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 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 can help patients better understand their own swallowing physiology and the rationale for recommendation I might be making with regards to exercises and other treatment.
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, particularly 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.
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. If the 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.
- 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.
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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