NYU NSSLHA Receives 2019 Gold Chapter Honors

Badge that reads "Gold Chapter Honors NSSLHA 2019"

Congratulations to the entire NYU National Student Speech Language Hearing Association (NSSLHA) chapter on receiving 2019 Gold Chapter Honors — the highest level of recognition awarded by National NSSLHA.

The NYU NSSLHA chapter demonstrated an outstanding effort to inspire, empower, and support students studying communicative sciences and disorders by organizing a range of impactful activities in the past academic year. 

Among these events, NYU NSSLHA orchestrated a letter-writing campaign advocating for the Audiology Patient Choice Act, a piece of legislation that aims to expand individuals’ access to audiology services. The chapter also organized a variety of community outreach events to increase NYU’s awareness of the field, including hosting public webinar discussions on communication change for transgender or gender non-conforming individuals. Members also joined together for 5K race in honor of Better Speech and Hearing Month.

Students were also recognized for their commitment to fundraising throughout the year, supporting National NSSLHA’s efforts to provide scholarships to future speech-language pathologists in need of financial support.

The Department of Communicative Sciences and Disorders is proud of NYU NSSLHA students. Click here to check out the chapter’s Facebook page and stay updated on future events and initiatives in the fall.

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What We Know (And Don’t Know) about Stuttering: An Interview with Eric S. Jackson

Assistant Professor Eric S. Jackson is a clinician-scientist and director of NYU Steinhardt’s Stuttering and Vvariability (savvy) Lab in the Department of Communicative Sciences and Disorders. We sat down with Eric to discuss his latest research on stuttering — including two recently published papers on the subject and a new grant from the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health (NIH).

Eric S. Jackson

What sparked your initial interest in researching stuttering?

I’m a person who stutters — that was probably the initial catalyst. I used to work in the financial services industry, and at that point, I was in a pretty bad place with my own stuttering. After having an amazing experience with therapy, I realized, “I want to be a catalyst in other people’s lives in the way my therapy was for me.” So I went back to school to get my master’s so I could become a speech therapist.

After a couple of years of working as a clinician, I decided that I wanted to pursue a PhD because there wasn’t enough that the field knew about stuttering. It’s interesting because stuttering basically started the field of speech pathology — it’s probably researched more than any other speech-language impairment. But in some ways, it’s one of the disorders that we know the least about. We know stuttering is context-based, we know it’s socially driven, but we don’t fully understand it yet — and that’s what my work tries to figure out.

That’s interesting. Why is stuttering so hard to fully study?

The tricky thing about studying stuttering is that it’s variable. Sometimes people will stutter on one word in one situation, and then while producing the same word in another situation, they won’t stutter. It’s very context-based, which makes it hard to elicit stuttering in a controlled research environment.

You were just awarded a substantial R21 Early Career NIH grant to research “The Impact of Social-Cognitive Processing on Stuttering.” How will this study address the particular challenges in researching stuttering?

We’re actually getting people to stutter in the lab. One of the shortcomings of prior work is that researchers looked at the brain in non-social contexts, like when a person who stutters is reading words off a computer monitor. If stuttering is a social phenomenon, we should look at it in the context of social interaction — that’s what’s really novel about the project.

The technique we’re using is called functional near-infrared spectroscopy (fNIRS), a brain imaging technique that uses light to detect changes in blood flow in the brain and provides an indirect measure of neural activation. The problem with many standard, widely-used neuroimaging techniques is that the process is really unnatural. For example, during fMRI of the brain, a person has to lie down in a giant magnet — and can’t really talk because any movement is going to create noise in the data. The nice thing about fNIRS is that you just put a cap on somebody and he or she can sit upright, across from another person, and talk — allowing us to put “the social” into stuttering experiments.

You recently had two papers published about stuttering, one in the Journal of Fluency Disorders and one in Neuroscience. Could you talk a bit about each?

The paper in the Journal of Fluency Disorders looks at a phenomenon called anticipation. In many many instances, people who stutter know which word they’re going to stutter on — that’s anticipation. The tricky thing about anticipation is that the speech pathologist can’t see it. It’s a covert phenomenon, but it’s so central to the stuttering experience. In previous work, I created a scale called the Stuttering Anticipation Scale, which essentially helps us quantify how often people who stutter engage in different kinds of responses to anticipation. We’re trying to make the unobservable observable.

In this particular study, we did a factor analysis leveraging the scale where we tried to identify the different ways people were responding to anticipation. We found that people tend to display one of three responses: avoiding an anticipated word, implementing a speaking strategy to help them say the word, or stuttering regardless of anticipation. The next step is to research any links that seem to make an individual more likely to engage in one of those responses over another.

To date, the paper in Neuroscience is the largest fNIRS study of adults who stutter. We looked at the differences in speech planning versus speech execution, which is something that hasn’t really been previously looked at all that much. And we found differences between those two processes that will give us more information on overall speech production in the long run.

What is something you wish more people knew about stuttering?

The first thing that comes to mind is the covert nature of stuttering. People who stutter get very adept at knowing they’re going to stutter and preventing stuttering from coming to the surface. We have to do a better job of explaining that while stuttering may not be seen or heard, a person could still be stuttering beneath the surface.

Lend Your Voice to the NYU NSSLHA Voice Drive

The advent of synthetic voices has had an incredible impact on the speech-impaired community, giving those with communication loss access to a voice. However, the options available have tended to be limited, potentially stifling a user’s sense of individuality. In response to this, students within the NYU Steinhardt Department of Communicative Sciences and Disorders chapter of the National Student Speech Language Hearing Association (NSSLHA) are holding a voice drive to help individuals with speech loss reclaim ownership of their voices.

To participate in the drive, donors submit recordings of their own voices to a “Human Voicebank” to be potentially matched with a recipient who shares similar vocal characteristics. Once a match is made, the donor’s recordings are blended with 2-3 second samples of the recipient’s voice to create a synthetic voice that maintains the vocal quality and identity of the individual with communication loss.

The drive is being held in collaboration with VocaliD, a company that was founded by a speech-language pathologist to create custom digital voices.

A screenshot of VocaliD’s Human Voicebank recording interface.

The voice drive will run through June 21. To contribute your voice to VocaliD’s Human Voicebank, email nsslha.nyu@gmail.com.

Student Spotlight: Future SLP Supports Son’s Paralympic Dreams

We sat down with Jayna Miller, a student in the online Speech@NYU program offered through NYU Steinhardt’s Department of Communicative Sciences and Disorders. This year, Jayna moved across the country to help her son turn his Paralympic table tennis dreams into reality — all while working toward her master’s in speech-language pathology.

Tell me a little bit about yourself.

I published a children’s book several years ago and believed that writing and illustrating books would unquestionably turn into a career. However, when I had my first son, Andrew, my focus turned to his medical needs. He was born with a rare — and usually lethal — type of dwarfism called Campomelic Dysplasia. We were told not to expect him to live more than a few hours, but he showed us that he had different plans. Even though his life has been punctuated by surgery (he has had more than thirty orthopedic and neurosurgeries since birth) he has refused to allow it to handicap him. Recently, we relocated to California from Ohio so that Andrew could pursue his dream of qualifying for the Paralympics in table tennis. He now trains with the US Paralympic table tennis coach, competes in tournaments across Europe and South America, and plans to attend law school someday.

Jayna and Andrew together.
Jayna and Andrew at the Gold Meets Golden Party, an annual event that brings together celebrities and athletes before the Golden Globes.

What was it like relocating across the country while continuing your studies?

It was challenging. We decided rather quickly to move forward with this about a year ago when Andrew had a big leg surgery that didn’t go well and he wasn’t going to be able to walk anymore. I felt like I had to do something to really show him that he could still do amazing things. So we decided to come out here so he could train with one of the US Paralympic table tennis coaches.

Andrew has training about six days a week twice a day now. I’ve learned to fit in school work and studying around his schedule. I’ll get up early if I need to, take him to practice, come back home, do more school work, take him back to practice, and sometimes work late if I need to. There were adjustments, but seeing Andrew so happy — seeing him be able to pursue his dream — has definitely made this worthwhile.

Good luck training, Andrew! How did he get started playing table tennis?

Growing up, I really tried to keep Andrew’s focus on things that were positive and activities that he could do. When he was 12, I bought a ping pong table for Christmas. My other son is a competitive tennis player, and I thought, “This is something that both of the boys can do together.” Andrew immediately took to it.

After a couple of years, someone suggested that he enter a local tournament. He did, and he was beating grown men! We found a coach in Columbus who could give him a few lessons and he started winning more tournaments and getting these huge trophies.

Andrew standing near his many table tennis trophies.
Andrew and his table tennis trophies.

Then someone suggested we think about Paralympic table tennis. We took Andrew to a tournament in Las Vegas. He was playing and the national US Paralympic National Team Coach for table tennis walked by. She introduced herself and said she thought Andrew had a lot of potential. They started having weekly Skype lessons until we moved to San Diego.

Andrew has since won his first big international table tennis match. He really wants to get to the Paralympics in Tokyo next year — he’s so motivated right now.

Can you tell me about what sparked your interest in pursuing speech-language pathology? Why now?

I was always interested in language when I was younger. But I didn’t really know about speech-language pathology until I had Andrew. He was born with a cleft of the soft palate, so we started working with SLPs probably day eight of his life. Later we were told that he was severe to profoundly deaf and that he would eventually be completely deaf. We found a school in Ohio that specifically focuses on teaching deaf students how to speak, and within three years he went from using 100 percent sign language to being 100 percent oral. All the while, I was observing the power of SLP intervention and thinking, “It is amazing to watch your child go from not being able to communicate anything to reading stories, writing stories, and giving speeches.”

When I got divorced 8 years ago, the first thing that came to mind was “I’m going to go back to school and I’m going to be a speech pathologist.” I started applying to grad school and learned that NYU had an online program. I looked at on-campus programs, but at the time, my kids were finishing high school and I didn’t want to have to move away. NYU stood out because of its reputation and because the people who contacted me from the program were so friendly, supportive, and enthusiastic. They really seemed to want to help me get in.

What would you tell other people thinking about pursuing an online degree?

It takes a lot of dedication and resilience to make it as an adult online student– but it absolutely can be done. There were plenty of obstacles in my way, but I’m progressing toward my degree with the help of NYU’s amazing group of advisors. They’re making sure I have support — because life happens.

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Dr. Sonja Molfenter Honored at Dysphagia Research Society Awards

NYU Steinhardt’s Department of Communicative Sciences and Disorders is pleased to announce that Assistant Professor Sonja Molfenter was honored at the Dysphagia Research Society Awards for her investigations of nutrition and swallowing in healthy aging.

Molfenter is conducting this work in collaboration with Kathleen Woolf, an associate professor in the Department of Nutrition and Food Studies.

As part of the recognition, Molfenter was awarded the Sumiko Okada Fellowship, which enables researchers studying dysphagia to present their work at the Japanese Society of Dysphagia Rehabilitation in September.

The department is also excited to report that alumna Erica Herzberg, a speech-language pathologist at NYU Langone Rusk Rehabilitation who continues to work part-time in Dr. Molfenter’s lab, was also recognized at this year’s Dysphagia Research Society Awards.

Herzberg received the Spring Publishing Travel Scholarship in the clinician category, which supports honorees’ attendance of the Dysphagia Research Society Annual Meeting and Preconference.

Congratulations, Sonja and Erica!

Dr. Molfenter and Erica Herzberg holding their awards in front of a harbor view.
Dr. Molfenter and Erica Herzberg holding their awards at the Dysphagia Research Society Awards in San Diego, CA.

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Alum Spotlight: Christina Foto Nelson (MS ’14)

Photo of Christina Nelson standing in front of the door to a classroom.

Christina Foto Nelson, alumna of NYU Steinhardt’s MS in Communicative Sciences and Disorders program, is a speech-language pathologist at PS 84 in Brooklyn, NY. She is a part of the school’s ASD Nest inclusion program, a collaborative program between the NYC Department of Education and NYU Steinhardt for students with Autism Spectrum Disorder (ASD) in community schools.

Christina works primarily with K-4 students with ASD, utilizing specialized social interventions to engage them in authentic, shared experiences, foster peer connections, and develop problem-solving abilities.

We spoke with Christina to learn more about her work and the advice she has for future speech-language pathologists entering the field.

How do you think your time at NYU Steinhardt shaped your career path?

My first field placement experience at PS 165 in the ASD Nest program truly shaped my career as a speech-language pathologist. During my time there, I witnessed the value of the program and solidified my passion for working with students with ASD.

What techniques do you use to engage your ASD students in the speech-language process?

At the beginning of every year, I gather information about what my students are interested in and plan long-term projects surrounding their areas of interest. For example, one of my second-grade groups all share an interest in outer space. Across several months, they worked together to make a telescope, build a rocket ship, and create imaginary planets and aliens. After we completed those projects, we celebrated by traveling in our rocket ship to go on “space adventures” to visit the different planets we created!

What is your favorite memory from your time at NYU Steinhardt?

It’s hard to choose, but one of my favorite memories was being assigned my first client in the department’s on-campus clinic. After years of coursework, it was finally time to put my knowledge into practice!

What advice would you give to current students preparing to become speech-language pathologists

Do not underestimate the power of investing time and energy in building a positive relationship with all of the students or clients on your caseload. When you have a strong foundation to work from, you can push them to do the tasks that might be the most challenging.

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Speech@NYU Students Visit NYC for On-Campus Clinical Immersion

This semester, 96 students in the Steinhardt online MS program in Communicative Sciences and Disorders, Speech@NYU, traveled to New York City from across the country to participate in an on-campus immersion alongside faculty and peers. Over the course of four days, Practicum I and Practicum II students had the opportunity to dive into local field work and develop their clinical competencies through hands-on workshops.

Photo of students touching audiometers and wearing headphones.
Speech@NYU students learning procedures for conducting hearing screenings.

Following a welcome breakfast and introduction led by CSD Chair Christina Reuterskiold, students embarked on a dynamic schedule of events with their online cohorts.

“We see each other online on a daily basis, but it’s great to meet in person,” said Carolin Amperse, a Practicum I Speech@NYU student who traveled to the immersion from California.

Through a series of collaborative workshops, program faculty taught students essential clinical techniques, such as best practices for conducting hearing screenings, oral-sensorimotor examinations, and working with early childhood populations.

Photo of Alicia Morrison and two students holding plastic animal toys that can be used in pediatric linguistic screenings.
Online and on-campus CSD students collaborating as Clinical Assistant Professor and Director of Clinical Education, Alicia Morrison, demonstrates techniques for conducting pediatric linguistic screenings.

The immersion also included a mock diagnostic simulation that enabled Practicum I students to experience the clinical diagnostic process from start to finish. Practicum II students meanwhile participated in the session to provide mentorship and share feedback with individuals in the first year of the program.

During the latter half of the immersion, students in both cohorts visited local field sites to administer hearing, speech, language, swallowing, and cognitive screenings to members of the community.

A student holding a tongue depressor in her purple-gloved hand.
Speech@NYU students working with their on-campus mentors to practice administering oral-sensorimotor examinations.

Students pursuing on-campus degrees through the department were also present throughout the immersion, participating in events such as National Student Speech Language Hearing Association Night. At this event, online and on-campus students worked together to prepare supplies for Jumpstart, an early education organization that provides language, literacy, and socio-emotional programming to children in under-resourced communities.

The department looks forward to hosting future cohorts of Speech@NYU students at the clinical immersion experience and welcoming Practicum I students back to campus next semester as a part of Practicum II.

About Speech@NYU

Students pursuing NYU Steinhardt’s MS in Communicative Sciences and Disorders have the possibility of completing their degrees online through Speech@NYU. The program is designed to provide students located across the country with access to a rigorous SLP curriculum taught by NYU faculty actively working as clinicians and researchers in the field.

This May, the department will celebrate an exciting milestone — the very first graduation of a Speech@NYU cohort. The program’s inaugural class of online students will join together on campus for a third time to enjoy a graduation ceremony and celebration.

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NYU Steinhardt CSD Department Makes Strides with Cultural and Linguistic Diversity

When it comes to Cultural and Linguistic Diversity (CLD), NYU Steinhardt’s Communicative Sciences and Disorders Department has embraced it in so many areas of their work. Here’s a rundown of recent developments:

In 2016, the department launched its Bilingual Extension Program, one year later bringing in María Rosa Brea, PhD, CCC-SLP, Clinical Associate Professor, as its Director. Dr. Brea involves high-impact practices (HIPs), including service-learning projects, in her courses. Reflecting her commitment to bridge learning with service to the community, she received the University of South Florida Provost’s Outstanding Community-Engaged Teaching Award in 2015 and the NYU Steinhardt Faculty Star Award in 2018. In further support of the Bilingual Extension Program, the Department hired Visiting Assistant Professor Alisha Gandhi, who holds New York State certification as a bilingual SLP, so she could supervise our Bilingual Extension Program students in the CSD Speech-Language-Hearing Disorders Clinic.

Beyond heading up the Bilingual Extension Program, Dr. Brea also founded and is faculty advisor to an NYU student organization, the Bilingual Language and Literacy Investigative and Networking Group (BLLING), which seeks to advance knowledge about bilingualism and cultural competence in the field of Communicative Sciences and Disorders through education, research, and community outreach.

Addressing Dr. Brea’s BLLING Group in September with a presentation, Ten Tips for Speech Pathology Management for Bilingual Aphasia, was Dr. Samantha Siyambalapitiya, PhD, BSpPath (Hons I), BSc, CPSP, who stopped by the NYU Small Talk Language Development and Disorders Lab for a few weeks as a visiting scholar and collaborator. On sabbatical from Griffith University, Brisbane, Australia, Dr. Siyambalapitiya spent many days working in person with her usually distant research collaborator Dr. Christina Reuterskiöld, chair of the NYU CSD department and Post-Doc Vishnu KK Nair. Dr. Siyambalapitiya is an internationally recognized researcher with expertise in a highly specialized field, focusing on understanding and managing communication disability in individuals who are from culturally and linguistically diverse backgrounds (CALD), including bilingual speakers.

This academic year (and beyond), CSD has brought in several additional scholars and researchers, greatly expanding our CLD offerings:

On campus during September, CSD hosted visiting scholar Karla N. Washington, PhD, CCC-SLP, S-LP(C), Reg. CASLPO, Associate Professor, Communication Sciences and Disorders from the University of Cincinnati, who collaborated with Dr. Tara McAllister and her Biofeedback Intervention Technology for Speech (BITS) lab. Dr. Washington delivered a presentation to our Research Colloquium, Measuring Speech Intelligibility in Jamaican Creole (JC)- and English-speaking Preschoolers: Validation of the Intelligibility in Context Scale in a Bilingual Population.  In it, Dr. Washington described the first validation study of the Intelligibility in Context Scale (ICS) for use with speakers of JC and English and detailed psychometric evidence regarding use of the ICS and ICS-JC in a sample of children without disorders using measures of speech sound production. This is the first study to collect ICS data using auditory and written administration with findings to suggest that auditory administration, which might be necessary for language with a new or absent written form, does not negatively impact the psychometric evidence obtained.

Vishnu KK Nair, PhD is a two-year Post-doctoral Research Fellow in the Department for all of 2018 and 2019. With strong interdisciplinary research training in speech-language pathology and cognitive science, Dr. Nair completed his doctoral thesis in 2016 from the ARC Centre for Excellence in Cognition and its Disorders, Macquarie University, Australia. His research focuses on understanding the cognitive and linguistic consequences of bilingualism in children and adults with and without language impairment. Together with Associate Professor and Department Chair Christina Reuterskiöld, he is currently involved in international collaborations and research projects on longitudinal social-communication outcomes in bilingual children with autism and language intervention in bilingual children with developmental language disorders. Dr. Nair’s passion lies in bridging the gap between clinical and cognitive sciences and he is committed to research with a strong experimental focus and real life clinical implications for the remediation of language impairment in bilingual children and adults. This past March, Dr. Nair presented a talk to the CSD Research Colloquium entitled, Effects of bilingualism on cognitive control and novel word learning, and he also delivered a talk to the CUNY Graduate Center Colloquium on Oct 17.

Keisha T. Lindsay, PhD, CCC-SLP, came on board to the CSD Department in the NYU Provost’s Post-Doctoral Fellowship Program as a Steinhardt Dean’s Fellow, through August, 2020. While here at NYU, Dr. Lindsay will pursue her research, teach CSD students, embrace NYU’s vibrant intellectual life through scholarly networking opportunities, and receive co-mentoring from CSD’s chair, Dr. Christina Reuterskiöld, and Dr. Shondel Nero in the Department of Teaching and Learning. Dr. Lindsay will present at the CSD Research Colloquium on November 6, The Phonological Features of Trinidadian English (TrE) and Trinidadian English Creole (TrinEC). Beyond her ASHA certification, Dr. Lindsay is registered with the Council of the Professions Related to Medicine in Trinidad and Tobago. Dr. Lindsay’s research examines how speech and language skills develop in children from culturally and linguistically diverse backgrounds, with a particular focus on language acquisition in children from the English-speaking Caribbean. A practicing clinician both in the U.S. and the English-speaking Caribbean, Dr. Lindsay uses her clinical experiences to inform her research agenda and goals.

Stay tuned for more CLD advances in CSD.

CSD Department Researchers Identify Tool to Help Transgender Women Have a More Authentic Voice

Researchers in NYU Steinhardt’s Department of Communicative Sciences and Disorders identified visual-acoustic biofeedback as a new tool to assist in voice modification therapy for transgender women. The research, which appears in the latest issue of the Journal of Voice, identifies a new avenue for this technology as a tool to help trans women find a voice that matches their gender identity.

“Our voices are so much a part of who we are,” said Deanna Kawitzky, the study’s lead author, who conducted the research as a student in the Department of Communicative Sciences and Disorders. “For transgender women, it can be really challenging to find a voice that matches how they choose to present their gender identity. This study suggests that biofeedback may be used as a tool to help trans women achieve a voice they are comfortable with. Biofeedback has not been used in this way before, and we’re excited to have identified a new direction for transgender voice therapy research.”

Understanding Biofeedback
In biofeedback, bodily functions are electronically monitored and visually displayed to help someone achieve more voluntary control of that function. Although usually used to measure functions such as heart rate, blood pressure, or skin temperature, biofeedback can also be used to visualize speech and has thus become a tool for individuals seeking to change their voice or articulation patterns.

How it Works
In visual-acoustic biofeedback, the learner speaks into a microphone and views a real-time representation of the acoustic signal of speech on a monitor—in this case, the resonant frequencies of the vocal tract. These frequencies signal the differences between sounds, such as “ah” versus “ee,” but also differ across male and female speakers. In the present study, transgender female participants were provided with targets representing resonant frequencies that are typical for cisgender female speakers. They produced words while viewing the biofeedback display and were encouraged to adjust their speech until their resonant frequencies lined up with these targets. Participants were able to make a significant shift in their resonant frequencies in response to the biofeedback targets. In addition, words that were produced with higher resonant frequencies were rated “more feminine” by blinded listeners.

This research was conducted in the Biofeedback Intervention Technology for Speech Lab (BITS Lab). The lab is led by the study’s co-author and Associate Professor of CSD Tara McAllister.

“Many people want to change the way they speak—whether they have a speech disorder, or speak English as a second language, or are seeking to achieve speech that better matches their gender identity,” said McAllister. “However, our speech patterns are deeply ingrained over years of experience, so change can be extremely difficult. Research in BITS lab aims to understand how technology can help people make these changes in a quick and lasting way.”

The research offers a preliminary suggestion that biofeedback could also be a useful tool in voice modification therapy for trans men and the trans community more generally.

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Dr. Sonja Molfenter Publishes New Study in Dysphagia

As adults age, they all experience a natural loss of muscle mass and function. A new study published in Dysphagia by Assistant Professor Sonja M. Molfenter finds that as the loss of muscle and function in the throat occurs it becomes more difficult for efficient constriction to occur while swallowing – which leads to an increased chance of food and liquids being left over in the throat. The study helps explain why 15 percent of seniors experience dysphagia, or difficulty swallowing.

Among other health issues, swallowing difficulties can lead to malnutrition, dehydration and pneumonia – from food and drinks being misdirected into the lungs. Swallowing difficulties can also have a financial impact. Other studies have demonstrated that when patients with dysphagia are admitted to the hospital, they normally experience a 40 percent longer length-of-stay than those without dysphagia – estimated to cost $547,000,000 per year.

Molfenter and her colleagues noted that dysphagia in older adults is particularly relevant as the proportion of seniors in the United States is projected to increase to over 20 percent by 2030.

“Dysphagia has serious consequences for health and quality of life,” said Molfenter, the study’s lead author. “This research establishes the need for exercise programs for older adults that target throat muscles just like those that target the muscles of the arms, legs and other parts of the human body.”

Charles Lenell also of NYU and Cathy L. Lazarus of Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai contributed to this study.

The study was funded by the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health (NIH).

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