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The myth of a plateau in aphasia

Has your loved one been discharged from therapy because they’d ‘reached a plateau’?

I’m betting that almost everyone was told at some point that your loved one was done with treatment. Sometimes this comes on suddenly, as in “he’s being discharged in 3 days”. You thought everything was going well, and now you learn that wasn’t the case.

A ‘plateau’ is supposed to mean that the patient’s performance has stopped at a certain point. You may be told that there’s nothing more to be done. Sometimes the therapist uses those exact words–”You aren’t going to get any better than this”.

The primary force is the insurance company, because the facility needs to get paid. The insurance company will only authorize so many visits for therapy. You can fight for more visits, and sometimes you may get them. However, your therapist must show that you are making progress in therapy.

Progress is all about how the goals are written. It’s also about the approaches your therapist takes in rehabilitating speech and language. There may also be other factors, such as swallowing, that take priority.

The speech therapist is 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. However, most therapists don’t get extensive training in aphasia, so they only know what they were taught in school. Once that’s exhausted, they don’t know what to do next. They have to treat a LOT of different disorders, not just aphasia, so they need to know a little bit about everything.

Most therapy that people have received before they come to the Intensive Center consisted of worksheets, naming pictures, and matching things. Almost all therapy was a ‘testing’ situation, not a ‘teaching/learning’ session using multiple modality approaches to enhance retrieval.

If I have a client name 10 photos each day, I’ll end up with a percentage correct. But if I don’t do something to help that person learn in a way that works for them, I’m not going to get a change in that percentage. Then the patient with aphasia will have “plateaued”.

At the Aphasia Center, we 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 right away, then I change what I’m doing. The “bag of tricks” is endless.

However, if I don’t support the client’s personal aphasia, then there will be a point at which it stops. If I then say that “you can’t go any further”, then it puts the responsibility on you. It must be your fault. BUT, if I change the way I do the treatment, then we can find the keys to unlock the client’s specific way to make learning and retrieval easier.

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 exactly what that means. Are they saying that without 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. There is always hope.


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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.