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!

More Help With Goals

• How to Write Excellent Speech Therapy Goals
• Goal Bank for Adult Speech Therapy (150 Goals!)

When Should I Modify My Goal?

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

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

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 MODIFY	EXAMPLES
Treatment approach	Compensatory (diet modifications) vs restorative (exercises)
Diet texture	Regular, easy-to-chew, soft & bite-sized, minced & moist, pureed
Amount of food	Entire meals, ounces, per item
Initiation	How and when you prompt them to initiate picking up food or chewing
Mastication time	Within 60 seconds, within 30 seconds
Swallow timeliness	Within 15 seconds, within 10 seconds
Liquid textures	Thin, slightly thick, mildly thick, moderately thick, extremely thick
Amount of liquids	Ounces, sips, spoonfuls
Presentation	Self-fed, therapist-controlled (“SLP pinched straw”)
Exercises	Muscle groups (labial, lingual) and intensity (number of repetitions)
Safe swallowing strategies	Bolus hold for discoordination, double swallows for laryngeal residue
Postures	Chin tuck for penetration
Environmental	Quiet environment, seated with other people
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)

How to Modify Memory Goals

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 MODIFY	EXAMPLES
Treatment approach	Compensatory (visual aid) vs restorative (task analysis)
Memory length	Recall after 30 seconds, recall after 15 minutes
Modality	Type of information to remember is verbal, visual, or written
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Complexity	Change the challenge (remember 1-3 items vs paragraph level information)
Length & complexity	Change the length and/or complexity of the task
Patient & caregiver education	Provide written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modifications	Minimize background noise

How To Modify Attention Goals

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 MODIFY	EXAMPLES
Treatment approach	Compensatory vs restorative
Area of attention	Selective, sustained, alternating, divided
Complexity	Amount or type of information to attend to (short paragraph vs page-level)
Response time	Attends for 3 minutes vs 15 minutes
Strategies	Finger scan while reading, verbal rehearsing task
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Provide a written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modifications	Noise-canceling headphones
Modality	Type of information presented is verbal, visual, or written

How To Modify Problem Solving Goals

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 MODIFY	EXAMPLES
Treatment approach	Compensatory vs restorative (metacognition techniques)
Complexity & length	Task with 1-3 items, tasks with 5-7 items
Modality
Response time	Finish simple math problems within 30 seconds, fill pill box within 10 minutes
Exercises
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Provide a written copy of strategies used in-session & discuss ways to incorporate them into daily life
Environmental modifications	No speaking during task, gradually increased background noise during task

How To Modify Visual Neglect Goals

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 MODIFY	EXAMPLES
Treatment approach	Compensatory (refer for prism lenses) vs restorative (scanning environment)
Complexity	Type of information (large print, word-level, simple photo), how many times they attend to affected side
Response time	Attends to affected side 30 seconds, 10 minutes
Environmental modifications	Dark mat on a light floor in doorways, post-its on left-side of computer
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Functionality of exercises	Cancellation worksheets to teach scanning strategies, functional reading tasks
Strategies	Red anchor on affected side, lighthouse strategy
Patient & caregiver education	Provide a written copy of strategies used in-session & discuss ways to incorporate them into daily life

How To Modify Aphasia Goals

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 MODIFY	EXAMPLE
Treatment approach	Compensatory (use opposite word), restorative (SPPA)
Language expression modality	Talking, writing, AAC
Language reception modality	Listening, reading
Response time	Responds within 30 seconds, responds within 10 seconds
Length & complexity	Single letter, single word, longer words, phrases, sentences
Environment	Familiar environment, unfamiliar, quiet, noisy
Partner	Familiar, unfamiliar
Emotional content	Neutral, funny, slightly stressful
Strategies	Word-finding strategies, AAC
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Provide a written copy of strategies used in-session & discuss ways to incorporate them into daily life

How To Modify Dysarthria Goals

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 MODIFY	EXAMPLE
Treatment approach	Compensatory (pacing board), restorative (LSVT)
Length & complexity	Monosyllabic words, bisyllabic words, sentences, phrases
Presentation	Presented verbally, written, modeled
Time	Sustained sound for 5 seconds, 10 seconds
Intelligibility	70%, 80%, 90%, 95% intelligible
Loudness	35 dB, 75 dB
Partner	Listen is familiar, unfamiliar
Environment	Quiet, some background noise, noisy, echoey
Strategies	Talk big, talk loud, talk short
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Provide a written copy of listener tips & discuss ways to incorporate them into daily life

How To Modify Apraxia Goals

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 MODIFY	EXAMPLES
Treatment approach	Compensatory (needs board), restorative (sound production treatment)
Length	Single syllables, monosyllabic words, bisyllabic words, phrases, sentences
Place of articulation	Bilabials, alveolars, palatals, length of syllables, automatic vs volitional speech
Position	Initial, final, medial target syllable/word
Presentation
Modality
Response type	Automatic or volitional. Patient responds to a model or self-generates
Intelligibility	70%, 80%, 90%, 95% intelligible
Partner	Familiar, unfamiliar
Environment	Quiet, some background noise, noisy
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Provide 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 approach	Compensatory (confidential voice to reduce vocal tension), restorative (massage)
Subsystem	Respiration, phonation, articulation
Vocal quality	Roughness, breathiness, strain, pitch, loudness
Vocal pitch	400 Hz, 350 Hz
Vocal loudness	35 dB, 45 dB
Length & complexity	Syllables, words, phrases, sentences, pages Tense vs lax vowels
Environment	Quiet, some background noise, noisey, echoey
Communication Partner	Familiar, unfamiliar
Strategies	Chant talk, yawn/sigh
Cues	Amount (min mod, max, dependent) or type (verbal, visual, written, tactile)
Patient & caregiver education	Continually provide caregiver education, training, and support so that they can carry over strategies in daily life

How To Modify Resonance Goals

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 MODIFY	EXAMPLES
Referrals	Otolaryngology, prostheses, pharmacy, audiology

How To Modify AAC Goals

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 MODIFY	EXAMPLES
Alternative access	Stylus, laser pointer, joysticks
Device type	No-tech, low-tech, high-tech
Symbols	Alphabet, drawings, icons
Display	Symbols size, symbol location, symbol color
Selection technique	Direct (point), indirect (scanning until cursor selects intended symbol)

How To Modify Fluency Goals

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
Environment	Familiar or unfamiliar listener, group, mock scenarios
Speech modifications	Reduced speech rate, easy onset
Stuttering modifications	Cancellations, pull-outs
Address negative reactions	Avoidance 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!

More Resources

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