About the Author:
Sarah Baar is a speech-language pathologist working in Grand Rapids, MI. She’s had the opportunity to work in many settings across the continuum including acute care, acute rehab, home & community, and outpatient therapy, as well as being involved in various leadership projects. In 2016, she started the Honeycomb Speech Therapy website and blog as a way to promote person-centered and functional therapy ideas for adult rehab. Those who have attended her speaking events enjoy her practical approach and tips that the everyday SLP can implement for a functional therapy approach.
Today, we are talking about why Functional Treatment for Everyday Cognition matters.
Functional Treatment is a person-centered approach. Using a person’s own goals to improve their performance and meaning in life tasks is the very essence of person-centered care. We know from research that person-centered care offers better patient satisfaction and outcomes. Those who are highly involved in setting personal goals have better outcomes when treatment is done (Webb & Gluecauf, 1994).
Why do we care about a person-centered approach? Person-centered care has become the standard across health settings, and therefore our speech therapy treatment and resources need to change from decades ago. As SLPs, we are no longer telling a patient what their problem is and what we are working on. Instead, we are collaboratively identifying person-centered goals, therapy, and outcome expectations. The Worldwide Health Organization describes person-centered outcomes as focusing on the activity and participation of a patient (can they make their own coffee? Set an alarm? Use their call light?), as opposed to measuring impairment level outcomes only (sustained attention, problem-solving, memory).
Is the functional approach just another option in our treatment bag? This approach is not just “another option” because it’s fun to have options; it’s actually the best option when considering large healthcare initiatives as well as our own SLP literature. We are in a new era as SLP’s, as our own SLP literature for the adult neurogenic population has shown ample evidence that cognitive-communication therapy MUST be performed in-context if we hope to make a difference in someone’s everyday life. Research has shown that using workbooks in therapy does not generalize to everyday life skills or strategies. Playing games–either board games or nonfunctional apps– only improve someone’s skill at playing that actual game.
Does this functional / person-centered approach apply to treating cognition for adults with brain injury? Best practices indicate that for cognitive intervention to be meaningful in real-life; we MUST practice skills and strategies in a real-life context. That means that drilling a skill with a worksheet, game, or app has not been proven to make a difference when someone is using cognitive skills in real life. This includes problem-solving, attention, planning, memory, and organization (Ponsford et al., 2014).
"I’m not sure what I would do in treatment if I didn’t have worksheets or games." I’ve been where you are! You have “Tossed The Workbooks”, “Closed The Game Closet”, and “Scrapped the Nonfunctional Apps.” NOW WHAT? The good news is that research supports MANY treatment options and frameworks that have been shown to improve everyday activities for cognition.
Alas, with productivity demands, busy caseloads, full extracurricular lives, or kids interrupting your sleep at night (That's me, currently!), you might notice that while you attempt to read the current research, it's not always "sticking" for the moments you need to remember some of the key details. And let's be honest, we don't exactly have time to thumb through articles or textbooks trying to recall specific recommended guidelines for the population that benefits from a certain treatment.
Clinical SLPs, I hear you (I AM you!) and I want to help. Today I'm sharing a simple "Cheat Sheet" that I use to recall evidence-based treatments that can be applied to meet functional goals in cognitive therapy. All of the treatment packets in my store include a simple Cheat Sheet that can be used to decide if a certain treatment would be appropriate for a patient, at a glance. But today, I stuck them all together so you can see the info in a simple table.
If you are just catching up, I have created some great resources that give functional treatment ideas using evidence-based cognitive treatments:
Book 1: Goal Management Training
Book 2: Step-By-Step Activities
Book 3: Task-Specific Cognitive & Language Supports
Book 4: Spaced Retrieval
When it comes to choosing my treatment methods, I first listen for the functional needs during the assessment, and then use a Cheat Sheet like the one below to collaboratively choose a treatment plan with the patient. This way, I know that I am bringing a best practice treatment to meet a real need for the patient (but also don't have to rely on my memory to recall all these facts independently during the evaluation! I actually have this printed out to refer to):
Click the image to enlarge or to download/print your own copy.
What else is in your evidence-based treatment box for functional cognition? I'd love to hear! If this info is new to you, be sure to head over to my website and sign up for Functional Freebies to get you started on a person-centered approach for speech therapy.
>> You can also check out other posts in the Functional Cognition Series.
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More Resources for Functional Cognition
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