Healthy Matters - with Dr. David Hilden
Dr. David Hilden (MD, MPH, FACP) is a practicing Internal Medicine physician and Chair of the Department of Medicine at Hennepin Healthcare (HCMC), Hennepin County’s premier safety net hospital in downtown Minneapolis. Join him and his colleagues for expert knowledge, inspiring stories, and thoughtful insight from the front lines of today’s hospitals and clinics. They also take your questions, too! Have you ever just wanted to ask a doctor…well…anything? Email us at healthymatters@hcmed.org, call us at 612-873-TALK (8255) or tweet us @DrDavidHilden. We look forward to building on the success of our storied radio talk show (13 years!) with our new podcast, and we hope you'll join us. In the meantime, be healthy, and be well.
Healthy Matters - with Dr. David Hilden
S04_E16 - We're Talkin' Speech-Language Pathology
05/25/25
The Healthy Matters Podcast
S04_E16 - We're Talkin' Speech-Language Pathology
With Special Guest: Adam Terrell, MS
When it comes to the field of Speech Pathology, we might tend to think it's all about helping people with the challenges of a stutter or helping kids get out a proper "R" sound - but it turns out there's a lot more to it! Communication is a 2-way street, and there can be a lot to manage when it comes to speaking, listening and retaining information. From a child struggling to say their first words, to stroke survivors, a Speech-Language Pathologist (SLP) can be essential to opening up the doors of language and communication.
But it turns out there's even more to it - and joining us on Episode 16 of our show is Adam Terrel (MS). He's a SLP at Hennepin Healthcare and he'll walk us though what the job is really like in a hospital setting and the variety of patients helped by the work of SLPs. We'll cover everything, from diagnosing swallowing issues to therapies and outcomes for those looking to regain their voice. Communication is an essential part of our lives and whether you're a parent, a patient or just curious about the world of Speech-Language Pathology, you've come to the right place. Let's get talking!
American Speech-Language-Hearing Association I ASHA.org
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
And now, here's our host...
Speaker 03:Hey there, welcome to the Healthy Matters podcast. I'm pediatric nurse practitioner Shayonda Beecher, a previous guest of the show, and I'll be sitting in for Dr. Hilden for this episode. Today we're going to dive into the wide world of speech pathology. So I see a fair amount of this in my field, pediatrics, but today we're going to be joined by Adam Terrell, who is an expert in the subject. He's been a big help to many, so Adam, welcome to the podcast. Thanks
Speaker 00:for
Speaker 03:having me. So let's start with the basics. Speech-language pathology. What is it?
Speaker 00:Yeah. So speech-language pathology encompasses a lot. Speech kind of refers to more of the muscles, lips, voice box, and how that impacts verbal communication, where language is going to be more that underlying system of how sentences are structured, grammar, reading comprehension, written comprehension, things like that. So speech-language pathologists work to help people with their speech, their language, cognition, and swallowing kind of throughout the continuum of healthcare and the lifespan.
Speaker 03:So it's not just speech therapy. It's a lot more than that. There's a list of disorders here that's kind of long, so I'm wondering if you can help us define and distinguish between the following. So for example, what's the difference between a speech disorder and a language disorder?
Speaker 00:So speech disorder, like I said, is going to be those lips, tongues, and voice movement. What people might traditionally think of when they think of speech therapy, producing certain sounds clearly or working with people who stutter to reduce that just language disorders are going to be more that underlying system so difficulties expressing thoughts understanding what people say might show up with difficulty comprehension finding your words and expressing full and complete thoughts
Speaker 03:so how does that play along with like a communication disorder or if something's related to your voice like a voice disorder
Speaker 00:so voice disorders are typically going to be related to the voice box or the larynx itself so difficulties how your vocal folds move open or close too much or too little movement or any damage that happens to the vocal folds that might impact how that voice is produced. Communication disorders can overlap with language disorders, but can also refer to difficulties with like social interaction, what we call pragmatics or how you do kind of navigating those hidden parts of language, how close to say to someone, how much eye contact, too much eye contact, things like that.
Speaker 03:So you mentioned vocal folds. And for those of us who may not know what that is, can you break that down a little bit further for us?
Speaker 00:Yeah. So you have kind of two pieces of of like tissue and muscle that sit right behind your Adam's apple in a V shape. And it's open when we're breathing. But then when we turn our voice on, those vocal folds squeeze together, vibrate, and that's how you produce your voice. And then that whole system is part of what we call the larynx.
Speaker 03:Excellent. Okay. So keeping with like the area of the mouth that we're talking about here, do you ever work with swallowing disorders?
Speaker 00:Yeah, a ton. That's a lot of what SLPs do in the hospital. Someone might have a swallowing disorder for a lot lot of different reasons, and whether that's difficulty with chewing, moving the food around in the mouth, or getting that safely to the stomach rather than the airway.
Speaker 03:So you think about swallowing disorders, speech disorders, voice disorders, and all of that's controlled by the brain. Do you ever work with cognition disorders?
Speaker 00:Yeah, that's primarily where I practice. So working with people after stroke or traumatic brain injury to help support or find ways to kind of work with changes in attention, memory, planning, speed of thinking, organization, things like that.
Speaker 03:Can you give me an example of that? I'm just curious. Yeah. What a cognition disorder looks like when you first meet with somebody and then what do you do to help improve their outlook?
Speaker 00:Yeah. So that might look like a lot of distractibility or kind of forgetting things, whether that's where they put their keys earlier in the day or like what day it is. So it can really look like a lot of different things depending on the severity. What we'll kind of come and do is find ways that people can structure their environment or set up the day so that they're better able to focus kind of with where their attention might be. Coming up with like different strategies or tools to support their memory, maybe writing things down, getting a notebook or a calendar system in place that they can consistently refer back to.
Speaker 03:So wow, that's really more than just speech therapy.
Speaker 00:Yeah.
Speaker 03:So you spoke a little bit about folks that had maybe a traumatic brain injury or stroke. Do you ever work with kids with developmental delays?
Speaker 00:I personally don't, but... SLPs as a whole absolutely do. We have a great pediatric program here, and then SLPs are also really involved in early childhood or working in the schools with pediatrics as well.
Speaker 03:And for the adult population, you mentioned stroke, brain injuries. What about folks with dementia or Parkinson's or ALS? What kind of support do they get from SLPs?
Speaker 00:Yeah, absolutely. So a lot of those more progressive diseases, we're really focusing on how to support swallowing and nutrition as the disease progresses, but also looking at what effective communication the looks like as our way of understanding or expressing changes over time, finding ways to really focus on expressing and understanding those things that are important. With like ALS, for example, as some of those speech systems deteriorate, working on coming up with other ways to communicate. So whether that's what we call voice banking, where you might record someone's voice early on in the process so that we're able to kind of synthesize it or mimic it over time, or using what we call AAC or alternative and augmented communication to develop like a tablet or iPad kind of picture or sentence communication where you're able to type or write out what you're thinking.
Speaker 03:So I'm thinking Stephen Hawking,
Speaker 00:right? Yeah, great example.
Speaker 03:So is that sort of what happens in clinic too or
Speaker 00:with our patients? Yep, so we have, especially in our ALS clinic, that's a lot of that alternative and augmentative communication. So setting up a device, getting it to track someone's eyes so that they're able to express their thoughts just through looking.
Speaker 03:That's pretty
Speaker 00:cool.
Speaker 03:Yeah. What about folks with cancer We're seeing a lot more head and neck cancers.
Speaker 00:Yeah. So it can look, again, very different depending on where someone's at with their cancer diagnosis. But looking at adaptive ways to feed, there's different utensils that can be used to kind of help bypass the tongue or work around the tongue, determining what foods might be kind of safe to eat, ways to strengthen or like manage the tissues after radiation can be a really big way that speech pathologists are involved with head and neck cancer. And then looking at to voice changes as well. If someone has a total laryngectomy where their entire voice box is removed, how can we still effectively communicate without the ability to produce voice?
Speaker 03:My kid's going through puberty. His voice is changing.
Speaker 00:Do you guys do anything for that? Unfortunately, no.
Speaker 03:Speaking of my kids, we are very familiar with sports injuries. We see a lot of our favorite athletes getting PT or courtside or after the season's over. But there's people that use their voices a lot too, singers or teachers. Do you ever work with folks that have voice disorders because of overuse of their profession?
Speaker 00:Yeah, yeah. So singers, teachers, public speakers, religious leaders, like very high risk for voice strain, voice overuse. So yeah, absolutely work with them to kind of establish good vocal hygiene That's what we call. So what sort of things can you be doing day to day? Are you getting enough water? Are you having times where you're not using your voice to kind of protect that mechanism? And then different exercises and relaxation techniques to help kind of reduce some of that strain as well.
Speaker 03:So are you telling me that Taylor Swift and Beyonce both have an SLP?
Speaker 00:Most likely.
Speaker 03:Okay. So you're not with Taylor Swift or Beyonce, but you work here as a speech language pathologist. What do you do in a day to day?
Speaker 00:So I work in our outpatient TBI program. So primarily I'm working with people after mild to severe trauma. traumatic brain injury. Seeing patients for about an hour, working on different ways to manage their cognitive skills primarily, but then also some communication intervention as well. But we have SLPs all throughout the hospital. We have a team that works in inpatient rehab, kind of really helping people get high-intensity therapy throughout their stay. We have people in acute care. We have our pediatrics outpatient and inpatient as well. So we're all throughout the clinics and hospitals.
Speaker 03:So you see a patient following a stoke, and you're working with them hour a day. What's your trajectory in time spent with them? Is it based on their severity? What does the progression look like from the first day you meet them to graduation?
Speaker 00:Yeah, yeah. So again, yeah, really going to depend on patient by patient and severity, really want to kind of do an in-depth assessment on how those cognitive communication and swallowing skills are working. So we'll do a clinical exam of the swallow where we have them eat and drink and we look at kind of mouth and motor movement, see how those nerves and muscles are working. And then if needed, we might do a more in-depth assessment of the swallow where we either take some x-rays or some pictures to see how food and liquid are moving, making sure those are going down safely. And if not, what can we do about it? But then also really trying to establish kind of what thinking and communication skills look at. Does the person have better verbal output than they do comprehension? So are they better able to express their thoughts than they're able to understand? Is their understanding really good, but they're having a tough time expressing their thoughts? And then what can we do to support that? Using like a picture communication board, writing things out, using more simple sentences, things like that. We really want to see where their strengths, where their weaknesses are, and really establish what we want to be working on.
Speaker 03:So I can imagine that you're meeting this person for the first time. You may not Do you pull in family or others to help evaluate?
Speaker 00:Absolutely. Yeah. Yeah. Family, friends, whoever's nearby. Such great input for not only telling us what that baseline is, but what sort of things are important to communicate about so that that way we can really tailor our therapy to what's important to the patient.
Speaker 03:You mentioned x-rays and imaging to get a sense for swallowing, but are there other technology or devices that you would use in your assessment or evaluation of the progress?
Speaker 00:Yeah, so the two big ones for swallowing do what we call a modified barium swallow study, which is an x-ray of the swallow. And then we can also do what we call a flexible endoscopic evaluation of the swallow, where we take a camera down the nose and look at the swallow from kind of the top down. Other... Technology we might use if someone's having any difficulty breathing, they have a tracheostomy or a tube just below their Adam's apple to help them breathe, we'll use, it's called a speaking valve, where we can kind of create a one-way valve to help them turn on their voice, essentially, and that has some really profound impacts on the swallowing communication as well.
Speaker 03:I know that you're focused on individuals who have had a stroke and helping them recover after a brain injury, but it sounds like the profession itself is seeing everybody from baby to
Speaker 00:elderly. Yeah, all throughout the lifespan.
Speaker 03:So how does that look from when you're training to be an SLP? Do you have to understand how everything works for every single age group?
Speaker 00:Yeah, yeah. So the practicum for undergraduate and graduate school is across the lifespan. I know some programs are getting a little more tailored these days to kind of have you pick a little earlier on in your career path if you think you want to go more pediatrics or more adults, more medical or more school. But at least when I went through it, it was
Speaker 03:everything. And so tell me, because we're reaching graduation season or we are in graduation season, there's probably a couple folks out there who are trying to figure out what they want to be when they grow up. How does one become a speech pathologist?
Speaker 00:Typically, it's a four-year undergraduate program for speech-language pathology, and then you do two years of graduate school on top of that. After that, you'll have about a nine-month fellowship program, and then you're a fully licensed speech therapist.
Speaker 03:And that fellowship, is that then defined to the population you want to work with?
Speaker 00:Yeah. So at that point, you're working full-time. You're just not fully certified. Got it.
Speaker 03:Okay. We're talking with Adam Terrell, who is a speech-language pathologist. We're going to take a quick break, and when we come back, we're going to dive in a bit deeper into the wide world of speech pathology. Stay with us. We'll be right back.
Speaker 02:When Hennepin Healthcare says, we're here for life, they mean here for you, your life. and all that it brings. Hennepin HealthCare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at hennepinhealthcare.org. Hennepin HealthCare is here for you and here for life.
Speaker 03:And we're back talking to Adam Terrell of Hennepin Healthcare about speech pathology. So Adam, how did you personally get into this field?
Speaker 00:Yeah, so it's kind of in the family business. My mom's actually a speech-language pathologist. Does she work here? No, she's back in Wisconsin. She works primarily in the schools and is now teaching at a university. But so I've kind of always known about it and been fascinated by language and the way it kind of shapes people. the way we think about things and how we determine what's important to us, who's close to us. And then, yeah, once I really found out about the whole brain side of speech-language pathology, that had me sold. I love seeing how the brain works, how language is so just embedded throughout the brain. And then once I learned more about speech pathology, finding out ways that you can not only see how language plays out in the brain, but how you can help and support language, yeah, I was sold.
Speaker 03:Very cool. Can I ask a question? I'm going to jump on a tangent here. You spoke a bit about language and development and cognition. At Hennepin, we see a lot of patients who do not have English as your preferred language of choice. When you have somebody that speaks Spanish, Somali, Hmong, how does that work. How do you as an English speaker navigate language differences when you're trying to tackle language?
Speaker 00:Yeah, great question. So, I mean, we're incredibly lucky to have a phenomenal interpreter department here. So, we work really closely with them to kind of help bridge some of those cultural differences to help figure out how children or adults might be using their language. So, there are certain milestones or ways that we use language kind of across the board. And then there's a lot of cultural nuance. So, we really lean on the interpreters for that cultural nuance. piece, but then we're looking at like kind of those root foundations of language. How are you using language to express wants and needs? How are you using it to maintain social closeness, exchange information? That's where we kind of fit in. And that's the system of language rather than the language that's being spoken or used.
Speaker 03:Good clarification. I appreciate that. Thank you. So we've got the basics down. I want to dive into why the work in speech pathology is so important.
Speaker 00:So I think communication is hopefully relatively straightforward. That's how we build closeness with people. Relationships, exchange information, you know, it's a pretty day-to-day function. For the majority of people, not all, but speech is going to be the primary way that that communication is exchanged. We also use that reading, writing. So any challenges there are going to have huge impacts on safety, independence, well-being, but also ability to advocate and navigate resources and the community. I think swallowing is a big one too, just because so much of our social time is spent around a table. And so if there's a change to how you communicate, interact with meals, that's going to have huge social and emotional repercussions. And so being able to step in and help with that is huge.
Speaker 03:I love how you say much of our time is spent around a table and that significance that plays to social interactions. We've heard a lot about loneliness and the pandemic in recent years. And I wonder what roles do cognition and communication play when it comes to mental health issues like isolation and quality of life?
Speaker 00:Yeah, absolutely. I think cognition is a cognitive resources we need to even have a conversation is really easy to overlook. The amount of attention we need to not just pay attention to what we're saying, but listen well, be able to plan what we want to say and listen, be able to understand, perspective take, all huge parts of cognition and communication. So when we see changes with that, it becomes harder to engage in good quality social interaction and communication. When something's hard, we tend to not want to do it. This feedback loop of it's difficult to do, so we don't do it, so we do it less, so it becomes more difficult, really, really drives that social isolation.
Speaker 03:So let's talk about the swallowing disorders. What are some of the serious complications they can lead to?
Speaker 00:The big two that we see with changes in swallowing are malnutrition and lung infection, predominantly aspiration pneumonia. So When eating is difficult or impacted, not being able to meet your nutrition and hydration needs is huge. Unintentional weight loss will just kind of have huge impacts on the whole body. And then as well, if that food and liquid isn't going down the right tube, it's going into your lungs rather than your stomach, that's going to lead to infection. If your body's kind of already at a weak point because of that malnutrition, that infection is going to be a lot harder to fight off.
Speaker 03:So you're saying that when you identify something as aspiration pneumonia, that's when the food goes down the wrong tube.
Speaker 00:Yeah, yeah. So aspiration is just the term we use when food goes past your vocal folds into your lungs where we don't want it to be.
Speaker 03:Correct, yeah. So it sounds like you've touched upon a lot of different symptoms and disorders that I know that I've seen in my community and even in my family. And I'm sure some of our listeners are wondering the same thing I am. How does someone get help if they think that they have it? Yeah. or their relative has it.
Speaker 00:So if you're seeing any of these signs, that's a good time to talk with your primary care provider.
Speaker 03:And when do you know when it's time? Like, how do you know it's time to see the speech-language pathologist?
Speaker 00:Yeah, so it really depends on a lot of different factors and where you're seeing that. I would say, like, with pediatric populations, if they're not hitting their developmental milestones, initiating communication, you know, establishing good eye contact, things like that.
Speaker 03:So you're saying establishing good eye contact and communication, that's well before they start saying their first few words.
Speaker 00:Yeah, yeah. So that's attention, being able to kind of attend to what the parents are looking at, saying, things like that. Huge developmental milestones for communication.
Speaker 03:And what about for our elderly?
Speaker 00:Yeah, so changes in swallowing. If you're coughing, choking, feeling like foods are stuck during meals throughout the day, that's a really good time to potentially look at getting the swallow checked out. But then also changes in communication or thinking, you know, difficulty finding words, understanding more frequent distractions, misplacing items, anything like that, as well as like obviously any medical event, a stroke, TBI, yeah, probably good to get looked at by a speech pathologist.
Speaker 03:So it sounds like the first thing to do is see your primary care provider, get that referral. And then are we all looking for a speech-language pathologist here at Hennepin? Are there community resources that can help provide education on this?
Speaker 00:Yeah, absolutely. So typically more pediatric focus is going to be through the schools. Not always, but we know therapy works best in the environment that the person's in since kids are Most often in school, that's going to be the kind of the best place to provide therapy. Other community resources, I would say our national organization, the American Speech Language and Hearing Association, or ASHA, is a great resource that you can look up when it might be time to talk to a primary care provider about a referral. They have great resources for how to kind of initiate and talk through that with PCP as well.
Speaker 03:Before we wrap up here, I just had a couple more questions for you. What surprised you the most about your career?
Speaker 00:I think the variety. I think there is this, for better or worse, commonly held idea that speech therapy is just working on ours. And that's absolutely part of it, and that is meaningful and great. But I think being able to just see the variety within the field and what that means to each person that... Like working on ours is just as important as working on swallowing and being really able to see how people are using their communication and what that means to gain that back and effectively communicate.
Speaker 03:So it sounds like it's really gratifying work. Are there any patients who you or your colleagues have helped out and that stand out to you?
Speaker 00:Yeah, I think working with people to get them back to work is always a really fun and rewarding experience, especially after a significant life event, having to take that time off and being able to rebuild those skills. There's several people that come to mind that worked with for over the course of months and really being able to walk through that process, see them get back to part-time work, full-time work, and then get back to where they were before their injury is incredibly rewarding. Being able to help someone find their voice in a really vulnerable and scary time is such a privilege. And so there are a lot of different stories that come to mind of whether it's being there with someone when they first put on a speaking valve and hear their voice for the first time after a long period of time. That's just such a cool moment to be a part of.
Speaker 03:Wonderful. So are there any final thoughts to leave our listeners with?
Speaker 00:Yeah, there is help. We see really good outcomes from speech therapy, that if people are experiencing any difficulties with communicating, swallowing, understanding, a referral is well worth it and that we do see really good improvement.
Speaker 03:So we've been talking today with Adam Terrell, who is a speech pathologist at Hennepin Healthcare. He's one of several speech pathologists here and can help you or a loved one struggling with these conditions. I want to give a huge thank you to Adam for joining us.
Speaker 00:Thanks for having me.
Speaker 03:Thanks for listening. My name is Shayanga Beecher, standing in for David Hilden, who will be back in two weeks. And until then, be healthy and be well.
Speaker 01:Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.
