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