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.
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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)
| 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
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
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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