If you’re a speech-language pathologist (SLP) working with adult patients, you’ve likely encountered people who you weren’t sure how to help. Maybe they just wanted “to get better” but couldn’t think of a specific real-life outcome they wanted to see. Or maybe they were severely impaired with a progressive disease, and we couldn’t see anything to offer beyond a session or two for “education.” If this sounds familiar, read on to learn about 10 ideas for the speech therapy patient we’re not sure how to help.
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My sources are Baylor & Darling-White (2020), Yorkston et al. (2017), my own clinical experience, and ChatGPT 4o to help me brainstorm more specific ideas to share with you. If you have further ideas, please share in the comments!
Outline:
- 1. Participation mastery.
- 2. Skill mastery.
- 3. Environmental barriers.
- 4. Social barriers.
- 5. Problem solving.
- 6. Educational resources.
- 7. Relationships with medical providers.
- 8. Self-efficacy.
- 9. Connect with peers.
- 10. Re-interpreting symptoms.
- Share your therapy ideas!
- Related Eat, Speak, & Think posts.
- References.
1. Participation mastery
Participation mastery involves helping our patient resume, improve, or maintain the ability to participate in a real-life activity. A key concept here is that our patient (or their family) must agree that the activity is important and relevant to them. (Baylor & Darling-White, 2020; Page & Yorkston, 2022)
Some patients will know exactly what they want to work on in speech therapy, but other patients won’t. In those instances, we may need to tap into our motivational interviewing skills or use tools such as a needs assessment questionnaire.
It’s not necessary to identify the specific participation-level goal at the initial visit. We may need to explore ideas and options while we work on skill mastery or other goal ideas from below.
2. Skill mastery
Skill mastery is our bread and butter as speech-language pathologists. We are skilled at reducing impairment and improving function. There’s nothing wrong with working toward skill mastery, but we should be aware that if that is ALL we do with our patients, then we are working under the old medical model. (Baylor & Darling-White, 2020; Yorkston et al. 2017)
The WHO ICF, ASHA, and CMS all support the newer biopsychosocial model of healthcare. And that’s good news for SLPs! It turns out that we are well-situated to help patients and their families improve life participation. And as a sweet bonus, tapping into ideas 3 – 10 below may also do double duty with improving skill mastery. (Baylor & Darling-White, 2020; Page & Yorkston, 2022)
3. Environmental barriers
Don’t skip this section! There may be more here than you’ve thought of!
It’s safe to say that SLPs are highly familiar with environmental barriers such as poor lighting, loud or distracting background noise, and trying to speak from room to room.
But there are other barriers to consider as well. For instance, technology can be a barrier. Think about our patients trying to use automatic phone menus, drive-through speakers, ATM keypads, smart home assistants, etc. (Baylor & Darling-White, 2020; Yorkston et al. 2017)
In addition, our patient may not have access to printed materials designed for people with low-literacy, aphasia, or a cognitive impairment. We could work with our patient to help them access printed or online materials, such as medical forms, financial and legal information, application for paratransit service, telehealth platforms, and so on. (Baylor & Darling-White, 2020; Yorkston et al. 2017)
Perhaps we help them create a “cheat sheet” of key personal information that they can refer to when filling out forms. Or perhaps we could help them fill out a one-time application during a session in which we support them in using strategies. If you have other ideas to share, drop them in the comments below!
4. Social barriers
Issues with social interactions can create huge barriers that keep our patients from resuming their life participation activity of choice.
For instance, our patient may feel rushed in trying to conduct business in person or over the phone. Or the person they’re speaking with may assume our patient is mentally impaired, from an intellectual standpoint, and not respect their agency. There are many possible situations, but my bigger point is that people tend to be facilitators or inhibitors, whether they’re aware of it or not. (Baylor & Darling-White, 2020)
So, we can teach our patients to be aware of communication styles and notice the people in their lives who are facilitators. Perhaps our patient can take note of the characteristics they appreciate in their facilitators and advocate for change with other communication partners.
And we can teach our patient how to interact with inhibitors. We can remind our patient that they can’t change how other people behave, but they can change how they themselves respond to rudeness or unthinking unkindness. For instance, we can teach them mini-scripts to prepare them to advocate for a slower pace of conversation.
We can also support our patients and families in advocating for changes to formal services and policies.
5. Problem solving
Problem solving is an essential skill for our patients and their families, especially for those who will be living with chronic impairments. We can empower them by teaching them how to think through communication challenges and breakdowns. (Yorkston et al. 2017)
Specifically, we can teach them to:
- Acknowledge the problem (don’t gloss over it).
- Identify contributing factors, going beyond the patient’s impairment.
- Brainstorm possible solutions, including things that communication partners could do.
- Try out a possible solution.
- Evaluate the result.
- Adjust as needed.
We’ve probably all taught problem solving skills to patients with cognitive-communication impairments, but how many of us have taught problem solving skills to the spouse of a patient with dysarthria?
6. Educational Resources
This can be a creative and interesting area to target. We can assist our patient or their family in accessing, understanding, and using resources resources related to their condition. (Yorkston et al. 2017)
For instance, we could help our patient investigate:
- Literature or videos.
- Support groups.
- Conversation groups.
- Community resources.
- Condition-specific apps and tools.
- Participating in research.
7. Relationships with medical providers
Given the higher incidence of adverse outcomes for people with a communication or cognitive impairment, this is a very important area to address. There are many ways we can help our patients (Yorkston et al. 2017). For instance:
- Teach communication strategies specific to medical encounters. Role play to practice the skills.
- Assist with creating a visual aid such as a list of concerns or a communication board.
- Empower patient to initiate teach-back technique if medical provider does not.
- Help patients understand, organize, and use information after the visit.
- Teach patient how to use health portals to communicate with providers.
- Develop an emergency communication plan. May include scripts or communication boards.
- Create a health information binder. May be physical or digital.
8. Self-efficacy
Self-efficacy is “the confidence one has in his or her own ability to accomplish the plan” (Yorkston et al., 2017, p. 9). Since self-efficacy is a critical skill needed for positive speech therapy outcomes, we can help our patients improve in this area. Self-efficacy can apply to many types of activities, including:
- Routinely completing a home exercise program.
- Trying out a new communication strategy in real life.
- Having the confidence to advocate for oneself.
We can teach our patients how to use self-monitoring tools, such as timers, alarms, journals, calendars, or other apps. In addition, we can teach goal-setting skills as well as time management skills.
It’s important that any plan feel doable. So we can teach our patients how to plan their activities in ways that feel achievable to them. And we should make sure our home exercise programs feel reasonable to our patients and their families. (Yorkston et al. 2017)
I mentioned self-advocacy scripts in the social barriers section above. Creating a script to advocate for oneself is very much a self-efficacy skill. For instance, we may assist our patient to practice a request for more time.
Noticing small successes is important for building confidence and sustaining motivation. We can help our patient appreciate the successes to support a positive mindset.
We can also use motivational interviewing to explore any unhelpful attitudes or beliefs. Of course, we should use clinical judgement about when to refer a patient to a mental health professional. While counseling is within our scope of practice, we’re not equipped to treat someone who is living with a significant mental health condition.
9. Connect with peers
Peer-support and peer-modeling can be very powerful for recovery. We can help our patient find someone living with similar challenges, or peers who accept our patient as they are. (Yorkston et al. 2017)
Depending on our patient’s circumstances, they may prefer finding peer support or a peer model online or in real life. For instance:
- Social media.
- Books and movies.
- Online or in-person support or conversation groups.
- Peer mentorship program.
- Online support community.
- Group therapy.
- Peer-run workshops or conferences.
- Collaborative projects, such as creating arts, volunteering, or advocacy.
- Hobby-based groups to find people with shared interests.
10. Re-interpreting symptoms
It’s not uncommon for patients and family to feel that their communication or IADL challenges are due to the speech, language, or cognitive-linguistic impairment. But many factors may impact a person’s ability to succeed. Here’s an example from the literature.
Yorkston et al. (2017) describe a patient, John, who has dysarthria secondary to Parkinson’s disease. John feels left out of the weekly family gatherings because no one can hear him. John and his family think that the problem is John’s soft speech, and they look to speech therapy to “fix” him.
Defining the breakdown as solely due to his speech intelligibility leaves the only possible route to improvement being to change his speech. That puts all the pressure on him.
-Yorkston et al., 2017, p. 10-11.
Speech therapy can certainly help him to increase his vocal loudness, but we know that patients may still struggle to speak with intent when they are tired, overwhelmed, or sick. In addition, their dysarthria may continue to worsen over time.
Yorkston and colleagues suggest taking a look at the broader picture. What if we learned the following:
- John’s family believes that John can speak loudly whenever he wants to.
- They think John just interested in talking as much anymore.
- The family gathers on Sunday, including sons, wives,and young children.
- The football game is on the TV, with the family all in one room.
This suggests some possible interventions. For instance, we could:
- Support John in educating his family about the nature of dysarthria.
- Encourage John in finding opportunities to converse with his family.
- Perhaps his sons could call or visit 1:1 during the week.
- Maybe the family could come early or stay after the football game.
- The TV could be muted during commercials.
- Teach John repair strategies, for when his attempts at communication fail.
- Talk with John to see what possible solutions he sees.
Other options include:
- Consider the vision and hearing status of conversational partners.
- Reframe symptoms as a beneficial adaptation, rather than viewing it as a sign of lost skill.
- Normalize the learning curve for acquiring new strategies or using new devices.
Share your therapy ideas!
Above, and in the handout, I share many concrete ideas for how to help adults in speech therapy across 10 different domains. I’m sure there are many ideas that haven’t occurred to me. Please share your ideas for therapy in the comments below!
Related Eat, Speak, & Think posts
- An easy way to write participation-level speech therapy goals.
- Soft skills for SLPs: Taking your practice to new heights.
- A PROMising shift: SLPs offer person-centered care.
- Learn how Goal Attainment Scaling can make SMART goals better.
References
- Baylor, C., & Darling-White, M. (2020). Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework. American Journal of Speech-Language Pathology, 29(3), 1335–1360. https://doi.org/10.1044/2020_AJSLP-19-00043
- Page, A. D., & Yorkston, K. M. (2022). Communicative Participation in Dysarthria: Perspectives for Management. Brain sciences, 12(4), 420. https://doi.org/10.3390/brainsci12040420
- Yorkston, K., Baylor, C., & Britton, D. (2017). Incorporating the Principles of Self-Management into Treatment of Dysarthria Associated with Parkinson’s Disease. Seminars in Speech and Language, 38(3), 210–219. https://doi.org/10.1055/s-0037-1602840
Free DIRECT downloads: 10 ideas to help the speech therapy patient we’re not sure how to help (cheat sheet). (Email subscribers get free access to all the resources in the Free Subscription Library.)
Featured image by Bongkarn Thanyakij on Canva.com.
Lisa earned her M.A. in Speech-Language Pathology from the University of Maryland, College Park and her M.A. in Linguistics from the University of California, San Diego.
She participated in research studies with the National Institute on Deafness and other Communication Disorders (NIDCD) and the University of Maryland in the areas of aphasia, Parkinson’s Disease, epilepsy, and fluency disorders.
Lisa has been working as a medical speech-language pathologist since 2008. She has a strong passion for evidence-based assessment and therapy, having earned five ASHA Awards for Professional Participation in Continuing Education.
She launched EatSpeakThink.com in June 2018 to help other clinicians be more successful working in home health, as well as to provide strategies and resources to people living with problems eating, speaking, or thinking.
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