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Focus on Geriatric and Adult Services

Making Q&A Easier

Published May 1, 2014 8:47 AM by Jennifer Kay-Williams

Speech therapists ask a lot of questions; it's part of the nature of our job. There is a fine balance between asking questions to target therapy goals, and making the patient feel like she is being quizzed. I cannot count the times that I have been asked why I asked so many questions or why I needed to know these things about the patient. Let's face it, not many people look forward to seeing the person who just asks redundant questions, or makes them name countless lists of words and recall pointless facts. It gets worse when patients know that they are not able to respond correctly, have trouble recalling words and information, or cannot put their thoughts into a coherent or intelligible response.

When patients get frustrated, they often act out in order to try to avoid the task. They suddenly have headaches, or want a nap, or need to reschedule. Eventually, they might start to refuse therapy altogether, and for good reason: they do not see the benefit or the purpose of all of the questions.

In order to increase the patient's willingness to complete verbal tasks, try to:

1. Carefully assess the patient's cognitive level via the Brief Cognitive Rating Scale, Global Deterioration Scale, Allen Cognitive Levels, Ross Information Processing Assessment- Geriatric, etc.. Use your clinical judgement to decide if lengthy or complex verbal tasks are even appropriate.

2. Be aware of any hearing loss, and keep in mind that hearing loss is not always reported in the chart at the time of admission. Many patients will nod and smile at questions that they do not hear clearly, and seem confused or disoriented.

3. Explain the purpose of each task to the patient at a level that he can understand.

4. Allow a few minutes for the patient to "warm up" at the beginning of the therapy session instead of jumping right into question and answer tasks. Let the patient tell you a little about her day or her family, and ask you some questions too.

5. Try written tasks as appropriate if the patient seems to become annoyed with constant verbal questions.

6. Make sure that all of your activities are appropriate to the patient's level. Adjust the complexity according to the patient's ability to respond correctly, and avoid letting the patient get frustrated or bored.

7. Do not simply read lists of questions from workbooks every day. Try to find out what the patient's interests are and develop questions around them.

8. Do more hands on, functional tasks that do not involve talking.

9. Bring an activity, such as a card game, organizational task, or snack to make, so that the spoken language tasks can be done in a more natural and cooperative setting. This might help the patient to relax and feel that therapy is more conversational and less confrontational.

10. Do not use the same questions and topics in every session. Alternate verbal and nonverbal tasks.

11. Enlist other therapists to bring a patient into conversational tasks. Each therapist can work only with their own patient, but the patients may feel more relaxed, and less as if they are being put on the spot.

12. Listen to your patient when she voices frustration or is tired of specific verbal activity, and let her know that you understand her frustration. Offer to giver her a break periodically.

13. Let the patient ask you questions.

14. Give consistent feedback and allow discussion of questions and answers. Don't make the patient feel that all you are doing is marking down the number of right and wrong answers.

15. Invite family members to join in, if the patient is willing and responds well to having observers in therapy, and let them ask and answer questions as well.

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Excellent and thoughtful suggestions for working with adult patients, especially when they are treated at a SNF or outpatient setting. Properly explaining the purpose of therapy and making tasks engaging and relevant to their life situation is especially important. For example, when working on memory tasks, I use the word "forgetfulness" instead of "memory" to explain the therapy because for most folks, "memories" are life events, but forgetting your keys, address or when to take medications are very concrete problems they can easily understand and be motivated to improve.

Evelyn Mariperisena-Meinert, AAC - SLP, Outpatient clinic May 9, 2014 9:02 AM
Pittsburgh PA

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