These days in speech therapy, it’s considered necessary to have therapy tasks be “functional.” We throw that term around – but are we all using it in the same way? Since Honeycomb Speech Therapy was started in pursuit of “functional” therapy ideas, Let’s discuss:

Let’s start with the basics. What does “functional” even mean? Well, according to the Cambridge Dictionary,

“Functional” means “intended to be used; practical rather than attractive.”

https://dictionary.cambridge.org/us/dictionary/english/functional

Interesting. Let’s put that definition in some therapy scenarios.

Mr. Stroke Client is being seen in speech therapy in Inpatient Rehab. Like all your clients who will be discharging home, you complete a checkbook balance task as part of an informal evaluation.

*Now, stop a moment. Here is a KEY point we can take away from the definition of “Functional. What absolutely matters here is if Mr. Stroke Client NEEDS to be able to balance his checkbook. After all, functional is talking about a skill that is intended to be used. It doesn’t mean he COULD use it. It’s talking about something he is INTENDING TO DO. Let’s tune back into the scenario:

Upon further questioning, you find out that Mr. Stroke Client does not balance a checkbook at home. In fact, he often uses cash, money orders and has his monthly payments set up automatically.

Where does that leave the task of checkbook balance? I would argue that this is no longer a functional task to complete with Mr. Stroke Client. This is not a task he intends to do. Now, it may make you feel like a put-together SLP because you have a stack of tasks you do with every patient, regardless, but I think that you’re falling into the “attractive” pit of wanting to look like you have it all together and sacrificing practicality.

Another scenario: You pick up Ms. Moderate Dementia in the SNF setting to address better cognitive habits to fill her time. You find out she used to be a gardener, so you spend the next 4 weeks keeping her entertained with talking about garden seeds, doing a plant craft, and looking at pictures of different plants.

*Let’s stop again. Is this a functional task? Are you working on something she is intending to do? Or, are you falling prey to doing an activity that is “attractive” but it’s not actually practical and a need for her. If you’re entertaining her with a topic that is a real-life topic, it still doesn’t make that therapy task functional. In order for a task to be functional, your therapy goal should be improvement in a task outside of the therapy session (something she’s intending to do).So how could you actually do something functional in this scenario? Let’s tune back in:

With Ms. Moderate Dementia, as you’ve created a personalized memory book with her filled with her favorite types of plants, and given her a small planting station to explore during the day, the staff has reported decreased behavioral outbursts and increased communication meal times. Staff meetings feel that these positive changes have occurred due to SLP involvement in meeting the need of creating personalized memory and interest aids that Ms. Moderate Dementia can utilize with set-up only by staff.

Do you see the subtleties here that have BIG IMPACT differences? In the first part of the scenario, the reason you were doing the garden tasks were to keep her entertained – it didn’t have a lasting effect. In order for a task to be functional, it can’t just be in a real-life realm. It has to be a task that is working on making an improvement in someone’s everyday function. It has to be meaningful, relevant, and something that the person is intending to do. In the 2nd part of the scenario, the same tasks were functional because they were used to make a practical change for the patient.

Whether you use the word “functional” “person-centered”, “meaningful”, or “real-life”, I hope you consider the therapy tasks you are doing. I hope you can see how you are working on a skill that is practical, that is a need that can be used in their everyday life, and that you don’t fall prey to the tasks that just look attractive from a time-filling standpoint.

What are your thoughts? I’d love to hear! Chime in below or email me [email protected].