Long-term Goals: A Review
Long-term goals are developed as an expected outcome for patients with communication and swallowing disorders. Based on a patient's prior level of function, current assessed level of function, and projected ability to improve and reach goals, the SLP creates goals that the patient should be able to attain in a specific time period. Therapists from all disciplines often use 12 weeks as a reasonable amount of time to reach a long-term goal; 6- or 8-week targets might be more reasonable for some patients.
The long-term goal must be functional and attainable, and based directly on the SLP's assessment of the patient's current function, which is compared to the patient's previous abilities. For example, a person who was able to communicate independently and complete household management tasks, but has mild word-finding impairments post-CVA, will have a completely different goal that a person who is nonverbal following the latest of several strokes. A patient who had no diet restrictions but has been placed on pureed foods secondary to recent onset of swallowing impairments due to muscle weakness and difficulty chewing foods has a different outlook than a patient with a progressive neurological disease and a history of aspiration. When choosing long-term outcome to targets, we must be honest about the underlying reason for impairments and the efficacy of known treatments.
Many patients will have long-term goals that target the patient's ongoing use of strategies in order to maintain the highest level of function when faced with the likelihood of progressive decline. I work with many patients and family who are dealing with the early stages of dementia of various causes. Initial therapy may target the patient's use of visual aids and memory notebooks to maximize that person's safety and independence in their living environment for as long as possible. As the patient's cognitive abilities decline, the SLP may reassess the patient in months or even years, and develop patient strategies that are simpler for the patient to implement.
Later, as cognitive abilities decline further, the patient might benefit from skilled services targeting maintenance plans and caregiver instruction to improve the patient's participation in simple daily activities and social interactions by teaching others how to interact with and help that patient.
Not all patients who previously consumed an unrestricted diet or independently handled household tasks will regain those abilities. Long-term targets sometimes have to be modified if patients do not demonstrate progress toward the short-term goals that measure the progress needed achieve the long-term goal.