4 Steps for Making Progress in Therapy
With independence, medically trained Speech Therapists play a significant role in the recovery of key functions adults lose, whether because of a stroke, disease or age-related declines. These areas are the function of the swallow, voice and cognitive communication impairments (e.g., word-finding difficulties, memory loss, attention deficits, and declines with problem-solving abilities). It’s such a diverse area; even many medical professionals are unaware of the entire spectrum that a speech therapist can treat. Therefore, most patients or loved ones end up having to be their own advocates for this much needed referral.
As with any type of therapy, making progress can be challenging. Based on the most common mistakes I’ve come across in a patient’s treatment plan, I’ve put together the 4 steps for maximizing progress.
Negative attitudes will derail even the best treatment plan. If you are pushing to get therapy for your loved one, but your loved one does not want it, most likely nothing good will come out of their treatment sessions. The patient must want to get better and be willing to work hard for it. Progress is a road full of efforts and will not show up just because they have therapy sessions.
There are many professions that are so broad they end up branching out into specialists. This is the same with speech therapists. There are three distinct areas based on age alone: 3 and under, school-aged, and adults. Each age group has its own unique set of problems.
An adult in need of a medically trained speech therapist may get their therapy in places such as in their home (through a home health agency), an outpatient center, a hospital, or a skilled rehab center (nursing home). Depending on the location, these places may have a hard time getting an experienced speech therapist onboard. Bigger cities have access to a broader talent pool. If access to speech therapy candidates is limited, often the company will take anyone with a Master’s Degree in Speech-Language Pathology that is properly credentialed to work within their state.
There are more speech therapists trained to work with children than there are for adults, so they often get hired even though they lack any experience for the population they are about to work with. Children that need speech therapy are often dealing with developmental delays along with their medical condition. Adults have already acquired their skills and now have a loss of ability due to a medical condition. This is one of the many significant differences between these populations.
You want to make sure the therapist has experience with your specific problem and patient population. Most therapists further their expertise and knowledge through various certifications that allow them to be more specialized. This is because even within a certain population, there are still many areas that a speech therapist can treat. Each area (swallowing, voice, cognition, communication) requires a special set of skills and training to work with. Ask the therapist to show you any certifications they have that show knowledge for your particular issue. This is just one way you can better match yourself with the right therapist for you. Sometimes it takes trying out several therapists before you find a suitable match.
This brings me to the next key step: how often are you working toward your goals? If you had an acute episode (e.g., stroke, head injury), the first few months of your recovery is when you can expect the most “spontaneous gains”. In other words, progress without having therapy. However, I would not recommend waiting it out, as therapy is the most crucial component for a fuller recovery. The sooner the better (particularly within the first 2 years) in order to minimize your loss. The more severe the problem, the more you need to work. This may mean every day. Yes, that’s right. This doesn’t mean you have to have a treatment session every day. A good therapist will create a home exercise program so that you can carry over the exercises on your own. Then, your treatment sessions with the therapist can focus on more intensive exercises to push your progress further along. A more severe problem might require sessions with the therapist anywhere between 4-6 days a week, with the goal to taper down when progress is evident and you are better able to carry out a home exercise plan independently.
How difficult are your exercises? On a scale of 1 to 5 (with 1 being “Very Easy. I can finish in 15 minutes with no help at all” and 5 being “I had to ask my significant other for help after struggling for an hour on my own”), where would you rate your exercises? Anything below a 3 or at 5 is not helpful. The sweet zone is 3-4. Just like your muscles need to be challenged if you are working to recover a total knee replacement, so does your brain to recover a neuro function (e.g., memory, word finding).
In the 80s, there was a very controversial study performed by behavioral neuroscientist Edward Taub on wild Silver Spring monkeys. The monkeys in this study had a nerve surgically severed in their brain, resulting in not being able to move one of their arms. This is what a stroke can do to the body. The good functioning arm was constrained on the monkey in a sling. The researchers fed the monkeys through a pellet system that required use of their hand to get the food. In order to get fed, they had to use their impaired arm. To the surprise of many, these monkeys could regain function in their bad arm because they had no other choice but to use it or starve.
Yes, I know this is a horrible study. But it happened and because of it, neuroplasticity began to be understood and therapy models grew significantly from it. This study revealed the significance of both frequency and intensity for the cortical remapping of the brain after injury. Prior to this experiment, researchers believed that injuries to the brain could not heal. I’m not suggesting your therapy needs to be this drastic, just emphasizing the importance of frequency and intensity. Use it or lose it!
If you followed these steps and still have no progress, it could be you just need more time or even a break. Therapy is hard work and can be overwhelming. Be persistent and stay positive!