So often after receiving a diagnosis like aphasia, brain injury, stroke, or dementia, the diagnosed persons and their families are overwhelmed by appointments. Here, we attempt to demystify your first appointment.
Stroke Treatment, Aphasia Treatment, and TBI Treatment – The First Steps
Although there is often variation across disciplines (occupational therapists, speech therapists, neurologists), first visits to begin therapy to will usually look pretty similar.
TIP: Remember, you are entering the office and care of someone experienced in working with cognitive and communication disorders. This is a safe space! They know things are hard for you right now, and are there to help you make this process as painless and positive as possible, and to get you on the road to rehabilitation.
Step 1: Make the appointment
- Getting started: Generally, you’ll need to call to make an appointment to meet with a clinician. If this is tough for you right now, try reaching out to family member to help out. Alternately, if the phone is really hard, you can always go into a clinic in person and talk with the receptionist (who usually is very used to talking with folks with communication difficulties).
- Getting a callback: Sometimes a clinician will call you back to get more information on your status. This helps them to assign you to the right therapist who can best help you, and to prepare for your assessment.
- Scheduling: Depending on the clinic, it may take a bit to get in to see a clinician. Some clinics have waiting lists, while others can see you fairly quickly.
- Timing: In most places, you can expect your first session to last at least an hour. This is because they need to get your history and assess your current cognitive and communication skills, in order to provide the a customized treatment plan.
Step 2: Send your information in ahead of time
- History Forms: Many clinicians will e-mail or mail you a history form to complete before you arrive. You may need to send this back before or bring it to your first visit.
- Additional Information: Some clinics also request that you send prior testing information along. That might include previous therapy for your disorder, or hospital records of the event that led to your disorder. If no one asks for this information, it’s best to bring it with you anyway! It will help your clinician to better understand your needs.
- What if I don’t feel like I can manage to get this information ready on my own? If you do not feel confident filling out a form, you have a few options. First, remember, clinicians understand this may be tough! Your best efforts will help them regardless, even if to show that filling out forms is a good skill to address in therapy! You can also ask a family member to help out. Or, you can tell the clinician or receptionist that you are not able to fill the form out – they won’t be upset! They'll go through the information with you when you arrive.
Step 3: Arriving at your first therapy appointment
- Who to bring: Often it's helpful to bring a family member along who is familiar with your history and current levels of functioning. We know it stinks to have someone to talk for you – and your goal in therapy will be to get you to a point of independence - but the clinician needs to get the most complete and accurate history upfront, and if you feel that you might need help with this, asking for help from family is a good strategy.
- Greetings: Just like most appointments, you’ll check in with the receptionist when you arrive. If there isn’t a receptionist around, don't worry. Some clinics are smaller and may not have a full-time receptionist – the clinician may just come out to get you when he or she is ready.
Step 4: The therapy facility or clinic
- Where it's located: A lot of clinics are in outpatient facilities within hospitals or medical complexes. Others may be in community centers, independent store fronts, or even home offices.
- Inside the clinic: Clinics vary a lot. Some feel a lot more medical than others. Usually there will be a table and chairs for you, the clinician, and anyone you’ve brought along.
Step 5: They'll start with your history
- Setting the stage: The first thing they'll ask is: “So what brings you here today?” This gives them an idea of your goals, a first take on your communication skills, and is needed to address. Try not to worry about how you are communicating. Wherever you are with your skills is where clincians will meet you.
- Learning about you: Next, they'll want to hear about your entire medical, educational, and social history. All of these facts will help them to target and individualize your therapy. Sometimes their questions will seem awkward, but the more information they have from you, the better therapy will be.
Step 6: Assessment
- Formal Assessment: First appointments usually include some form of formal assessment. This usually comes in the form of an assessment like the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, the Arizona Battery for Communication Disorders of Dementia, the Peabody Picture Vocabulary Test, the Expressive Vocabulary Test, or the Cognitive Linguistic Quick Test.
- Oral Evaluation: You may also have an oral mechanism evaluation. With this assessment, clinicians are trying to assess your articulators (the parts of your mouth that make speech sounds and help with swallowing). They’ll take a look in your mouth, have you move your tongue, jaw, and lips, and test your strength and range of motion.
- Other Possible Assessments: Depending on your individual needs, they may also check out the following communication systems with either informal observation or formal assessment:
- Speech – are there any difficulties on certain speech sounds or patterns?
- Voice – is your voice on the quiet side? Raspy? Gravely? Wavering?
- Fluency – is there any stuttering? Hesitations?
- Pragmatics – how are you doing with social interaction?
- Swallowing – This isn’t really communication, but is in the scope of practice for an Speech-Language Pathologist, and can be life threatening, so they will check for this. Are there any signs of difficulties with swallowing? If yes, they may have you try a variety of different foods and liquids to see if you have trouble, and they’ll feel your throat while you swallow to get a feel for whether the cartilage and bone beneath is moving properly.
Step 7: Wrapping up the appointment
- Your turn to ask questions: At the end of the appointment, you’ll often be asked if you have any questions, or if you have any specific goals you want to work on in therapy. Don’t be afraid to self-advocate and ask about what’s worrying you, or to say exactly what you want from therapy. You are the star of this show; the therapy is about your needs and goals!
- Explaining findings: Sometimes you’ll get an overview of findings right there on the day of the evaluations. That may not always happen though. Not to worry, that just means the clinician is not done assessing and may have a few more things to check, or that wants to organize their thoughts before presenting everything to you.
Step 8: Follow up after the appointment
- Reports: Usually you’ll receive a typed report of what was found. Generally there will be goals written out based on your current level of communication and cognitive needs.
- Goals: If you’re worried that the goals seem to easy or too hard, don’t worry - sometimes clinicians don’t write in all of the steps leading up to a goal, and are constantly re-evaluating and adjusting goals as needed for patients. They may not list ultimate goals at first, either – sometimes clinicians will list first step goals with the plan to re-evaluate after 6 months or a year to update goals and to increase the challenge.
- Starting Therapy: In the evaluation report, we’ll usually suggest a frequency and length of therapy – basically how often should you come and how long should your sessions be.
- Future Appointments: Finally, they’ll set up therapy appointments with you. Now the real work of recovery can begin! (And it might involve customized Constant Therapy tasks, too!)