Using Real Life Situations to Improve Carryover for Cognitive Therapy
Using Real Life Situations to Improve Carryover for Cognitive Therapy
Jolie Parker, MS CCC-SLP
I’ve been hearing about speech-language pathologists taking patients, or clients, out for coffee, to a restaurant, or to a grocery store for cognitive assessments and therapy. That’s exactly what I am doing with my traumatic brain injury clients now. I’ve heard that even hospital speech-language pathologists are doing these activities now. As a speech-language pathologist working with clients with neurological diagnoses in a post acute residential setting, I find this therapy technique to be much more valuable, effective, and fulfilling than doing drills and worksheets in a therapy room.
While on an outing, there are constant opportunities to assess, assist, and teach cognitive skills in real life settings, with all the distractions and complications of the real world. Does he remember to put on his seat belt? Does he look both ways before crossing the street? Does he interact appropriately with the public? Is he able to problem solve, sequence, and organize information to accomplish tasks such as skills needed when grocery shopping? Is he able to handle cash transactions correctly? Can he compare prices and make appropriate selections? Are certain environmental stimuli overwhelming, distracting, or confusing for him?
There is so much more information available when interacting with clients in the real world instead of the speech therapy room, especially when you are working with clients with traumatic brain injury, stroke, or other neurological diagnoses. Cognitive skills are so complex. A client may be able to perform written tasks or answer correctly when you ask them how to do an activity, but then when they leave the speech therapy office and try to do things in real life, it’s a different story. Our goals really are not for the client to be able to do things correctly in our office. Our goals are for the client to be able to function doing numerous activities in the community and interacting with others in all environments. It makes a lot of sense to provide cognitive assessments and treatment sessions in real life settings as much as possible.
When we learn skills in a therapy room, it is often a whole other task to get those skills to carry over into real life. Many skills taught in the speech therapy room never become part of the client’s everyday life outside of therapy due to poor carryover, through no fault of the client and despite best efforts of the client and the speech-language pathologist. It’s just a huge step from the therapy room to real life. When we learn skills and compensatory strategies through consistent practice in real life situations with a therapist, we obtain instant carryover. The skills may then be applied and used every day and will provide maximum benefit to the client.
Jolie Parker, MS CCC-SLP is a speech-language pathologist with over 18 years experience who specializes in traumatic brain injury, stroke, and dysphagia rehabilitation. She lives in Altamonte Springs, Florida with her husband and two teenage children. She is a current ASHA member and co-inventor of the ISO Swallowing Exercise Device.
