Comprehensive Speech-Language Pathology Clinical Goal Templates

Dysphagia Long-Term Goals

Safe and Efficient Swallow Function: The client will maintain adequate hydration/nutrition with optimum safety and efficiency of swallowing function on P.O. intake without overt signs and symptoms (s/s) of aspiration for the highest appropriate diet level.
Compensatory Strategy Utilization: The client will utilize compensatory strategies with optimum safety and efficiency of swallowing function on P.O. intake without overt signs and symptoms of aspiration for the highest appropriate diet level.

Dysphagia Short-Term Goals - Swallowing

Mastication: The patient will masticate food adequately to safely consume a specific diet level (e.g., regular, mechanical soft, pureed, etc.) with a specific percentage ( $%$ ) of verbal, visual, and tactile cues.
Jaw Coordination and Sensation for Pocketing: The patient will complete daily oral-motor exercises to increase buccal tension to within functional limits to eliminate pocketing of food in the anterior and lateral sulci with a specific percentage ( $%$ ) of verbal, visual, and tactile cues and a specific percentage ( $%$ ) of effectiveness.
Jaw Coordination and Sensation for Anterior Loss: The patient will complete daily oral-motor exercises to improve jaw closure and reduce anterior loss to keep food/liquid in the mouth while eating with a specific percentage ( $%$ ) of verbal, visual, and tactile cues and a specific percentage ( $%$ ) of effectiveness.
Oral Coordination and Sensation for Bolus Formation: The patient will complete daily oral-motor exercises to increase oral sensitivity to a functional level for bolus formation and optimum safety with a specific percentage ( $%$ ) of verbal, tactile, and visual cues and a specific percentage ( $%$ ) of effectiveness.
Oral Coordination and Sensation for Swallow Delay: The patient will demonstrate a swallow delay of only $1-2$ seconds following thermal gustatory stimulation on $10/10$ therapeutic trials to reduce the risk of food residue falling into the airway.
Lip Coordination and Sensation: The patient will complete daily oral-motor exercises to increase labial function with a specific percentage ( $%$ ) of verbal, tactile, and visual cues and a specific percentage ( $%$ ) of effectiveness to prevent food or liquid spillage from the oral cavity.
Lingual Coordination and Sensation for Range of Motion (ROM): The patient will complete daily oral-motor exercises to increase lingual range of motion, strength, and coordination with a specific percentage ( $%$ ) of verbal, tactile, and visual cues and a specific percentage ( $%$ ) of effectiveness for effective bolus formation and to reduce the risk of food residue falling into the airway.
Lingual Coordination and Sensation for Lingual Elevation: The patient will complete daily oral-motor exercises to increase lingual strength and range of motion for adequate lingual elevation and anterior to posterior movement with a specific percentage ( $%$ ) of verbal, tactile, and visual cues and a specific percentage ( $%$ ) of effectiveness to reduce the risk of food residue falling into the airway.
Diet Upgrade Trials: The patient will demonstrate diet upgrade trials without signs and/or symptoms of aspiration with $10/10$ trials.

Swallowing Techniques and Compensatory Strategies

Specific Swallowing Techniques: The patient will demonstrate adequate use of a specific technique (e.g., supraglottic swallow, Mendelson maneuver, effortful swallow, etc.) to eliminate s/s of laryngeal penetration and/or aspiration of a specific diet (pureed, mechanical soft, etc.) or specific liquids with a specific percentage ( $%$ ) of verbal cues during $80\%$ ( $8$ out of $10$ swallows) of therapeutic trials.
Swallow Initiation: The patient will demonstrate a swallow delay of only $1-2$ seconds following thermal tactile stimulation on $10/10$ therapeutic trials to decrease aspiration risk.
Compensatory Strategy Application: The patient will demonstrate adequate use of the following compensatory strategies (chin tuck, multiple swallows, head turn, etc.) to eliminate s/s of laryngeal penetration and/or aspiration of a specific diet (pureed, mechanical soft, etc.) or specific liquids with a specific percentage ( $%$ ) of verbal cues during $80\%$ ( $8$ out of $10$ swallows) of therapeutic trials.
Self-Monitoring: The client will demonstrate the ability to adequately self-monitor swallowing skills and perform appropriate compensatory techniques to reduce s/s of aspiration.
Liquid-Solid Alternation: The patient will alternate liquids-solids bites to clear stasis through the buccal cavity of residue with a specific percentage ( $%$ ) of visual, verbal, and tactile cues.

Language, Cognition, TBI, and Dementia: Long-Term Goals

Functional Cognitive-Linguistic Skills: The client will develop functional, cognitive-linguistic-based skills and utilize compensatory strategies to communicate wants and needs effectively, maintain safety during Activities of Daily Living (ADLs), and participate socially in a functional living environment.
Memory and Spaced Retrieval: The client will use appropriate memory strategies to schedule and recall weekly activities, express needs, and recall names to maintain safety and participate socially in a functional living environment.
Expressive Language Proficiency: The client will develop functional, cognitive-linguistic-based skills and utilize compensatory strategies to communicate wants and needs effectively to different conversational partners, maintain safety, and participate socially in a functional living environment.
Right Hemisphere CVA Specific: The client will recall and demonstrate use of compensatory strategies for L-side neglect to improve reading and writing skills in functional activities.
Traumatic Brain Injury (TBI) Specific: The client will learn and recall strategies to compensate for frontal lobe deficits to improve the ability to participate in daily tasks and participate appropriately in conversation.
Dementia-Specific Cognitive Goals: The client will develop functional, cognitive-linguistic-based skills and utilize compensatory strategies to communicate wants and needs effectively, maintain safety during ADL’s, and participate socially in a functional living environment.

Orientation, Attention, and Sequencing STGs

Orientation via External Aids: The client will use external memory aids and compensatory strategies to recall routine, personal information, and recent events to improve orientation to time and recall daily events with a specific percentage ( $%$ ) of accuracy and specific cues.
Orientation via Mental Awareness: The client will improve orientation by communicating mental awareness of daily routines, personal information, and recent events with a specific percentage ( $%$ ) of accuracy and specific cues.
Attention Task Performance: The patient will complete a specific attention task (sustained, selective, alternating, or divided) with no more than $X$ number of redirections when given minimal cues (verbal, visual, or tactile) with a specific percentage ( $%$ ) of accuracy.
Attention Persistence within Session: The patient will demonstrate adequate attention to therapy tasks with no more than a specific number of redirections in a $45-60$ minute session when given minimal cues with a specific percentage ( $%$ ) of accuracy.
Attention Duration: The patient will attend to therapy tasks for $X$ number of minutes when given no more than $X$ number of redirections with a specific percentage ( $%$ ) of accuracy.
Sequencing of Daily Tasks: The patient will verbally communicate sequences/steps and perform multi-level daily living tasks with a specific percentage ( $%$ ) of verbal, visual, and tactile cues in order to complete activities of daily living.

Auditory Comprehension and Problem Solving

Question Comprehension: The patient will demonstrate the ability to comprehend utilizing verbal presentation of specific questions (simple/complex…close-ended, open-ended) with a specific percentage ( $%$ ) of verbal, visual, and tactile cues in a functional living environment.
Gestural Expression: The patient will gesture appropriate use of functional items with a specific percentage ( $%$ ) of visual, verbal, and tactile cues in order to increase gestural expression of wants and needs in a functional living environment.
Following Multi-Step Directions: The patient will demonstrate the ability to follow multi-step directions related to the functional living environment with a specific percentage ( $%$ ) of verbal, visual, and tactile cues in order to increase functional integration into the environment.
Functional Problem Solving and Safety: The patient will demonstrate functional problem solving and safety awareness with a specific percentage ( $%$ ) of verbal, tactile, and visual cues for daily living tasks in order to increase safe interaction with the environment and decreased assistance from caregivers.
Reasoning Tasks: The client will complete simple/complex reasoning tasks to improve problem-solving and safety awareness with a specific percentage ( $%$ ) of accuracy and specific cues.
Convergent Categorization: The client will complete convergent categorization tasks with a specific percentage ( $%$ ) of accuracy and a specific percentage ( $%$ ) of cues.

Memory and Spaced Retrieval STGs

Recall of Functional Information: The patient will demonstrate recall of functional information following a delay (immediate, short-term, or long-term) with specific cues in order to increase functional integration into the environment.
Planning and Scheduling: The patient will demonstrate the ability to plan, schedule, and follow through with events/activities with a specific percentage ( $%$ ) of accuracy and specific cues.
Mental Manipulation: The patient will complete a mental manipulation task with a specific percentage ( $%$ ) of accuracy and a specific level of cueing in order to increase functional integration into the environment.

Reading Comprehension and Written Expression

Reading Fact Recall: The patient will recall a specific number of facts from a specific length of material (sentence, paragraph, several paragraphs, or page) with a specific percentage ( $%$ ) of accuracy and specific cueing.
Written Script Following: The client will demonstrate the ability to follow a written script to complete functional tasks with $80\%$ accuracy.
Response to Visual Cues for Sequencing: The client will respond to visual cues in order to improve sequencing to complete daily tasks and recall directions with $80\%$ accuracy.
Compensating for Visual Deficits: The client will recall and demonstrate a strategy of responding to visual cues to improve reading skills and compensate for visual deficits during activities with $80\%$ accuracy.
Word/Letter Identification: The client will identify words or letters with a specific percentage ( $%$ ) of accuracy and specific cues.
Matching: The client will match items (word to word, picture to word) with a specific percentage ( $%$ ) of accuracy and specific cues.
Tracing: The client will trace shapes, numbers, and letters with $80\%$ accuracy.
Generating Personal Information: The client will generate name, address, and phone number in writing with $80\%$ accuracy.
Writing Task Steps: The client will write steps to complete a given task with $80\%$ accuracy.
List Writing: The client will legibly/completely write lists (grocery, to-do, etc.) with $80\%$ accuracy.
Correspondence: The client will write a letter and address an envelope to a given person with $80\%$ accuracy.
Functional Sentence Writing: The client will demonstrate functional writing skills at the sentence level using compensatory strategies to complete daily activities during $80\%$ of trials.

Expressive Language and Conversation STGs

Naming: The patient will name objects, pictures, people, and/or activities verbally with a specific percentage ( $%$ ) of verbal, tactile, and visual cues to improve verbalizations.
Sentence/Phrase Completion: The patient will perform sentence/phrase completion tasks related to ADLs and safety verbally with a specific percentage ( $%$ ) of visual, tactile, and verbal cues to increase automatic verbalizations in the functional living environment.
Sentence Formulation: The client will formulate sentences with given words related to personal needs, ADLs, and safety with a specific percentage ( $%$ ) of effectiveness.
Conversation Initiation and Maintenance: The client will initiate and maintain $1-3$ conversational exchanges related to personal needs with one other familiar listener with $80\%$ accuracy.
Short Phrase/Sentence Memory Communication: The patient will use short phrases or $3-4$ sentences to communicate memories of familiar objects and past experiences with $60\%$ effectiveness ( $6$ of $10$ ).
Verbal Utterances in Response to Props: The resident will make $10$ appropriate verbal utterances during a $15$ -minute conversation in response to props and minimal verbal cues by caregivers to reduce social isolation.
Identifying Non-Verbal Cues: The client will correctly identify and match facial expressions and body language related to moods/feelings with $80\%$ accuracy to improve interaction and conversation with family and staff.
Turn-Taking and Topic Maintenance: The client will demonstrate appropriate turn-taking and topic maintenance abilities during individual/group sessions with specific cues.
Answering Questions: The patient will respond to specific questions (simple/complex…wh-questions, yes/no questions, open-ended questions) with a specific percentage ( $%$ ) of verbal, visual, and tactile cues and compensatory strategies to increase communications within the functional living environment.
Categorization Utility: The client will verbally express $4$ items belonging to given categories with semantic and phonemic cues with $80\%$ accuracy.

Dementia Functional Maintenance Program

Wants, Needs, and Feelings (LTG): The resident will express wants, needs, and feelings through the establishment of an effective maintenance program to maximize functional communication.
Staff and Peer Interaction (LTG): The resident will appropriately interact with staff/peers given a specific level of assistance for initiation, turn-taking, and topic maintenance for communication.
Appropriate Behavior (LTG): The resident will demonstrate appropriate behavior to meet needs with staff and support of communication needs.
Memory Book Localization (STG): The client will recall the strategy of locating and utilizing a personal memory book to improve orientation and reduce repetitive question-asking behaviors in $80\%$ of trials.
Memory Book Usage (STG): The patient will learn effective use of a memory book to compensate for residual memory problems with $80\%$ accuracy.
External Memory Aid (STG): The patient will use an external memory aid with $80\%$ accuracy with verbal and tactile cues to maximize memory skills.
One-Step Directions (FMP): The patient will follow simple one-step directions utilizing compensatory strategies with $80\%$ accuracy.
Verbal Options for Needs (FMP): The patient will express wants/needs when presented with two verbal options with $80\%$ accuracy.
Yes/No Questions (FMP): The patient will answer yes/no questions with $80\%$ accuracy.
Structured Reinforcement (FMP): The patient will exhibit no more than $2$ specific behaviors in a $60$ -minute time period given a structured reinforcement program by caregivers for three consecutive days.
Group Turn-Taking (FMP): The patient will engage in conversation with at least $3$ turn-taking exchanges in a group setting given a specific level of assistance from caregivers for three days (X3).
Generating Wh-Questions (FMP): The patient will generate wh-questions to meet needs given cues/prompts with a specific level of assistance from caregivers with $80\%$ accuracy.
Responding to Wh-Questions (FMP): The patient will respond to wh-questions given two verbal options with $80\%$ accuracy.
Audible Voice Utility (FMP): The patient will utilize an audible voice in environmental noise for three settings over a period of three days.
Initiation Frequency (FMP): The patient will initiate communication exchanges $3$ times/day with staff/family/peers for three consecutive days.
Activity Participation (FMP): The patient will voluntarily/willingly participate in $3$ social activities a week for $2$ weeks.
Social Availability (FMP): The patient will voluntarily/willingly be available for social interaction with staff/peers for $30$ minutes a day over three days.
Baseline Skills for Design (FMP): The patient will demonstrate cognitive-linguistic baseline skills for the design and implementation of a functional maintenance program.

Motor Speech: Apraxia and Dysarthria

Functional Labial/Lingual Function (LTG): The client will develop functional and intelligible speech and utilize compensatory strategies through the use of adequate labial and lingual function, increased articulatory precision, and speech prosody.
Motor Programming and Articulatory Proficiency (LTG): The client will develop functional motor programming and articulatory proficiency and utilize compensatory strategies to express wants and needs for intelligible speech and functional prosody in the functional living environment.
Phonation (STG): The patient will utilize phonation at a specific level (word, phrase, or sentence) with a specific percentage ( $%$ ) of verbal, visual, and tactile cues in order to increase functional speech intelligibility.
Respiratory Support (STG): The patient will improve respiratory support and the use of respiration for the production of specific units (words, phrases, or sentences) with verbal and visual instructions/cues to increase functional speech intelligibility.
Consonant Articulation (STG): The patient will articulate consonants at a specific level (word, phrase, or sentence) with a specific percentage ( $%$ ) of verbal, visual, and tactile cues to increase articulatory precision and intelligibility in conversational speech.
Muscle Control for Basic Needs (STG): The patient will demonstrate adequate control (tongue control for tongue tip sounds $\text{t, d, n, l}$ ; lip control for labial and bilabial sounds $\text{m, p, b \& w}$ ; oral and facial muscle control; or jaw control) to produce $20$ understandable and functional units (words, phrases, sentences) related to basic medical, personal, and hygienic needs.
Clear Vocal Tones (STG): The patient will demonstrate the ability to produce clear vocal tones sufficient to support a specific level (word, phrase, or sentence) production to execute successful sender/receiver communication.

Voice and Tracheostomy/Ventilator Patients

Breath Control for Needs: The client will demonstrate breath control for a minimum of $3$ seconds when expressing personal needs.
Vocal Tones for Medical Needs: The patient will demonstrate the ability to produce clear vocal tones sufficient to support words related to medical needs with $70\%$ accuracy ( $70$ of $100$ ).
Pitch Variation: The patient will demonstrate the ability to produce two tones above and two tones below optimal pitch when communicating basic medical needs.
Cuff Management for Intake: The patient will demonstrate the ability to deflate the cuff and apply a speaking valve prior to oral intake to increase airway protection during the swallow with $80\%$ effectiveness ( $8$ out of $10$ ).
Tracheostomy Occlusion: The patient will demonstrate the ability to increase airway protection during the swallow by independently occluding the tracheostomy tube during the swallow with $80\%$ effectiveness ( $8$ of $10$ ).
One-way Speaking Valve Tolerance: The patient will tolerate a one-way speaking valve (demonstrated by an oxygen saturation of >95\%) for $20$ minutes by a set date.

Electrolarynx and Specialized Communication Techniques

Electrolarynx Activation: The patient will demonstrate proper activation/deactivation of the electrolarynx in conversational speech with $80\%$ consistency.
Listener Intelligibility: Without visual cues, the listener will understand the patient’s conversational speech with $80\%$ consistency.
Electrolarynx Placement: The patient will demonstrate proper placement of the electrolarynx with $80\%$ consistency during a $3-4$ word response task and with $90\%$ consistency overall by a set date.
Battery Maintenance: The patient will verbalize the proper technique for battery charging three times (x3) by a set date.
Stoma Noise Reduction: The patient will use electrolaryngeal speech in conversation without audible stoma noise with $90\%$ consistency.
Leak Speech Airflow Restriction: Given a visual cue from the ventilator and a verbal cue from the clinician, the patient will demonstrate the ability to restrict airflow through the glottis on inspiration (maintaining peak inspiratory pressure of >25\,\text{cm H}_2\text{O}) with $70\%$ consistency.
Cuff Manipulation: The patient/caregiver will demonstrate the ability to independently deflate and inflate the tracheostomy tube cuff three times (x3) by a set date.
Ventilator-Cued Speaking: The patient will demonstrate the ability to speak on exhalation in a phrase repetition task given a visual cue from the ventilator with $70\%$ consistency.
Five Steps of Cuff Deflation: The caregiver will independently demonstrate the proper five steps toward cuff deflation associated with providing the patient with verbal communication.
Physiological Tolerance: The patient will tolerate cuff deflation with an oxygen saturation of >90\% and a respiratory rate of $16$ for $15$ minutes five times (x5).
Adduction Exercises: The patient will independently perform $3$ adduction exercises ten times (x10) by a set date.

Talking Tracheostomy Tubes and Valve Management

Gas Supply Activation: The patient will demonstrate proper activation of the gas supply with $70\%$ consistency by a set date.
Volume Rating: The patient will maintain a volume rating of >3 on a scale of $1$ to $5$ ( $1=\text{poor}$ , $5=\text{excellent}$ ) with $80\%$ consistency.
Voicing Achievement: The patient will achieve voicing with a talking tracheostomy tube with $50\%$ consistency.
Response Speed: The patient will respond to yes/no questions within $3$ seconds beginning with the hand in a neutral position with $80\%$ consistency.
Cleaning Procedures: The caregiver will demonstrate the proper cleaning procedure for the talking tracheostomy tube three times (x3) given written instructions.
Oral Exercise Instruction: The caregiver will demonstrate the ability to instruct and assist in the patient's completion of $10$ oral exercises given written instructions.
Equipment Application/Removal: The patient/caregiver will demonstrate the ability to independently apply and remove the one-way speaking valve four times (x4).
Equipment Cleaning: Given verbal cues, the patient will demonstrate the ability to clean the one-way speaking valve.
Adduction Technique for Responses: The patient will demonstrate adduction technique during one-way word responses to questions with $80\%$ accuracy.
Ventilator Setting Adjustments: Given written cues, the patient and/or caregiver will demonstrate the ability to make changes in ventilator settings to accommodate the one-way speaking valve three times (x3).

Augmentative and Alternative Communication (AAC) Goals

Maintenance and Operations: The patient will demonstrate the ability to master basic maintenance and operations of the device (on-off, adjusting menu features such as voice and display) with $100\%$ accuracy within $2$ weeks.
Programming Messages: The patient will demonstrate the ability to program stored messages independently with $100\%$ accuracy within $2$ weeks.
Conveying Basic Needs: The patient will convey basic needs or make requests to caregivers by spelling or retrieving pre-programmed messages on the device independently and with $100\%$ accuracy within $2$ weeks.
Social and Interactive Use: The patient will initiate social greetings, offer information, ask questions, and express feelings and opinions through spelling and retrieving stored messages on the device during $1:1$ and group situations with familiar and unfamiliar partners independently and with $100\%$ accuracy within $3$ weeks.
Production Expediting: The patient will use strategies on the device to expedite message production when sharing information or asking questions of medical personnel independently and with $100\%$ accuracy within $3$ weeks.

Appendix: Goal Metadata Legend

e: Electrolarynx.
l: Leak speech.
t: Talking tracheostomy tube.
v: One-way valve.