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How To Modify Speech Therapy Goals For Adults

You’ve done a thorough assessment and carefully crafted an excellent goal for your patient.

But a few treatment sessions in, you realize that the goal isn’t quite right anymore. Maybe it’s too hard. Maybe it’s too easy. Or maybe it’s just ‘off’ in some other way.

No sweat! In this post, you’ll learn how to modify speech therapy goals for adults, with plenty of examples. Plus, you’ll get a bonus Mini Goal Bank PDF!

For even more help writing excellent goals, download our free Mini Goal Bank PDF!
For evidence-based speech therapy materials, check out our bestselling Adult Speech Therapy Starter Pack!

More Help With Goals

When Should I Modify My Goal?

how to modify speech therapy goals for adults

There are many possible routes to consider when helping patients climb toward their goals.

Let’s say that your patient performs at goal level for 3 sessions in a row. First of all, congrats—you’re an awesome therapist! It’s time to progress the goal forward.

Or maybe they’re not making much progress, despite a solid effort. No worries, you’re still awesome. Let’s dial the goal back a bit.

Here are common signs that it may be time to modify your goal. Your patient is:

  • Meeting their goal!
  • Improving rapidly
  • Making very little to no change
  • Getting worse
  • Frustrated with or unmotivated by therapy

How To Modify Any Goal

adult speech therapy goals

Before deciding how to modify your goal, zoom out to view the Big Picture purpose of speech therapy treatment: To improve a patient’s safety, independence, and quality of life.

Given your patient’s unique wants and needs, ask yourself, “How can I best support my patient’s Big Picture?”

For example, your patient with dysphagia can only safely swallow pureed foods and has a goal to “eat regular textures”. But this goal isn’t working because she hates her dentures and hasn’t worn them for months, even before her stroke.

To keep her safe and respect her definition of a good quality of life (not wearing dentures!), you adjust her goal to “safely swallow mechanical soft textures”.

How To Modify Dysphagia Goals

how to modify adult speech therapy goals

Choose one aspect of your dysphagia goal to modify. Remember the Big Picture purpose of improving patient safety, independence, and quality of life.

Dysphagia Goal Example

Current goal: “The patient will safely consume 8 ounces sequential cup sips of thin liquids without overt s/sx of aspiration in 100% of opportunities given occasional verbal cues to utilize safe swallowing strategies.”

Let’s say that your patient is doing great and needs an upgrade! How could you upgrade this goal?

Although there are several aspects you could modify, you think Big Picture and decide to focus on increased independence by decreasing cues. An example upgraded goal is:

“The patient will safely consume 8 ounces sequential cup sips of thin liquids without overt s/sx of aspiration in 100% of opportunities given IND use of safe swallowing strategies.”

Or maybe your patient is not doing great with the goal and needs a change. How would you downgrade the goal?

Again, you think of the Big Picture purpose and decide to focus on safety and quality of life. An example downgraded goal is:

“The patient will safely consume 8 ounces single cup sips of thin liquids without overt s/sx of aspiration in 100% of opportunities given occasional verbal cues to utilize safe swallowing strategies.”

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory (diet modifications) vs restorative (exercises)
Diet textureRegular, easy-to-chew, soft & bite-sized, minced & moist, pureed
Amount of foodEntire meals, ounces, per item
InitiationHow and when you prompt them to initiate picking up food or chewing
Mastication timeWithin 60 seconds, within 30 seconds
Swallow timelinessWithin 15 seconds, within 10 seconds
Liquid texturesThin, slightly thick, mildly thick, moderately thick, extremely thick
Amount of liquidsOunces, sips, spoonfuls
PresentationSelf-fed, therapist-controlled (“SLP pinched straw”)
ExercisesMuscle groups (labial, lingual) and intensity (number of repetitions)
Safe swallowing strategiesBolus hold for discoordination, double swallows for laryngeal residue
PosturesChin tuck for penetration
Environmental Quiet environment, seated with other people
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)

How to Modify Memory Goals

memory goals for adult speech therapy

Choose one aspect of your memory goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

Memory Goal Example

Current goal: “The patient will listen to paragraph-level information and recall details at 90% accuracy given occasional repetition in order to increase auditory memory ability.”

Your patient is doing great and needs an upgrade.

An example upgraded goal is:

“The patient will listen to multiple paragraph-level information and recall details at 90% accuracy given occasional repetition in order to increase auditory memory ability.”

Or, your patient is struggling and needs a change. Once again, remember the Big Picture purpose of therapy. You decide to focus on independence.

A modified goal is:

“The patient will listen to paragraph-level information and recall details at 90% accuracy given occasional repetition and cues to write down keywords in order to increase auditory memory ability.”

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory (visual aid) vs restorative (task analysis)
Memory lengthRecall after 30 seconds, recall after 15 minutes
ModalityType of information to remember is verbal, visual, or written
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
ComplexityChange the challenge (remember 1-3 items vs paragraph level information)
Length & complexity Change the length and/or complexity of the task
Patient & caregiver educationProvide written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modificationsMinimize background noise

How To Modify Attention Goals

attention goals for adult speech therapy

Choose one aspect of your attention goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory vs restorative
Area of attentionSelective, sustained, alternating, divided
ComplexityAmount or type of information to attend to (short paragraph vs page-level)
Response timeAttends for 3 minutes vs 15 minutes
StrategiesFinger scan while reading, verbal rehearsing task
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationProvide a written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modificationsNoise-canceling headphones
ModalityType of information presented is verbal, visual, or written

How To Modify Problem Solving Goals

problem solving goals for adult speech therapy

Choose one aspect of your problem solving goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory vs restorative (metacognition techniques)
Complexity & lengthTask with 1-3 items, tasks with 5-7 items
Modality
Response timeFinish simple math problems within 30 seconds, fill pill box within 10 minutes
Exercises
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationProvide a written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modificationsNo speaking during task, gradually increased background noise during task

How To Modify Visual Neglect Goals

visual neglect goals for adult speech therapy

Choose one aspect of your visual neglect goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory (refer for prism lenses) vs restorative (scanning environment)
ComplexityType of information (large print, word-level, simple photo), how many times they attend to affected side
Response timeAttends to affected side 30 seconds, 10 minutes
Environmental modificationsDark mat on a light floor in doorways, post-its on left-side of computer
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Functionality of exercisesCancellation worksheets to teach scanning strategies, functional reading tasks
StrategiesRed anchor on affected side, lighthouse strategy
Patient & caregiver educationProvide a written copy of strategies used in-session & discuss ways to incorporate them into daily life

How To Modify Aphasia Goals

expressive aphasia goals for adult speech therapy

Choose one aspect of your aphasia goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

Aphasia Goal Example

Current goal: “The patient will write sentences in response to verbal prompts with 80% accuracy given minimal written cues to communicate effectively.”

Your patient is doing great and needs an upgrade! You consider the Big Picture purpose of aphasia therapy and decide to focus on independence.

An example upgraded goal is:

“The patient will write sentences in response to verbal prompts with 95% accuracy given minimal written cues to effectively communicate.”

Or, your patient is having a hard time and needs a change. Here’s an example downgraded goal:

“The patient will write sentences in response to verbal prompts with 80% accuracy given minimal written cues and minimal verbal cues to communicate effectively.”

WHAT TO MODIFYEXAMPLE
Treatment approachCompensatory (use opposite word), restorative (SPPA)
Language expression modalityTalking, writing, AAC
Language reception modalityListening, reading
Response timeResponds within 30 seconds, responds within 10 seconds
Length & complexitySingle letter, single word, longer words, phrases, sentences
EnvironmentFamiliar environment, unfamiliar, quiet, noisy
PartnerFamiliar, unfamiliar
Emotional contentNeutral, funny, slightly stressful
StrategiesWord-finding strategies, AAC
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationProvide a written copy of strategies used in-session & discuss ways to incorporate them into daily life

How To Modify Dysarthria Goals

dysarthria goals for adult speech therapy

Choose one aspect of your dysarthria goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLE
Treatment approachCompensatory (pacing board), restorative (LSVT)
Length & complexityMonosyllabic words, bisyllabic words, sentences, phrases
PresentationPresented verbally, written, modeled
TimeSustained sound for 5 seconds, 10 seconds
Intelligibility70%, 80%, 90%, 95% intelligible
Loudness35 dB, 75 dB
PartnerListen is familiar, unfamiliar
EnvironmentQuiet, some background noise, noisy, echoey
StrategiesTalk big, talk loud, talk short
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationProvide a written copy of listener tips & discuss ways to incorporate them into daily life

How To Modify Apraxia Goals

dysarthria goals for adult speech therapy

Choose one aspect of your apraxia goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

Apraxia Goal Example

Current goal: “The patient will produce /h/ initial syllables at 70% accuracy given moderate articulatory placement and moderate visual cues in order to increase the ability to communicate verbally.”

Your patient is doing great: time to upgrade! An example modified apraxia goal is:

“The patient will produce /h/ final syllables at 70% accuracy given moderate articulatory placement and moderate visual cues in order to increase the ability to communicate verbally.”

If your patient is struggling and needs a change, a new goal could be:

“The patient will produce /h/ initial syllables at 70% accuracy given maximal articulatory placement and maximal visual cues in order to increase the ability to communicate verbally.”

WHAT TO MODIFYEXAMPLES
Treatment approachCompensatory (needs board), restorative (sound production treatment)
LengthSingle syllables, monosyllabic words, bisyllabic words, phrases, sentences
Place of articulationBilabials, alveolars, palatals, length of syllables, automatic vs volitional speech
PositionInitial, final, medial target syllable/word
Presentation
Modality
Response typeAutomatic or volitional. Patient responds to a model or self-generates
Intelligibility70%, 80%, 90%, 95% intelligible
PartnerFamiliar, unfamiliar
EnvironmentQuiet, some background noise, noisy
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationProvide a written copy of listener tips & discuss ways to incorporate them into daily life

How To Modify Voice Goals

Choose one aspect of your voice goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFY
Treatment approachCompensatory (confidential voice to reduce vocal tension), restorative (massage)
SubsystemRespiration, phonation, articulation
Vocal qualityRoughness, breathiness, strain, pitch, loudness
Vocal pitch400 Hz, 350 Hz
Vocal loudness35 dB, 45 dB
Length & complexity Syllables, words, phrases, sentences, pages
Tense vs lax vowels
Environment Quiet, some background noise, noisey, echoey
Communication PartnerFamiliar, unfamiliar
StrategiesChant talk, yawn/sigh
CuesAmount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver educationContinually provide caregiver education, training, and support so that they can carry over strategies in daily life

How To Modify Resonance Goals

resonance goals for adult speech therapy

Choose one aspect of your resonance goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLES
ReferralsOtolaryngology, prostheses, pharmacy, audiology

How To Modify AAC Goals

aac goals for adult speech therapy

Choose one aspect of your AAC goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFYEXAMPLES
Alternative accessStylus, laser pointer, joysticks
Device typeNo-tech, low-tech, high-tech
SymbolsAlphabet, drawings, icons
DisplaySymbols size, symbol location, symbol color
Selection techniqueDirect (point), indirect (scanning until cursor selects intended symbol)

How To Modify Fluency Goals

fluency goals for adult speech therapy

Choose one aspect of your fluency goal to modify. Remember the BIG PICTURE purpose of improved patient safety, independence, and quality of life.

WHAT TO MODIFY
EnvironmentFamiliar or unfamiliar listener, group, mock scenarios
Speech modificationsReduced speech rate, easy onset
Stuttering modificationsCancellations, pull-outs
Address negative reactionsAvoidance reduction therapy, pseudostuttering, self-disclosure, mindfulness

Conclusion

It would be nice if our goals were on target every time, but the fact is that people are unpredictable!

Our patients will keep us on our toes—it’s normal.

Whenever you feel unsure about how to modify a goal—or with any decision you need to make for your patient—zoom out and ask yourself, “How can I improve my patient’s safety, independence, and quality of life?” then go from there!

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