More successful brain rehabilitation: turning therapy goals into real-life activities

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Studies indicate that patient participation in relevant and personal goal-setting can result in greater satisfaction with the brain rehabilitation experience, along with improved recovery. But how do you make sure the goals are functional—in other words, that they relate directly to real-life activities that patients need and want to do outside of the clinic? This blog post shows how to connect those dots, and illustrates its points with examples.

Setting recovery goals is a central tenet of patient-centered rehabilitation from stroke or TBI. At the start of therapy, patients and their healthcare professionals jointly decide on the outcomes they would like to achieve during the rehabilitation period.

In the past, rehab goal-setting was based on a purely medical model. Decision-making was unilaterally driven by clinicians. However, this approach led to misaligned expectations between patients and clinicians, and goals were often unmet.

To overcome these shortcomings of clinician-only goal-setting, it has shifted toward a patient-centered model. Doing so ensures the rehab plan takes into account the patient’s needs and expectations while still adhering to clinical standards.

Many benefits to setting patient-centered functional goals in rehabilitation
Setting real-life goals is useful to encourage maximum patient engagement in rehab. Goal-setting empowers patients and ensures that therapy is targeted to address their priorities and is relevant to their lives and circumstances. Goals also provide structure to the rehabilitation process, as they inform treatment team planning and communication about patient progress.

To be sure, patient-centered goal-setting can be challenging, as patients may have difficulty understanding their own level of impairment and opportunity for recovery, which often contributes to idealistic goals. This can be mitigated by using a SMART goal approach – setting goals that are Specific, Measurable, Achievable, Relevant, and Time-bound.

In addition, if a clinician believes a patient goal cannot be safely achieved during the time frame of rehabilitation, they can work with the patient to redirect the goal, or to break it down into smaller, more achievable components.

Measuring patient satisfaction with performance on goals correlates with goal achievement
Studies have found that measuring patients’ satisfaction in their performance of specific brain rehabilitation goals—both before beginning therapy and after therapy—is a good method of assessing patients’ perception of their own progress. Assessing patient satisfaction with their abilities has been found to strongly correlate with goal achievement, and is used as a measurement that can inform the value of health care.

How to set real-life brain rehabilitation goals
When setting appropriate and functional therapy goals, it is important to involve the patient (and their caregivers) at the very start of therapy. If patients have a hard time thinking in terms of recovery goals, the following questions can be good prompts:

What can’t you do since your injury that you want to get back to?
What are you finding more difficult since your injury that you’d like to be easier?
How will you know when you’re ready to stop coming to see me?

Patients may respond with brain rehabilitation goals that are very general, long-term or impairment-based, such as “improve my balance” or “be more social” or “go back to work.” The trick is to turn these into shorter-term, manageable components related to everyday activities.

A key component of SMART goals is to incorporate “I will” statements. They’re more empowering. For example, instead of “speak better,” a patient’s goal could be “I will speak to my daughter on the phone for 10 minutes.” Sub-components of that particular goal could include things like “I will say “Hi, how are you?” accurately four out of five times,” and “I will learn strategies for word-finding.”

8 examples of functional therapy goals, with tasks that can help
Below is a table with (1) examples of general cognitive, speech, or language brain rehabilitation goals, (2) ways to turn them into real-life goals, and (3) therapy tasks that might improve the chances of reaching the goal.

Of course, everyone’s injuries and interests are different, and goals must be appropriate and uniquely relevant for each patient. As well, this list is not meant to be exhaustive, but more of an example of some of the goals we’ve known patients to work toward. We hope it inspires more productive goal-setting conversations with your clients!

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