realism that comes into it. There are moments where the news isn't so great at times, but it's always neutral or better. It's never negative. That, I think, was the primary reason why I actually got into speech pathology. 

The one thing I kind of held back, my adviser, Paul Cook, he was quite dysfluent. During my 201 class, where he was introduced to us or I was introduced to him and however you want to think about that, whoever walked in the class first, right? He showed videos of himself 20 years earlier. If you think back to your fluency course where you saw people with severe disfluency, with secondary characteristics and everything that comes with it, that was him. Look at him when I met him, 1989. He was maybe three percent dysfluent. 

To see the juxtaposition between the person you're watching, and I'll date myself, on a VHS tape and the person who's standing up in front of you who until he got to the 50th sentence that he spoke in that class, you didn't realize that he was dysfluent, wildly different. To see that change, knowing that I was going to be trained to do that and help somebody along that journey, that's what propelled me. Swallowing wasn't a thing in 1989, sorry to say, not at Michigan State. 

[00:18:57] MD: That's where we are now with respect to pediatric feeding disorder. Most people still don't have a differential course for peds dysphagia. It's embedded within the dysphagia umbrella, and only a handful of programs actually have a designated PFD course. Here at James Madison, I teach it. Right now, it's one credit. Starting fall of Õ25, it'll be two credits. I only know of a handful of programs where it's required. North Carolina Central University under Dr. Grace Hao, that's a mandatory three-credit class of which she's taught. I'm going to take it over adjunct. But there are so few of them. 

We are talking about it and lifting the next generation up for a subspecialty where 1 in 35 children under the age of five have PFD. But I have hope because if in '89 we weren't talking about dysphagia, in a little bit everybody will know about PFD like everybody knows about dysphagia. As frustrated as I am in one breath and the next, I'm like, ÒAh, but we'll get there.Ó 

[00:20:05] MB: Science and culture and acceptance and those big buzzwords take such a long time for things to get through. In the end, despite the length of time, we generally get it right. Let's put a little bit of context here, okay? Jeri LogemannÕs first book, her purple book, for those of us who are old enough and remember it, my pages, by the way, are starting to brown, 1983. 

[00:20:37] MD: That was the year I was born. 

[00:20:41] MB: Okay. 

[00:20:43] MD: Sorry. 

[00:20:46] MB: You're a babe. 

[00:20:49] MD: With Botox. 

[00:20:51] MB: Or I'm just old. I don't know which way we're going here. But at any rate, 1983 was her original book. Arguably, for good or bad, it was a landmarked publication in swallowing. I want to say that it was the first in speech-language pathology, and I think I'm pretty on point with that. I'll leave open the possibility that I'm definitely wrong and leave that be. But 1983 to 1989, six years, and Michigan State and many, many, many, I would argue most universities across the country, weren't even talking about swallowing. It just wasn't a thing. 

In fact, so much so that the first time Ð I actually went to bachelor's and my master's degree were from Michigan State. So I got to see the continuum. In that summer that I graduated in Õ92, they flipped over from the quarter system to the semester system. With that, for the first time in summer of 1993, I had the opportunity to take that swallowing elective course. I'll stress the term elective. I took that at a private girlsÕ school that was in Farmington, Michigan, a long way from East Lansing where the school was, okay? 

It was taught by a professor who had an adjunct appointment with Michigan State to be able to teach the course. I believe it was adjunct, and she was working at Oakwood Hospital in Michigan. Her name was Sue Fleming. Now, for anybody who knows the research, Sue Fleming worked with the group at the Detroit Medical Center, specifically Harper Hospital, to put out some of the research associated with PET, P-E-T, positron emission tomography very early in the nineties and late eighties. This was some of the seminal research that we understood about actually being able to quantify the amount of aspirations somebody had based on a radiolabeled tracer that people swallowed and had swallowing disorders, okay? That was Sue Fleming. Those are the folks at Harper Hospital in Michigan. 

[00:23:27] MD: Were you like hooked? Were you just Ð

[00:23:29] MB: Oh, I was totally hooked. 

[00:23:31] MD: I would sit in that class and be like, ÒThis is what I'm doing for the rest of my life,Ó because the first time I saw [inaudible 00:23:35], that was it. 

[00:23:35] MB: ThatÕs exactly what happened. Hands down, I knew in that moment. So prior to that, I was total Mr. Aphasia here, okay? Adult neuro, come one, come all. I'm all about it, okay? In that moment, sitting in that course for the first time ever at Michigan State University, I took the course with Sue Fleming. Now, I'll take you another step back. [inaudible 00:24:07] book, I think it was the second edition. It wasn't the green one. It was the pink one, okay? Our job with that book, it was an interesting task. Chapter by chapter, these were our assignments during the course. Chapter by chapter, we had to read, outline, summarize, and offer an opinion on each chapter, okay? Yes, it was as much work as you think it. 

[00:24:39] MD: I'm just thinking that's a terrible assignment to give students. 

[00:24:44] MB: Definitely in seven and a half weeks during the summer. This was two three-hour meetings. I think it was Tuesdays and Thursdays. Two three-hour meetings from Ð it was like five to eight, seven to nine. Maybe it was two-hour meetings. Whatever it was, it was in the evening. It was an evening course, it was twice a week, and it was as much work as you think it was. In the end, we were to compile a document, something similar to a term paper, if you will, about every single chapter in that book, okay?

She dangled in front of us the opportunity that maybe there'd be something with us on the back end of this. Okay. I wasn't even thinking about that. I just wanted to get through the course, okay? I had a couple Ð a midterm and a final. I did well on those. It was a great class. She was a great instructor, a wonderful human being. As it turns out, she was friends with my next-door neighbor growing up. Small world, right?

[00:25:49] MD: Yes. 

[00:25:50] MB: All right. At the end of the course, we all turn in our term papers, and she gets back with me, hands me Ð everything was in writing back then. There was no email. For those of you, yes, I'm dating myself, but these were the times I lived in. Everything was on paper. She wrote across the top of that term paper, ÒPlease see me.Ó 

[00:26:12] MD: If a professor writes that on your paper, you're like, ÒOh, God.Ó 

[00:26:15] MB: ÒWhat did I do?Ó 

[00:26:17] MD: Yes. My stomach just went clunk. 

[00:26:21] MB: Yes. It was absolutely that. It was hands down. The only thing that kind of looking back on that that kind of mediated that ÔahhÕ kind of feeling was the fact that it wasn't in red pen. It was in pencil, okay? In the end, she wanted me to refine it and submit it to the NSSLHA journal with her co-author, Ken Shotts, who was editor at the time in that journal or AE at that time with the journal. Nothing ever happened. It was never published. Don't go looking for it. It's not out there. I promise, okay?

Knowing what I know about publications, I'm saying, ÒPhewÓ because all I was doing was writing a term paper. That's it. That's only where my head was. Yes, I trusted her to guide through the process. I look back on this. I'm just glad. I could move on from this. But that course, independent of the term paper. That course arguably changed my life forever. That is the one that got me started. That is the one that made an indelible impression on me that has now lasted me Ð what was that, 2000? Listen to me. That was 1993. That was 31 years ago to put a time stamp on that. 

[00:27:49] MD: You had an opportunity, and you had someone that had passion. Okay. So wearing a different hat, folks, if you're in our world of dysphagia and if you're in our world of PFD, so many of our colleagues still don't know what it is that we do, right? That is on us, whether it be an interprofessional practice partner like a pediatrician who just wasn't exposed to PFD because we're only two years out to the ICD-10 code adoption. The onus is on us to lift, elevate, and spread the word. 

Actually, this year, I'm topic chair for PFD and swallowing disorders for ASHA Convention this year. In full disclosure, I was last year as well. But myself; Dr. [inaudible 00:28:31], who works here at James Madison University; Dr. Panayiota, who's up in Duquesne, Pittsburgh; and Dr. Memorie Gosa, who's down in Alabama. We are working with the supervision SIG to create a two-part invited talk at ASHA looking at the state of PFD and peds dysphagia currently being taught and then the clinical experience. Trying that academic into clinic so that we're increasing the opportunity on our end for students to have more in-depth exposure and experience because it's this. It's that moment. It's that personal connection that lights somebody up for this. 

Also, I have to take a huge step back. One of the reasons why we wanted to facilitate today's conversation is that there is a misconception that dysphagia looks the same across the life continuum. There's moments of truth to this, but the vast moments are significantly different because of anatomy and physiology. Also, when we're looking on the pediatric end, pediatric dysphagia falls under one of the four domains of pediatric feeding disorder. We have medical, psychosocial, feeding skill, and nutrition. Peds dysphagia falls under that medical diagnosis piece. 

We have neurodiverse adults that were a child with PFD and peds dysphagia that are now old enough to talk to us about it and their lived experiences. Marsha Dunn Klein is doing a tremendous body of work interviewing, researching these autistic adults, and having them share their lived experiences. If you're listening, I would call you to check out Marsha's work and come join us in ASHA if you're in the PFD world for that two-part talk so that we can facilitate and create more opportunities. 

Also, total squirrel, but have you ever heard of this book, Every Deep-Drawn Breath?

[00:30:41] MB: I have. 

[00:30:42] MD: Oh, my gosh. Okay. Well, don't tell me how it ends because I'm three-quarters of the way through. Folks, if you're listening, it's called Every Deep-Drawn Breath. Good Lord, I don't say Rs correctly, but this is why I do not do articulation therapy. It's by Dr. Wes Ely. He is from Vanderbilt, and it's a critical care doctor on healing, recovery, and transforming medicine, and ICU. But his walk in this book, thus far, because, again, I haven't finished, is all about how he started out in the medical thinking he just had to fix the baseline medical ideology. But then he realized, just like you said when we were starting, that it's that psychological. It's that counseling. It's that bonding with our patients piece. 

I got to be honest, this book has gotten my [inaudible 00:31:28] up a couple of times because, folks, if y'all don't know what [inaudible 00:31:31] means, it gets you hot mad, right? Let my little twang roll out. But he doesn't want to talk about the role of a speech pathologist. He talks about nursing. He talks about OT. He talks about pulmonary and respiratory therapists. But he doesn't talk about the role of the SLP in treating the medical. I'm like, ÒHow can you work at Vanderbilt and omit all of this?Ó Okay, that's my two cents take on it because I want to write him a nice little email and be like, ÒThis is fantastic. In your next edition, can you please include this profession into the book?Ó But there's my thought. What is yours?

[00:32:04] MB: I'm not going to get too much into the book. Yes, I've heard of the book. I have not read the book, full disclosure. 

[00:32:09] MD: Okay. [inaudible 00:32:10]. ItÕs my lunch date. 

[00:32:13] MB: Yes. The book came out, I want to say, a couple of years ago, a few years ago. Wes Ely, just to give you some background, is the primary researcher, primary author of the CAM-ICU, the CAM-ICU, the Confusion Assessment Method for the Intensive Care Unit or Cam-ICU. Anybody who has ever heard of the CAM-ICU, I promise that Wes Ely is the person who did that. I believe his initial work came out around 2001. It is over 20 years old right now. It has combined with the RASS or the Richmond Agitation-Sedation Scale, which is a scale of arousal, if you will, all the way from a minus five to plus four I think it is, essentially, from comatose to bouncing off the walls and uncontrollable. 

At any rate, those two scales work together, and he was the primary researcher on that, has done thousands of patients. If you go to icudelirium.org, you will see all of the rich history. He is the one responsible for that. He is the one who has put together this research on the backs of VA dollars and all of this to his credit and everybody else. Every one of his collaborators and everyone who's been involved with this is all free on that website in, I want to say, more than 20 languages. They have done a phenomenal in getting the word out about ICU delirium and made the tools available to all of us to be able to move forward and get our patients better. He is hands down one of the primary leaders in the critical care field and leading the charge in the area of delirium and recovery from ICU care or critical care. 

[BREAK]

[00:34:17] MD: Want graduate-level semester credits for your SpeechTherapyPD.com courses? They are available now in collaboration with the University of Pacific. As you know, most of our 750-plus video and audio courses are evidence-based, and all are super practical. Subscribe now. 

[INTERVIEW RESUMED]

[00:34:39] MD: When he writes, you want to cry sometimes. When he talks about patient care, the way he describes this one vignette sitting in a New Orleans hospital with a woman who just gave birth and knowing that she is going to pass, it just Ð bless. I was eating my tuna fish sandwich, and my students walked by, and they were like, ÒMrs. Dawson, are you okay?Ó I was like, ÒIt's just so good.Ó

Okay, big picture, the concept of this book is all about how he recognized we were over-sedating our patients and that the patients were leaving worse off cognitively, emotionally, even though they were physically healing. But that other piece was so broken, and he put it together that it was all of the medicine that we were giving. Then it's his life work narrated through a series of vignettes and interactions like how he goes over to Europe and how Europe has cutting-edge approaches where they hardly ever Ð well, it was cutting-edge at the time frame of the book, where they wouldn't sedate even their intubated patients, that they were lucid and awake. He talks about this was such an eye-opening experience because we come back here to the States, and most ICUs, they are heavily, heavily sedated. 

I bring this up because this is one of those overlaps from peds and adults, where our children have tinier volume of medicine, but they go through the same thing. We have patients that suffer emergent intubations, emergent trachs across the life continuum. Then as the SLP, whether you are inpatient, outpatient, home health, we are called in to do long-term care or acute care or even PO trials or an instrumental, and work our work. But it is a do we have an understanding of baseline anatomy physiology and what this patient has gone through in a medical perspective in order to offer the best services that we can offer. 

[00:36:49] MB: It's interesting. One of the battles that I put up as a rhetorical question because there really isn't a good answer to this, tell me the difference between a cognitive impairment and delirium. That's a rhetorical question. Don't Ð

[00:37:01] MD: I know. Well, [inaudible 00:37:02], I was like, ÒOh, but what about this, this, or this?Ó 

[00:37:07] MB: Here's the reality. Delirium is a cognitive impairment, okay? Immediately, you're answering a redundancy, okay? ItÕs a little bit convoluted in that way. By definition, having delirium is a medically induced cognitive impairment. It's in the DSM-5, okay? It is fluctuating attention with cognitive impairment. 

[00:37:37] MD: Some of that's permanent. 

[00:37:38] MB: That's what's interesting. The delirium is not permanent. The cognitive impairment, the long-term cognitive impairment, that's what may be permanent, okay? In the moment that you see somebody with delirium, by definition, they have a cognitive impairment simply from being delirious, okay? The only question in that moment is is it going to fade when the medical problem goes away? Or is it going to remain and lead to what may be a long-term cognitive impairment? 

What's really interesting is no matter what you do as a speech-language pathologist or, frankly, any allied health individual, you are not going to cure delirium, period. It is a medical problem, and it is caused by many, many, many things; everything from poison in the bloodstream, an electrolyte imbalance, an acute disorder, a neurological trauma. The list goes on. Many different things cause delirium. In the end, it stops fluctuating. Attention generally comes back, and you can focus and answer certain questions and so forth. Delirium, at that, point is gone. 

Now, what's left? You've got the memory impairment. You've got the thought organization impairment. You've got the potential naming impairment and other things that go on with delirium. What we're actually doing during delirium is that we're trying to bring down the patient who is hyperactive. We're trying to bring up the person who is hypoactive. WeÕre trying to square the person who is neither and is just calm and good to go in whatever discussion. They just happen to be a little bit confused, and they have Ð what we're trying to do is focus those individuals and bring in the skills that they have to be able to focus, to improve the outcomes of cognitive impairment on the back end. 

You're not treating delirium. You're treating the thought organization, the memory, the attention span, whatever subset of cognitive disorder that patient has in order to focus them and get them on the right path through the delirium that they're experiencing. 

[00:40:25] MD: This is one that I would encounter a lot. I started out with adults and then worked my way to pediatrics. Now, in retrospect, I think it's funny because I am such a peds therapist. I mean, energy level, laughter. I mean, fart jokes, the whole nine yards. But I always struggled. We had this one med-surg doc who always wanted me to go in and do a cog eval when the patients came in with UTIs. My pushback was I don't feel that it's ethically appropriate for me to do a cognitive eval and bill insurance right now when we are highly delirious because of the severity. The UTI has gone septic. You don't need me here now. What I do need to do is make sure are we safe. Do a dysphagia screen. Are we safe? Then come back in a day or two after the worst of the delirium had passed, and we were starting to heal. 

That, to me, seemed like an appropriate timing of assessment to intervention. When you're young, and folks, I say this because it's hard to advocate when you are younger and newer to our profession or you've changed settings and you're newer to that setting, but that just Ð it seemed like a mismatch and an unethical use of time and billing. Luckily, I worked for an amazing DOR who was a PT who went to bat for me and advocated for that. If folks are listening, do you know of a good resource to kind of help guide that clinical decision-making or to build off of my gut instinct? Is there a viable source to say, ÒDon't eval.Ó Or am I just totally nuts? 

[00:42:08] MB: As you kind of pointed out, and I think we're coming from or came from. I'm not sure what the right tense is here. 

[00:42:14] MD: It's okay. I wouldn't know. I don't treat that part. 

[00:42:19] MB: I'll just say we may be coming from. How's that? We'll leave that out there from two different perspectives I think. As a certainly lesser experienced clinician, and we're talking almost 30 years ago, I was of the same mindset. I think I approached it from maybe a little bit, maybe one degree off to the right or left, depending on how you think about this. I'm not talking politics here. It was one of those things where I didn't approach it because I couldn't do something for the patient. I didn't approach it because I was one SLP in 179 beds of a facility. 

The person who was delirious, which I really didn't frankly know a lot about, on the triage scale, a little bit lower than somebody who needed my attention first, okay? Maybe that's the way that I thought about it. Maybe that's the way I'm thinking about it right now. I'm just coloring the past. I don't know. But in this moment, in 2024, my thought pattern is, and this is after reading the literature, after knowing delirium as much as anybody in our field might. After having the discussion with psychiatrists who deal with this, rehab psychologists in ICU and all of the ICU docs and all of the experiences that I've had, there is a very strong opinion, a phenomenally strong opinion that we in allied health and very specifically speech-language pathology have a role in the face of delirium.

That is something similar to what we discussed or what I discussed just a few moments ago in that, no, we are not treating the delirium. The delirium is the result of, generally speaking, trauma, metabolic activity, medical problems, medicines. There's a whole list, and I can point you to resources, okay? There's a huge list of what causes delirium. When that stuff goes away, when it's treated, the delirium will go away. We are not going to change that. Delirium is a behaviorally manifest disorder, but it's not caused by behavioral problems, okay? It's not caused by the things that we think about in speech-language pathology, and with behavioral intervention we can make it go away, right? It's not retraining a ÒhabitÓ or retraining a behavior. That's not delirium. Delirium is a medical problem. I cannot stress that enough. 

[00:45:06] MD: In our tiny human world, we get patients that get urinary tract infections, pediatric Ð

[00:45:11] MB: Metabolic disorder. 

[00:45:13] MD: Yes. We have patients that have type one, type two diabetes. When their sugars are low or high, that's another example. Folks, these are ones that I'm just prattling off that I have witnessed firsthand, right? That's where the goose and the gander do meet, right? What's good for the goose is good for the gander. That's where adult to peds these things do cross over. Our pediatric patients will get sepsis, especially if they have complex ideologies going in. Medical stuff happens, which is why it's one of the domains of PFD. 

We have to acknowledge that it's uncomfortable because, unfortunately, a lot of our medical speech pathology coursework is geared for adults. I haven't seen a good resource yet for medical speech pathology for pediatrics. We need it. I have an idea for one. It's on the bulletin board at my house because I won't bring it in here until that bulletin board's knocked off. But this is the overlap. 

[00:46:17] MB: It's interesting because we talked about UTI. I'm sorry. I meant it was an infection, not a metabolic disorder. But a metabolic disorder is something so simple as an electrolyte imbalance. I just saw a patient in my outpatient clinic this past week whose sodium was down to 111. Now, this is an elderly individual, female. Anybody who has a sodium down to 111 is going to be phenomenally lethargic. That's hyponatremia, for those of you who are trying to keep up with the nomenclature here, okay?

Sodium is about 140 to 145 is what the low normal value is, okay? You can imagine. 111 is pretty dog on low. She was documented delirious. When the speech-language pathologist went to go see her, it was the last day of the admission. A clinical evaluation was completed. She was in there for a very short period of time. A clinical evaluation was done, and she was ultimately placed on a PEG tube following a swallow study that I didn't have access to. It wasn't part of our system. This is a patient who came to me from outside the system and had a PEG tube. 

I'm now seeing her approximately six to seven weeks later, 100% NPO, minus the occasional ice chip. She had been doing very well in home therapy. The speech-language pathologist who she was working with seemed to have given her a lot of different exercises. She seems to have gotten stronger. Ultimately, she told me this story in that when the SLP came in to evaluate her, she could barely remain awake. Her husband is nodding the entire time while they're in my office. They attempted the food, attempted the feeding anyway. 

Yes, that exasperating moment when that happened, I get it. In fairness, let's call this out for each one of the little components that it is, okay? Let's just think the best about everybody involved. The team wants that patient on an oral diet. They're doing everything they can. They did the right thing in getting SLP involved. Now, the SLP comes to the bedside. At the bare minimum, implicit pressures from the medical team, we need to get this patient eating. We need to pay Ð at the bare minimum, we need to get this patient evaluated, whether it's eating. It remains to be seen. But we need to get this patient evaluated, right?

Things, obviously, did not go well at the bedside. She ultimately went down for a modified barium swallow study. The modified barium swallow study showed continuous trace aspiration of whatever it was, and life wasn't good, et cetera, et cetera. Okay. On top of the fact that she was hyponatremic, she also had a stroke. 

[00:49:28] MD: Wait, acute or was this an old one?

[00:49:31] MB: Acute. 

[00:49:32] MD: Bless her bones.

[00:49:33] MB: Okay. I'll keep other pieces of the history out, just to try and keep the anonymity within range here. The bottom line is she had multiple medical problems. If the hyponatremia wasn't going to put her in the delirious straight, maybe the stroke might have. Maybe they did together. Bottom line, she had at least two reasons why she might have been delirious. Separate from that, she left the hospital after the results came back from the modified barium swallow study. She ended up with a PEG tube. She's been fed on a PEG tube, maintaining everything well. 

Again, the only thing that's keeping her going in terms of swallowing are ice chips. No history of upper respiratory infection. She's got a lengthy other medical history, and we'll keep that where that is. The acute matters were a metabolic disturbance in the electrolyte imbalance and a neurological problem in the stroke that she had which was relatively small because here we are six or seven weeks later, she walked into my office with a walker. There's no apparent Ð I mean, if you really had to look, there might have been some facial weakness unilaterally. But from the untrained eye, from her friends, from her parents, from her whoever, nobody would have seen it. 

Me as a clinician, I was specifically looking for it, and I still question whether I'm making stuff up, or it was that slight that it actually existed, okay? So I'm not convinced that it was a large stroke at all or an impactful stroke. Her speech was fine. Her language was fine. There were a couple of hiccups during the time where she was trying to remember something, and her husband filled in a word, okay? Maybe there was something going on there. Again, she's in her mid-70s. 

[00:51:37] MD: It could also be the baseline. 

[00:51:38] MB: Of course. As a therapist, do we ever know? Okay. The point was that she was approached by the SLP, fed at the bedside during a clinical evaluation. As much as the intention is to always, I think, get somebody eating, get the oral meds in place, et cetera, et cetera, I think there are sometimes when we just simply have to exercise caution. Nothing happened. I want to be very clear about that. There were no bad events. All of the recommendations were appropriate. But it comes back to something that I've been talking about for a very long time and specifically about post-extubation, which is not this case. But it applies to everybody. Whether you're pediatrics or whether you're adults, whether you're looking at a one-day-year-old, 10-year-old, or a 100-year-old doesn't matter. The fact is that if the person isn't able to accept food or drink, should you really be using it? That's the point here. 

I'll go one step further, and I'll just very simply say, would you feed your own child, your own sister, your own mother, your own grandmother? I'm sorry I didn't want to pick on the women. We'll put the grandfather, the father, your son, your brother in there, too, okay? Would you feed any one of them if they were three sheets to the wind somewhere in bed, unable to really have a conversation with you? I'm not talking about eyes closed. I can't tell you the number of patients I have fed with their eyes closed who have done perfectly well. That's one sign that they may or may not be appropriate. 

What is a better sign is their ability to converse with you, their interactions with you. If they can't willingly seemingly do well or well enough in your interactions, you really need to question whether you should be approaching them with oral food or oral liquid. Common sense should be clinical sense. 

[00:54:04] MD: There are Ð I have two cases that are brief that are the kissing cousins of your analogy, right? The first one was a little boy I worked with for years. He had Down syndrome. I picked him up when he was itty-bitty little fart of thing. He's only aspirated, chronically aspirated at Z, level zero, right, our thinnest of our thins. The second there was anything added to it, his aspiration resolved, right?

With Down syndrome, we have to recognize the potential comorbidities that go alongside that. One in four will have a diagnosis of celiac disease because they're carriers for it. There's an increased likelihood for pediatric leukemia, increased likelihood for a whole host of things, including midline deficits, so heart, gut, larynx. He got diagnosed with a level one laryngeal cleft. It was very, very subtle. We had to get him into a specialist. But it is an outlier that I have. There is documented evidence of an increased prevalence in individuals with Down syndrome having a laryngeal one cleft. 

If you have gone through and we've done all of the, as you said earlier, behavioral interventions, behavioral therapy, caregiver coaching, and it's still not changing or improving, what is going on? That's when we have to pull back on our team and say there is something different. So they went in. They did the surgery, the repair. He did great. Mom called me several years later after I discharged him and said, ÒHis appetite is just gone. We can't get him to eat. He's lethargic.Ó It's chronic. It was becoming chronic, and he did not have a feeding tube after we got everything straight. He didn't require a feeding tube. I was like, ÒWell, I can come back in.Ó 

But you know home health. I have to have a script. So I got a script. I came back. Little Bubby was just pale and lethargic and just down, right? Falling asleep sitting up and just couldn't hold it together. Again, we don't want to feed our babies or anybody for that matter when they're falling asleep. I said, ÒI have a hunch. Follow up with your pediatrician. Let's take a peek at his Vitamin D.Ó His vitamin D was in the toilet. 

Within our complex health situations, the primary source of vitamin D is the sun. But if we have a patient across the life continuum who has increased medical needs, how much actual factual sunlight experience and exposure did they get? I mean, we make it a priority to go outside and play basketball or run around outside at the end of the day, as long as it's not wicked freaking cold or wet, right? Because mommy's not doing that. You can't un-South Carolina me. For a reason that I see a difference in my own children. Bear is prone to the blues. They run in the family. But I get that baby out running in the sunlight, and he is right as rain because he's gotten vitamin D, which is what his body needs. 

My last thought process on this is there are hospital systems, and I am aware of one pediatric hospital here in the Commonwealth. Virginia is a Commonwealth. I forgot that when we moved here but where they are still doing PO trials on a CPAP for medically complex peds with the CPAP on. I wish you could see his eyebrows, y'all. His eyebrows just went [inaudible 00:57:33]. Despite the literature, that was so astronomically the research stated. They had to stop the trials in the research because of the frank aspiration it was causing. It's still being done and not for a lack of advocacy because I know that the advocacy has occurred. It's just this is how we do things here. This is our clinical approach. 

Sometimes, you can be the greatest therapist in the world. But if the culture cannot change, will not change, you have to decide if that's how you wish to treat your patients. Or do you need to go somewhere else where it better aligns with what your research and your heart tells you? So those are my final case study thoughts. But all of that, vitamin D, clefts have gone undiagnosed for years, especially a little level one. CPAPs, those things carry across the life continuum, even strokes. 

[00:58:37] MB: I think one of the lessons that we can take from this, culture aside, do you want to believe the data or not? Whether it is any clinician making the argument for, ÒI see these data. This is what I'm seeing. This is the way we should go,Ó and being, I guess, opposed by others who are saying, ÒEffectively, well, we've always done it this way,Ó that doesn't personally sit well with me. 

[00:59:09] MD: Thank you. Oh, it makes me so mad because then I'm like, ÒBut why?Ó 

[00:59:14] MB: I do not accept the status quo in many situations and especially, I think, number one on my list where I don't accept it is when I have data that say otherwise. It can be a small study. It can be the largest randomized trial known to mankind or any point between. If I've got data that suggests Ð let's be honest. There are no real definitive studies. The repetition of good studies is more definitive than any single study. 

The point is that when you have at least some indication data-driven that you should be practicing in one form or another, that's where the discussion begins. That's where you need to sit people down and say, ÒLook, this study that just came out suggests we could be doing X, that we might see better incomes. How can we implement this,Ó and have a good conversation with those who are effectively the gatekeepers to keeping that from happening or letting it go through. That's where my heels get dug in. 

[01:00:27] MD: Yes. The increase in prevalence in eosinophilic esophagitis in autistic children and adults, that's leading to food impaction in the esophagus. There was this study years ago, and it was a population of, I think, six, maybe eight. Of the participants, 60% that were completely combative during PO trials, during regular meal time, when they went and they got them to do a modified, which bless, that sounds like torture, 60% of the participants had a food impaction in their esophagus. Do you know why those tiny humans were combative? It's because they didn't have the capacity to communicate, ÒIt hurts. I'm uncomfortable.Ó 

That study right there with the known increase in prevalence of EOE, that's enough to drive us to say we should be working more with an allergist. Now that we have EOE being diagnosed in adults, and retrospectively they're like, ÒWell, I felt sick for so long when I eat.Ó We have the why because it's dairy. It's gluten. It's soy. It's whatever their respective allergen may be. But dairy's one of the primary ones. I'm all popping around, folks. I got all excited. This is why I don't sit. I have a standing desk for this reason. 

[01:01:41] MB: Yes. Well, I'm certainly not going to put the pin in that bubble. Let me tell you. To kind of draw an analogy and to draw adults and pediatrics together because I think that's really where we are. We're at that intersection, you and me, right? Let's draw a little bit of an analogy with the research and a little bit of an analogy by the research clinic. Much of what we know about swallowing from a speech-language pathology standpoint has come from neurology, laryngology, gastroenterology, and several other areas as well, right?

Most of the research we presented on this I want to say in 2018 in San Diego at Dysphagia Research Society. Most of the research is in neuro, in stroke. Where it isn't in stroke, it's in head neck cancer. Where it isn't in head and neck cancer, it's in pulmonary. Those are the three major areas where we have done research. Now, let's depart from that for just a second. Is any one of those going to help you immediately in translation to somebody who has an electrolyte imbalance? No. Okay. That's the simple answer, no. 

But are there things that we can do, we can extrapolate from that literature? Are there things that we are currently doing based on that literature that seem to have worked well, right? That's the analogy. That's part A. Part B is most of the research has been done in adults, and there's this punctate amount that has been done in pediatrics for many reasons. Not the least of which is it is damn difficult to do research in pediatrics in any way similar to adults, okay? There's the bottleneck right there. It's not that we don't want to. It's not that there aren't people doing it. It's not there isn't passion. It's not that there isn't desire. It's not that there isn't push from any one of a 100,000 sources. It's because it's damn difficult, all of the regulations, with all of the guards that we have in anybody younger than 18 years old. 

What I'm suggesting is this. Somebody told me a long time ago. A very good colleague said, ÒPediatrics aren't smaller adults. They're younger. Yes, they are smaller human beings, but they work differently.Ó The best approach until we find a better approach is that maybe there are analogies that we have in similar fashion to the pulmonary, the head and neck, and the neuro to speak pathology, broadly, as we also have from the adult learning to the pediatrics and adapting that learning with trying a few new things that might work. Maybe that's where we should be.

I flag caution, caution, caution, caution here, okay? This is a very broad brushstroke. I am not saying, to be clear, take what you know in the adult and apply it exactly to the pediatric model. That is not what I'm saying. What I'm saying is I think there is much to be learned from the adult model that in time and with appropriate opportunity, appropriate guardrails, appropriate research in these areas could be learned from the adult models. I'm sure that's what's going on anyway, simply because the research isn't there. But somehow, we all need to work together to do better. 

[01:05:38] MD: Yes. [inaudible 01:05:39]. Yes. Maybe a year and a half ago, two years ago, it'll be two years ago this summer, we had, well, Georgia Malandraki. She's been on a couple of times, and she was Ð essentially, she's a neuroscientist turned swallowing person is my undertaking the way her brain works. But she talked about those barriers to pediatric research in length, and went down that rabbit hole, and explained why it's so incredibly difficult. But we are on the cusp of breakthroughs because of where we are in the timeline, right? Because we now have researchers that are starting out and engaging in. 

Those that I personally look to and admire within the peds world that I know are moving as forward and will be growing it are Dr. Amy Delaney with Marquette. Well, Dr. Amy Ð I screwed it up, but I'm pretty sure she's at Marquette. Dr. Georgia Malandraki and her wife out of Purdue, they have Purdue I-EaT Lab. Dr. Memorie Gosa from Alabama, Dr. Jeanne Marshall from Australia and her colleagues down there, Dr. Madeline. I can't remember her last name. I think it's [inaudible 01:06:54]. Dr. Kelsey Thompson out of UNC-Chapel Hill. These researchers are moving us in those directions. Dr. Lindsay Turner who doing stuff on neonatal abstinence syndrome and also DEIA barriers to even get into the field. 

ItÕs coming and it takes time, but we have a foundation just like Dr. Martin Brodsky shared that we can extrapolate from and sprinkle in the new when it's coming. Hold hope. Yes, hold hope always. The slogan or the motto for South Carolina is while I breathe, I hope. I think that's become a personal motto of mine because I just think it's so profound. While I breathe, I hope for our profession, for our field for our tiny and not-so-tiny humans. My word of the year was going to be grace, but hope keeps popping up. Yes. 

Ah, okay. I could pick your brain for from ever, but I have a faculty meeting I need to get to. So do you have any closing thoughts or any spectacular resources you'd like to point us to? I know there's a fair few of us that work in the peds world. But because of our rural settings, we're across the life continuum and eval and treatment. So do you have a favorite resource you could recommend for guidance? 

[01:08:17] MB: I mean, to name one is kind of like picking your favorite child, right? 

[01:08:21] MD: Well, then give us a few. 

[01:08:24] MB: There's a very recent textbook that Debra Suiter and Memorie Gosa wrote a couple of years ago. Yes, Assessing and Treating Dysphagia. That is probably among the most contemporary resources. Another one, for those of you who are interested in ICU and ICU-like cultures, Marta Kazandjian and Karen Dikeman came out with their latest edition of their communication and tracheostomy book that I definitely encourage everybody to read. 

Aside from that, there's tons of stuff in the ASHA perspectives, newsletter journal, however you want to think about that. AJSLP is always with clinically appropriate, clinically applicable information. Dysphagia Research Society is a strong advocate for all swallowing research, no matter who you are and who you treat, and in recent years has had a very strong drive for pediatric research and presentations, which is always good. Of course, ASHA always has a great showing of all the research happening around the country and around the world. Those are among the list. How's that?

[01:09:37] MD: I love all of them. Also, DRS is always on my birthday. Every year, I don't make it, so I'm fingers crossed. I'm like, ÒI'm going to go in 2024,Ó and here we are and no, so maybe 2025. 

[01:09:51] MB: Well, for those of you who actually get to listen to this podcast ideally before DRS, it's in Puerto Rico this year, and it's going to be a fantastic meeting. I certainly encourage everybody to come out and see us. 

[01:10:04] MD: Yes. Then the last question of the hour, if you could pick someone, somebody's got some mad money, what organization or entity or nonprofit would you recommend that they donate their little love money to?

[01:10:18] MB: This is a Ð you asked me before the podcast, and I have, I think, three favorites. You've got the disease model and you've got the non-disease model, if you will, okay? Or arguably the one who deals with diseases and not diseases. I think, first and foremost, the ASHA Foundation is the place where I probably most frequently Ð I've been a donor for many years, and they do such great work in being able to support speech-language pathologists and audiologists in new research and in various ways, and really promote from within our profession. I'm a strong advocate of the ASHA Foundation. 

If you care to go down the disease model, the two nearest and dearest to my heart are the American Cancer Society and the American Heart Association. Both of those are always very good. There's a ton of very worthwhile charities out there, and I could take an hour just talking about all the ones that are worthwhile and near and dear and so forth. But I think those are the top three that I would definitely look toward. 

[01:11:31] MD: Yes. Folks, we had the pleasure of hosting the ASHA Foundation on First Bite I want to say June of last year. So if you want to know more about the ASHA Foundation specifically and what kind of research they support, both within our scope of speech-language pathologists and sister organizations and allied health professionals, I would check out the ASHA Foundation. Check out that episode and their website, so yes, yes. 

[01:11:58] MB: I have one more to kind of put a ring in your ear, if you will. Dysphagia Research Society has a research fund as well, and they are Ð for those of you, it's not a little-known secret but it is more recent than it is anything else. Sitting on the budget committee, I've had to work with this for several years. What they're doing right now, what DRS is doing right now is that they're gearing up to be able to distribute that money. They're looking to come to a certain amount of money where the money when invested will be able to self-fund, and they will fund at that bare minimum, so to speak, based on the interest and the return that they get from that initial principle. 

Not to get into financial discussion here, but the point here is that they're looking to build those reserves. Once those reserves are at a Òself-sustaining level,Ó then they're going to roll out funds in terms of grants and honoraria and things along those lines. I shouldn't say honoraria. Grants and stipends would probably be a better term for it. That will go very directly into swallowing research. For those of you who are interested, check out dysphagiaresearch.org, and you'll be able to learn more about it. 

[01:13:23] MD: Thank you. This was wonderful. You have to come back and do another one. This was great. 

[END OF INTERVIEW]

[01:13:28] ANNOUNCER: Thank you for joining us for todayÕs course. To complete the course, you must log into your account and complete the quiz and the survey. If you have indicated that you are part of the ASHA Registry and entered both your ASHA number and a complete mailing address in your account profile, prior to course completion, we will submit earned CEUs to ASHA. Please allow one to two months from the completion date for your CEUs to reflect on ASHA transcript. Please note that if this information is missing, we cannot submit to ASHA on your behalf. Thanks again for joining us. We hope to see you next time.

[01:14:08] MD: Feeding Matters guides system-wide changes by uniting caregivers, professionals, and community partners under the Pediatric Feeding Disorder Alliance. So what is this Alliance? The Alliance is an open-access collaborative community focused on achieving strategic goals within three focused areas; education, advocacy, and research. Who is the Alliance? ItÕs you. The Alliance is open to any person passionate about improving care for children with a pediatric feeding disorder. 

To date, 187 professionals, caregivers, and partners have joined the Alliance. You can join today by visiting the Feeding Matters website at www.feedingmatters.org. Click on PFD Alliance tab and sign up today. Change is possible when we work together. 

[OUTRO]

[01:15:01] MD: ThatÕs a wrap, folks. Once again, thank you for listening to First Bite, Fed, Fun, and Functional. I am your humble but yet sassy host, Michelle Dawson, the all things PEDs SLP. This podcast is part of a course offered for continuing education through SpeechTherapyPD.com. Please, check out the website if youÕd like to learn more about CEU opportunities for this episode, as well as the ones that are achieved. Always, remember, feed your mind, feed your soul, be kind, and feed those babies. 

[END] 



 
FBP 275		Transcript 

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