How To Generate A Prognosis

When generating a prognosis, it’s best to zoom out. You just gathered a lot of information about your patient, and it’s time to see the big picture.

Below is a step-by-step guide to generating a prognosis. Keep scrolling for details on how to do each step.

Determine their prior level of function
Determine their current level of function
Determine the onset of their diagnosis
Determine comorbidities (how many + severity)
Determine family/caregiver support
Determine awareness of deficits/insight
Factor in age
Choose a prognosis!

The Levels of Prognosis

You can typically break down prognosis into four levels:

LEVELS OF PROGNOSIS	What you expect:
Excellent	Fast progress. Most to all goals are likely to be met. Patients will return to an independent level with their goals. Patient will return to nearly PLOF
Good	Steady progress. Most to all goals are likely to be met
Fair	Minimal-some progress. No to few goals are likely to be met
Poor	No to minimal progress to be made. Goals likely will not be met unless they’re compensatory strategies or patient/caregiver/family education

1. Determine Prior Level of Function (PLOF)

generate a prognosis adult speech therapy

PLOF	Your patient was:
Excellent	Previously independent with all ADLs; was on a regular diet with thin liquids; and/or had no history of a communication, voice, motor-speech, and/or cognitive-communication deficits
Good	Nearly independent with most ADLs; and/or has only mild previous deficits affecting their communication and/or cognition
Fair	Previously on a modified diet with thickened liquids with chronic dysphagia; and/or has chronic aphasia, dysarthria, or apraxia of speech that impacts their communication daily; has a history of mild-moderate cognitive deficits
Poor	Has a feeding tube with chronic and severe dysphagia despite a history of extensive speech therapy; has ALS; and/or has an advance/end-stage progressive neurological disease

2. Determine Current Level of Function (CLOF)

CLOF	Your patient:
Excellent	Demonstrates minimal/mild deficits due to a CVA, TBI, or early-onset progressive neurological disease, highly stimulable to techniques and strategies
Good	Demonstrates mild-moderate deficits due to a CVA, TBI, or early to mid-onset progressive neurological disease, somewhat stimulable to techniques and strategies
Fair	Demonstrates moderate-severe deficits due to a CVA, TBI, or later-stage onset progressive neurological disease, minimally stimulable to techniques and strategies
Poor	Demonstrates severe-profound deficits due to a large CVA, TBI, or end-stage onset progressive neurological disease (such as ALS or end-stage dementia), not stimulable

3. Determine Onset of Diagnosis

Dx ONSET	How long ago was your patient’s onset?
Excellent	Very acute onset (often within 3 months of diagnosis). Time-frame depends on the diagnosis
Good	Acute to subacute onset of diagnosis (often within 3-12 months of diagnosis). Time-frame depends on the diagnosis
Fair	Subacute to chronic diagnosis (typically 1+ year of longer). Time-frame depends on the diagnosis
Poor	Depends on the diagnosis. Some patients with ALS deteriorate rapidly and are unable to speak or walk within 6-12 months

4. Determine Comorbidities

COMORBIDITIES	Your patient:
Excellent	Has no progressive diseases/diagnoses and/or minimal to only a few comorbidities that don’t affect their overall functioning
Good	Has an early-onset progressive disease/diagnosis and/or few to several comorbidities that somewhat impact their overall functioning
Fair	Has multiple comorbidities that greatly impact their overall functioning
Poor	Has a significant amount of comorbidities that are detrimental to their functioning and will impede any progress

5. Determine Family/Caregiver Support

caregiver support prognosis speech therapy

Little support typically means a worse prognosis for our patients.

However, there are cases where a patient doesn’t have a support system yet their prognosis is good or even excellent. These patients must:

Be cognitively intact
Independently complete their speech therapy and home exercise program and follow recommendations consistently

FAMILY/CAREGIVER SUPPORT	Your patient:
Excellent	Has strongly supportive family/caregivers that are highly involved, receptive to information received, and/or consistent with carryover of recommendations
Good	Has supportive family/caregivers that are involved, receptive to information received, and/or fairly consistent with carryover of recommendations
Fair	Has minimal support. Limited family/caregivers involved who are sometimes receptive to information received and/or inconsistently carry over recommendations
Poor	Has no support. If anyone is involved, they are not receptive to information, non-compliant, and/or do not carry over any recommendations

6. Determine Awareness of Deficits

AWARENESS OF DEFICIT	Your patient is/has:
Excellent	Very aware of their deficits and highly motivated to improve
Good	Aware of their deficits and motivated to improve
Fair	Some awareness of their deficits, but it may be limited. Variable motivation
Poor	No awareness or insight into their deficits due to the presence of severe cognitive deficits

7. Consider Age

how does age impact prognosis speech therapy

While age is a factor when generating a prognosis, its impact is not always linear.

Yes, geriatric patients in their 90’s will likely demonstrate slower progress than younger patients. But some geriatric patients will make good progress in speech therapy—as long as their goals are functional and obtainable, given their age.

Remember that, to an extent, age is just a number! Zoom out and look at the bigger picture when deciding how your patient’s age impacts their prognosis.

8. Choose A Prognosis

Take a look at how your patient “scored” on the factors above. Then generate a prognosis based on these scores.

Landing on a prognosis is not an exact science. You only have a finite amount of time and information about your patient.

Trust your gut and training, make your best guess, then call that your prognosis!

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