Why The Aphasia Plateau is a Myth

I’d like to address the concept of the ever-dreaded “plateau”. I’m betting that almost each and every one of you were told at some point that your loved one with aphasia was done with treatment. The reason for this was because they had reached a “plateau”. This is supposed to mean that the patient is as good as they can get right now–there’s nothing more to be done.

There are a few reasons why this type of thing happens.

The primary force is the insurance company, because the facility or therapist needs to get paid to see you. The insurance company will authorize so many visits for therapy, and then that’s it. You can fight for more visits, and sometimes you may get them. However, your therapist must be on board with this by showing your progress in therapy.

Progress is all about how the goals are written. It can be a fine line to juggle to document the therapy so that the client looks bad enough to need more therapy, but good enough to show that progress is being made.

The speech therapist is the second force for therapy discharge. Your therapist may have run out of ideas or ways to help you. They are bound by hospital rules, insurance rules, and ethics rules. An easy way to change the “plateau effect” is to change the goals or the way those treatments are administered. I’ve unfortunately run into therapists who not only discharged due to this plateau, but also said the client didn’t need more skilled speech therapy. This client was 28 year-old and could only say two words. This alleged plateau is a myth perpetuated by insurance and people who don’t know what else to do.

I have always practiced therapy that is designed specifically for each individual. In the course of working with a client, if I’m using a certain approach that isn’t catching on after a few sessions, then I need to change what I’m doing. My “bag of tricks” is endless. However, if I ignore the fact that what I’m doing doesn’t fit the person’s aphasia, then of course there would be a point at which it stops. If I then say that you “can’t go any further, it puts the responsibility on you. Just so you know, it’s not your responsibility to know how to do aphasia therapy. BUT, if I change the way I do the treatment, then we can find the keys to unlocking the client’s style of learning.

Don’t accept that your loved one has reached a “plateau”. If someone tells you “Maybe we can re-assess you in a month or so if you’ve made progress”, then ask that professional what that means. Is the thought that if the client doesn’t have therapy for a month that they will just get better by doing nothing? That doesn’t make any sense. If you can get better all by yourself, then why are you coming to therapy?

You can continue to make progress and continue learning years after your stroke. Don’t stop trying and get advice from as many professionals and support groups as you can. If you meet a roadblock with one therapist or company, find another one.

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About Dr. Bartels

Dr. Bartels is the owner of The Aphasia Center Intensive Aphasia Programs. She helps families with aphasia through communication training, personalized treatment plans and customized home programs.