“But What If My Patient Has Poor Insight?”
It isn’t uncommon for individuals with neurological changes to have reduced insight into their deficits. By this, I mean trouble identifying their weaker areas, not being able to tell when they are doing a poor job, or even having trouble relaying to rehab therapists what areas they want to improve in.
Speech Language Pathologists have a few different options when they encounter a patient with reduced insight into their deficits on their caseload. Let’s explore them!
1. You could administer a patient reported outcome measure (PROM). Sometimes, a PROM can prime a patient to think of problem areas that they spontaneously think of on their own. Never underestimate the power of a good PROM. To learn more about PROMs, read my blog entitled “What Are PROMs and Why Do SLPs Need Them”.
2. You could ask the patient’s family/caregivers or other members of your rehab team what challenges they are noticing. This makes for great interdisciplinary care, especially since others may see patients performing different tasks than you ever do.
3. You could provide a list of skills that you and the patient could target together and have them circle their choices. Again, this is to help prime the patient and take the pressure off the patient from thinking of things on their own.
4. You could pick a few tasks from the patient’s daily life, simulate them, and then assess how well the patient performs during the task. This will provide great information on what skills need improvement or not. To learn different assess a patient's performance with a task, read my blog entitled "Different Ways to Monitor Progress in Speech Therapy".
5. You could have the patient track their own data during a task. Doing so could allow them to see any discrepancies between how they “thought” their performance was and how it actually is. This may be the first time the patient sees they need help in a particular area so be sure to be compassionate.
Those were my 5 tips for addressing reduced insight in patients. I hope they were helpful! Let me know in the comments any other tips you might add.
As always, have some great therapy sessions!
-Dana (The Neuro SLP
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