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My Notepad

Welcome to Week 2 in the Speech Therapy Makeover series! I’m challenging myself to “make over” some traditional therapy tasks so they will be more person-centered (functional, meaningful, and relevant for the people we work with). We know that person-centered care offers the best results across the board for outcomes, patient satisfaction, and efficiency of meeting goals.

Week 2 Speech Therapy Makeover Task: Card Games as a therapy task or home program

The Challenge: Best practice guidelines describe treating cognition areas (including attention and problem-solving which are typically the “goal” with card games) in-context and related to a functional need. We are most likely to make a difference in someone’s everyday life if we use/practice/demonstrate/model with the actual tasks the Person we treat wants and needs to use.  For many people, playing cards may not be at the top of the goal list, so why not adjust this task to be person-centered?

Person-Centered Ideas: If your Person wants to return to playing a certain card game or head back to the casino, playing cards may be a great practice in speech therapy. For many people, playing cards is not related to a high-needs person-centered goal, so assigning card-playing as a therapy task or homework as a substitution for real-life practice may be off-target. Playing cards certainly isn’t bad for someone, but it may not be the best choice for our primary goal in speech therapy: carryover for everyday life. What about personalizing a home program according to what your Person wants/needs to do? This will help you and the Person think about home programs as a way to engage/practice skills in real life (as opposed to thinking that a home program is practice for the speech therapy session). This mindset helps both SLPs and patients keep tabs on how progress is going “in the real world”–which is what it is all about!

*Treating Attention: Instead of using a card game to practice sustained attention, what about assigning participation in something that requires sustained attention (Person input is important here!). Better yet, use an evidence-based treatment approach to do this, like Goal Management Training, Step-by-Step Instruction, or External Cognitive Support! Examples I have used: Set the table 5x this week, Goal-Plan-Do-Review for shopping for a birthday gift online without getting distracted, work on your building project for 30 minutes (set a timer) and report back on how you did staying on task. For alternating attention, consider adding natural practice for the person’s situation (Use the strategies we practiced when you are at breakfast trying to read the newspaper and converse, take notes at your church service, be the driving direction “navigator” while also conversing in the car).

*Treating Problem-Solving: Instead of using a card game to target problem-solving, consider choosing a relevant topic/goal and use a Goal-Plan-Do-Review format for home program. Does your Person have an insurance issue they can’t figure out? Make a plan for calling, which questions to ask, then review the process next session. Is your Person grocery shopping? Maybe training this skill as a Step-by-Step Activity would work best. Have him price-compare grocery items across 3 stores and explain rationale for why he chose a certain store. Is your person having a hard time sending a phone text message? Maybe an external cognitive support like a picture sequence reminder would work.

*Treating Turn-taking: Create a log or plan xx conversation opportunities that the Person will participate in. We are talking REAL LIFE CONVERSATIONS (Not games!) Use a log for the Person or conversation partner to track the behaviors you are targeting.

Setting Goals: Instead of writing a generic goal (“The patient will complete sustained attention tasks with 80% acc.”), I have been working on writing more person-centered goals for the past few years (“The patient will sustain attention in home setting to resume setting the table and folding laundry with independent use of strategies as identified with SLP.” or “The patient will improve turn-taking in conversation in social settings as evidenced by spouse self-rating (baseline 2/10) and patient self-rating (baseline 4/10).”).

Thanks for reading! If you would like more person-centered therapy ideas, please check out my Shop. Be sure to follow on Facebook , Pinterest, Instagram or sign up for email updates to receive the series right in your inbox. If you have any ideas of speech therapy tasks you think need a “makeover”, email me at [email protected].

5 Responses

  1. Thank you for these excellent ideas and encouragement! I have loved your resources and I really look forward to your posts 🙂

  2. I love these ideas and I definitely would like to give my treatments a makeover, but how would you apply these functional goals to the inpatient rehab setting? Many of my patients require lower-level cognitive tasks or do not have many responsibilities in their homes d/t caregivers. And since my patients stay for about 2 weeks, games seem to be a good way to engage them. I would love any suggestions you have!

    1. Leah, you are asking some GREAT questions!! I am currently working on a packet that specifically addresses how we can discover functional needs across any setting. I’m going to send you a private email with more detailed thoughts, and an article I LOVE for inpatient rehab (Inpatient Rehab: Is It Time For a Change? By Dr. Lyn Turkstra)

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