Written by Caleb Harrison, Speech Language Pathologist

As the true "front line" of therapy, caregivers need to be included in the treatment process to continue supporting patients beyond rehab.

As a speech-language pathologist (SLP) in the outpatient rehabilitation setting, my role is to guide patients’ recovery as they reintegrate into life in their communities. The patients for whom I provide treatment have experienced injury or illness affecting their communication and/or swallowing abilities, and they continue to require support as they return home from the hospital.

Without the 24/7 support and supervision of hospital staff, this return to home life can be daunting. Who will assist them with their modified diet? How will they order coffee at Tim Horton’s? How will they explain to their friends that they need them to speak a bit slower or listen more carefully? How will they voice their opinions on current events? While I can provide treatment, identify and practice compensatory strategies, and support self-advocacy, much of my intervention with patients relies on the involvement of their caregivers.

Caregivers bring an expertise unattainable to clinicians—expertise on the patients themselves. SLPs provide tools and strategies to support communication, assessing patients’ needs and making recommendations to accommodate their participation in daily activities requiring communication. Perhaps the patient requires an alternative communication strategy, such as a tablet or communication book. Maybe the patient needs support in increasing the clarity of his/her speech. Or it might be the case that the patient simply needs support in strategizing how to communicate that they have difficulty understanding what people say to them, so others can make the appropriate accommodates. While SLPs can work with patients on all of these aspects of communication and more, time and resources are limited, and unfortunately we cannot continue providing treatment indefinitely. We turn then to the true “front line” of therapy—caregivers—to continue establishing and meeting goals beyond the rehabilitation setting.

Caregivers benefit from having an established common ground with the patient—they know their routines and interests, so while SLPs may have the expertise and experience in recommending and initiating communication strategies, caregivers are best equipped to implement them. Caregivers are crucial to patient success given their history with the patient—relationships, experience, and knowledge of the patient make them an excellent source of information to guide treatment decision-making and provision. Caregivers can provide feedback about what works and identify functional complications that arise outside of the clinical environment.

I include caregivers in the treatment process whenever I can because these are the people with whom the patient primarily communicates. They truly are experts in this regard. But caregivers don’t always feel like experts. Often caregivers feel overwhelmed by the challenge of supporting patients or accommodating changes in their abilities to function independently. Part of my role then is to support caregivers, encouraging them to acknowledge patients’ competence as well as their own. This takes the form of education, communication strategy identification, practice, and support.

Providing caregivers with the tools they need to continue supporting patients beyond rehab is paramount to ensuring ongoing recovery and participation. Recovery is a lifelong process—who better to facilitate this than those with whom patients spend their lives?

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