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My Notepad

It’s Think-It-Through-Thursday! Here’s a new series to give you and your SLP colleagues some food for thought. Feel free to print and discuss at lunch or use for continuing education or journal review! I will include a recent research article and some thoughts about how this relates (or doesn’t relate) to some of the practices we have in adult speech therapy!

Today’s topic: How Impairment Levels Relates to Activity and Participation

*Spoiler Alert: Level of Impairment does NOT correlate with Activity and Participation! What does this mean for your speech therapy practice?

Article Link: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.888.932&rep=rep1&type=pdf Advancing the Evidence Base of Rehabilitation Treatments: A Developmental Approach.(Article in Physical Medicine & Rehabilitation, Vol 93 (80) in 2013. Authors: Whyte, J. & Barrett, A.M. MD.)

This article (written by MDs and a bit “heavy” to read) describes phases of research–and that the most mature and applicable research in the rehabilitation fields going forward will HAVE to assess how a treatment impacts real-world outcomes in the community. Just because a treatment shows someone improves in an impairment (ex: sustained attention in isolated tasks improved from severe to moderate-severe), most treatments do NOT also comment on how effective the treatment was in improving the activity (ex: writing checks correctly) or participation (ex: returning to work).

What does this mean for our evaluation with adults in speech therapy? Level of impairment does NOT correlate with activity or participation consistently. So, we can’t infer how someone’s activity or participation is actually going at home by standardized testing results alone. For examples, if a person has moderate deficits in reasoning and severe impairments in memory, do you know if they can still cook for themselves? The answer is NO–each person’s impairment will affect their activity and participation in a different way.

But the tests I give only list impairment-level results. What can I do? Because impairment-based results do not give us the full picture– or tell us about activity and participation which is our ultimate goal!–our evaluation must also include what is called a needs-based assessment to determine the impact of impairments on activity and participation. In fact, it is listed as a BEST PRACTICE for aphasia and TBI to include needs-based assessment or non-standardized assessments (See ASHA’s Practice Portal if you want more info!)

What do you recommend for a needs-based assessment? I prefer having an efficient system to gather information about someone’s participation and activity level. Perhaps you have a checklist of info that works in the setting you are in. I’ve created checklists in the following resources to efficiently gather activity / participation data–each is unique to the activities described in each packet:

Home Sweet Home Series

Back To Work Series

Med Management Packet

Cooking Packet

Thanks for thinking it through! After reading the article, is there a treatment technique you might want to rethink because you aren’t sure how it impacts the ultimate goal of improving activity or participation?

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4 Responses

  1. Completely agree with these ideas in theory – and besides the needs assessment, there should be an emphasis on the development of more assessments that bridge impairment and activity/participation like the FAVRES, CADL, SCAAN. In practice, however, especially when working with individuals with mild language and cognitive-communication deficits in an outpatient setting, many of my patients and their families report no functional activity/participation deficits. However, when I complete more “functionally-based” assessment tasks, I do find deficits that are concerning for return to work/community. Often, I am stuck between a rock and a hard place because of comments like “I would never do this at work” or “This is trying to trick me”. I acknowledge that insight is a significant factor, especially when many of these individuals have yet to return to work (I typically see them 2-3 weeks post CVA). In an ideal world, I hope that there is a trend in developing assessment tools that allow therapists to actually observe individuals in their work environment (just like the way OTs complete kitchen assessments to assess cooking safety) and come up with functional strategies that are relevant to people’s lives. It pains me that our current system revolves around seeing if the person fails at the activity/participation task before they are ready for therapy. We don’t give people the opportunity to “fail” in a safe environment first prior to allowing reintegration into the community. This is the case in Canada at least, not sure how things are structured in other countries.

    1. Love this, Violetta! I agree with all of the above– this is why I created the Back To Work Series so we could practice those real, actual work tasks and develop strategies or accommodations before they actually “fail” at work!

  2. WHY ARE WE YELLING?!?? ; ) Great information, helps to reframe how I think about my clinical choices in therapy!

    1. Ha! This made me laugh! I am a non-tech running a blog…and I can’t figure out how to change the caps vs no-caps on my current theme!! No yelling at my computer over here!

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