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
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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