How To Generate A Prognosis

You’ve assessed your patient and determined they’re appropriate for treatment. Now it’s time to come up with a prognosis!

To do this, you must answer one important question: How likely is your patient to make good (or not-so-good) progress throughout the course of treatment?

In this post, you’ll learn how to generate a prognosis for adult speech therapy patients. You’ll find our step-by-step process for wading through all of the information—to help you settle on a prognosis you can feel confident about.

For ready-made speech therapy materials, check out The Adult Speech Therapy Starter Pack!

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How To Generate A Prognosis

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.

  1. Determine their prior level of function
  2. Determine their current level of function
  3. Determine the onset of their diagnosis
  4. Determine comorbidities (how many + severity)
  5. Determine family/caregiver support
  6. Determine awareness of deficits/insight
  7. Factor in age
  8. Choose a prognosis!

The Levels of Prognosis

generate speech therapy prognosis

You can typically break down prognosis into four levels:

ExcellentFast 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
GoodSteady progress. Most to all goals are likely to be met
FairMinimal-some progress. No to few goals are likely to be met
PoorNo 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:
ExcellentPreviously 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
GoodNearly independent with most ADLs; and/or has only mild previous deficits affecting their communication and/or cognition
FairPreviously 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
PoorHas 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)

CLOFYour patient:
ExcellentDemonstrates minimal/mild deficits due to a CVA, TBI, or early-onset progressive neurological disease, highly stimulable to techniques and strategies
GoodDemonstrates mild-moderate deficits due to a CVA, TBI, or early to mid-onset progressive neurological disease, somewhat stimulable to techniques and strategies
FairDemonstrates moderate-severe deficits due to a CVA, TBI, or later-stage onset progressive neurological disease, minimally stimulable to techniques and strategies
PoorDemonstrates 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

onset of diagnosis speech therapy
Dx ONSETHow long ago was your patient’s onset?
ExcellentVery acute onset (often within 3 months of diagnosis). Time-frame depends on the diagnosis
GoodAcute to subacute onset of diagnosis (often within 3-12 months of diagnosis). Time-frame depends on the diagnosis
FairSubacute to chronic diagnosis (typically 1+ year of longer). Time-frame depends on the diagnosis
PoorDepends on the diagnosis. Some patients with ALS deteriorate rapidly and are unable to speak or walk within 6-12 months

4. Determine Comorbidities

comorbidities prognosis speech therapy
ExcellentHas no progressive diseases/diagnoses and/or minimal to only a few comorbidities that don’t affect their overall functioning
GoodHas an early-onset progressive disease/diagnosis and/or few to several comorbidities that somewhat impact their overall functioning
FairHas multiple comorbidities that greatly impact their overall functioning
PoorHas 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
ExcellentHas strongly supportive family/caregivers that are highly involved, receptive to information received, and/or consistent with carryover of recommendations
GoodHas supportive family/caregivers that are involved, receptive to information received, and/or fairly consistent with carryover of recommendations
FairHas minimal support. Limited family/caregivers involved who are sometimes receptive to information received and/or inconsistently carry over recommendations
PoorHas 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

speech therapy prognosis
AWARENESS OF DEFICITYour patient is/has:
ExcellentVery aware of their deficits and highly motivated to improve
GoodAware of their deficits and motivated to improve
FairSome awareness of their deficits, but it may be limited. Variable motivation
PoorNo 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

choose a speech therapy 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!

More Resources for New SLPs

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