I’ve enjoyed hearing feedback from you all about short term goals and how they work for you. Many of you are more specific in creation, but are focused on the same end goal. If you have no idea what I’m talking about, check out Part I of this series about Short Term voice rehabilitation goals.
Let’s get to chatting about goals for the Long Term. Perhaps you are a speech-language pathologist who has abandoned some goals in the Short Term that were no longer appropriate for your patient. Maybe your patient has met all the Short Term goals and has a dramatically improved quality of life. This may be the perfect time to complete final acoustic measures, possibly a re-videostroboscopy, and a Vocal Handicap Index.
Goals are a guide, they should be personalized for each patient and each plan of care, but here are some examples:
Long Term
(1) Patient will demonstrate voice production abilities which meet the needs for activities of daily living while maintaining health of true vocal folds within 12 weeks as evidenced by patient report and SLP observations. (I have 12 weeks, because I always guess that 9-12 weeks is long enough for a patient to come to 4-6 sessions, with illness, no-shows and cancellations. Is your patient able to talk for work? Is the fatigue or throat pain lowered or eradicated completely?)
(2) Patient will decrease or eliminate pathology while improving overall health of true vocal folds by eliminating vocal misuse within 12 weeks as evidenced by patient report and SLP observations. (This can be a goal, but it’s not always going to result in an improved vocal quality or less pain when vocalizing. Many voice users have pathologies on their vocal cords, and have no issues. They can even learn to manage the pathology by not aggravating it, and avoid surgery this way. Consider if elimination is TRULY the goal by discussing with the patient. You might be surprised that they really want to either sound better or feel better, and aren’t as worried about the vocal cords looking normal.)
(3) Patient will maximize efficiency of the vocal mechanism relative to existing laryngeal disorder through coordinating subsystems of voice within 12 weeks as evidenced by patient report and SLP observations. (This is an expansion of STG #5, and this target voice should be present across your patient’s speaking or singing patterns. Sometimes you improve efficiency of vocal subsystems and there is an improvement not only in voice qualitiy but also pain, AND you get lucky and the excrescence goes away with voice rehabilitation alone!)
(4) Patient will achieve improved/normal voice assessed with perceptual scales, acoustic and/or aerodynamic measures within 12 weeks. (We have to be careful when using the word “normal” because there are norms, but one deviation might not represent the whole person across all voice contexts. Using the Patient Reported Outcome Measures (PROMs) like the Vocal Handicap Index (VHI), and Objective acoustic data like the Acoustic Voice Quality Index (AVQI) & Cepstral Peak Prominence, and perceptual rating systems like CAPE-V, you can track progress for your patient and also help back up your data for insurance reimbursement. I mean, who doesn’t like to see tangible progress that is quantitative? By the way, Cepstral Peak Prominence (CPP) is considered the most sensitive and robust way of determining severity of a dysphonia….that’s right, more than Jitter…more than Shimmer……)
(5) Patient will return to vocal activities of daily living with reduction and/or elimination of complaints regarding vocal production within 12 weeks as evidenced by patient report and SLP observations. (Your patient sometimes will come in and meet this goal, without having met all the short term goals, and you have no choice but to say hooray for you, and you never see that person again. It know it’s hard, since you didn’t finish your plan of care as you initially indicated, but this was the outcome we were looking for! The patient is happy, you shouldn’t just keep them on case-load to fill time slots.)
(6) Patient will acquire vocalization skills to meet personal and professional needs while maintaining and improving health of true vocal folds as evidenced by patient report, as measured by improvement in acoustic measures, and as assessed through videostroboscopy and through perceptual analysis. (You may delete this or combine it with #5, but it could stand on its own as well. Patient report and your skilled clinical assessment are both important factors here.)
Feel free to add your own modifications to these goal examples, especially if you are making goals patient-centered. Remember to be sensitive to your patients and consult with them when making goals, because it’s not up to you to decide what they MUST do, you’re a clinical expert and a consultant meant to guide.
I have a few sample evaluation templates within these products as well:
- Voice & Upper Airway Disorders Assessment Guide (Adult) (Includes samples of behavioral, acoustic and aerodynamic assessment of voice, chronic cough assessment guide, Inducible laryngeal obstruction (ILO) assessment guide and multiple report examples)
- Voice in a Jiff+: Hospital, Clinic or SNF (Instantly downloadable manual and videos to help assess and treat adult voice disorders)
- Guide for Pediatric Voice Assessment (includes video modeling for evaluation, as well as cards to allow the child more control & autonomy during the assessment.)
- Voice in a Jiff: Pediatric Edition (Instantly downloadable manual and videos to help assess and treat pediatric voice disorders)
- Spasmodic Dysphonia Voice Evaluation Guide (A differential diagnosis tool in English and Spanish for determining if it’s SD, muscle tension dysphonia, or tremor)
**This Blog was originally published in 2017. It has been updated as of Tuesday March 5, 2024.
About the Author: Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She evaluates and rehabilitates voice, upper airway disorders and swallowing at her private practice, ATEMPO Voice Center, and lectures on voice science internationally. She is a classically trained mezzo soprano with a minor in vocal performance from Texas Christian University. She has collaborated on and authored multiple peer reviewed published research articles about her community-based voice specialty clinic. She continues to develop a line of instantly downloadable voice assessment and voice therapy materials on TPT or her ATEMPO voice center website. Follow her on Pinterest, on Instagram or like her on Facebook.
