At the onset of any therapy whether for speech, swallowing or both, I am required to establish a treatment plan which includes short- and long-term goals which include a time frame for attainment, such as 30 or 60 days. Treatment goals are based in part on my initial assessment of a patient as well as any statements the patient makes regarding what concerns them and what they hope to improve in response to out-patient therapy.
If I am seeing an individual because of changes to speech and voice, I will use that initial visit to assess their stimulability for improvement, employ various techniques (behavioral and instrumental) to determine if their vocal instrument is working, and assess whether they possess adequate cognitive skills and motivation to perform any independent practice that may be required.
If I am seeing a patient with dysphagia (swallowing problem), I will typically review any screening tools they have completed to better understand their perception of the problem and review their video-swallow study with them. The visual images obtained on an instrumental swallowing assessment are also necessary to help patients better understand their own swallowing physiology and the rationale for recommendation I might be making with regards to exercises and other treatment.
Patient Goals
When formulating a treatment plan and writing goals, I also state the patient’s goal/s including what they expect to achieve by participating in speech therapy. Sometimes they are quite clear in what they state, for e.g.: “I want my wife to understand me,” “I don’t want to have to repeat myself so many times,” “I want to drink water without choking,” “I want to stop drooling.” In other instances, patients may be unsure or unclear about what speech therapy can offer them, and in fact, may have come to see me only because their neurologist made the recommendation or because their spouse has concerns.
Reconciling treatment goals with a patient’s goals, while at the same time also incorporating the goals of a spouse or other care-partner can at times be a challenge. If a patient lacks insight as to the impact of their speech or swallowing impairment or has a cognitive impairment that limits their ability to independently carry-out home practice or behavioral strategies therapy may seem to them a “waste of time.” If the spouse who must transport the person with PD to therapy several times a week has a different set of expectations, they too, in the end, may feel frustrated when the outcome does not meet their expectations.
Patients AND Therapists are All Different
Just as no two people with the same medical diagnosis may respond to treatment in the same way, no two therapists, even if trained in a similar approach may treat similarly. Some therapists will attend a workshop in which they will learn an approach, and apply it to ALL patients with the same medical diagnosis (e.g. Parkinson’s) regardless the patient’s motor speech or swallowing symptoms or response to treatment. When a therapist becomes to rigid in their thinking or approach to treatment, they may fail to investigate all available options that might be of benefit to the patient.
Flexibility and Critical Thinking Necessary Therapy Tools
When one is a graduate student in speech-language pathology, they begin to work with patients whose symptoms they have only read or heard about in a course, and consequently it is often difficult for the student to adapt within a session to an unexpected response or lack of response by the patient to a written plan. Similarly clinicians who become wed to a particular approach, may practice for many years and still provide ALL patients with the same approach, sometimes leaving patients at discharge to believe that they “failed” treatment rather than the approach failed them.
No Two People Are Alike
For most people with Parkinson’s disease or a related neurodegenerative disease diagnosis, medications and medical treatments may change yearly or even more frequently depending on the patient’s response and disease progression.
In the same way, based on a patient’s response to therapy, treatment goals may change, and a weekly review of goals helps to clarify what is expected of the patient during treatment and post discharge. When one approach does not yield improvement in motor speech symptoms, rather than providing more of the same thing, it may be important to explore what other options are available. When a patient has a chronic or progressive disease diagnosis, the improvements attained in 30 days of treatment may be short-lived if we do not include a home maintenance program post discharge. For individuals who live in a ALF or who live alone, communication goals may be particularly difficult to maintain if they have limited opportunities for interaction with others.
What Are Your Goals?
Whether you realize it or not, throughout your life you have set the intention to attain some goal. You may have had a goal to buy a home or car, go on a vacation, propose to your spouse, obtain a college degree. Some daily goals are less elaborate and might include such things as: to clean out the garage or closet, to wash the car, to prepare taxes.
Regardless how big or small the goal, once you set the intention, you begin to take the steps that will help you attain it.
It’s very possible, that many of you reading this never set out to make improving speech or swallowing a life goal, but a diagnosis of Parkinson’s, or a stroke, or other neurological disease may have led you to a speech-language pathologist. So, what can you expect to gain from enrolling in speech therapy?
- Ask your therapist that question.
- Ask what YOU will be expected to do in therapy and at home.
- Ask for a copy of your written treatment plan.
- Ask yourself if you are committed to the goals and able to perform the home practice without assistance.
- With the help of your therapist establish an action plan.
- Review your short-term goals weekly and assess whether they remain meaningful and attainable.
Therapy of any sort is a dynamic process, and with 40 years of practice under my belt, I can tell you that there is no one size fits all and the best laid plans often change multiple times once therapy has begun. When focusing on communication, the needs of your primary communication partner/s must also be considered and inviting them to participate in treatment visits may help to educate them about the problem and identify strategies which can improve communication at home.
Got Questions?
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My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice