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With the onset of PDPM, group therapy can account for up to 25% of a patient’s weekly therapy minutes in skilled-nursing facilities.
When used appropriately, groups can be a great addition to any speech therapy patient care plan. They can add functional interactions with peers that a patient would not achieve in a 1-1 patient to clinician dynamic. Communication with unfamiliar partners, divided attention with environmental distractions, and problem-solving can all be addressed in a speech therapy group treatment. Groups can provide patient-centered care and help to achieve goals.
Therapy groups can be more comparable to real life, and target pragmatics, language, and cognitive goals that may be otherwise hard to address in individual sessions. In fact, Fama ME et al., (2016) demonstrates that in aphasia groups, patients with severe non-fluent aphasia tend to initiate more communication with more treatment modalities and communicate for social closeness. Groups can be a great functional bridge to generalize learning from individual sessions into community activities, even with patients who have severe deficits.
Here are some suggestions for speech therapy group ideas to facilitate in your SNF. All of these groups can target a variety of goals for patients.
Word of caution, groups can get chaotic and it can be difficult to take data on each individual patient. You can prepare for the group by making a list of the goals you are targeting for each patient and take data on the list for each goal as you go.
In the past, I used cooking groups as a part of functional cognitive therapy for many patients. Cooking groups were one of my more favorite things to do. You start by gathering 2-4 patients in the kitchen and giving them a recipe to complete, as well as individual roles.
Tasks in the cooking group can address all areas of cognitive and language functioning. From reading a recipe to safely navigating the kitchen, there are a lot of skills to address in a functional kitchen group. You can address cognitive skills such as attention, sequencing, visuospatial, problem-solving, and executive functioning. Language goals can be targeted for verbal expression, auditory comprehension, and reading comprehension. The group can also address physical and occupational therapy goals if you co-treat with a PT or OT.
One of the most fun parts of the cooking group is the reward! At the end of the group, you have a snack that your patients can eat or share with their families.
Dysphagia is one of the less creative facets of SLP intervention to target both individually and in a group. However, it can be beneficial to work on dysphagia exercises in a group setting to improve the motivation and participation of patients. You can have patients work on chin tuck against resistance, expiratory muscle strength training (EMST), and other appropriate dysphagia exercises in the group setting.
A dysphagia group can also be a great place to review safe swallow strategies and the importance of oral care. If there are patients that need practice with functional use of safe swallow strategies, you can coordinate a dysphagia group at a mealtime.
I love cards and board games as functional therapy materials because they are familiar to the patient and can be highly rewarding. However, it can be difficult to perform individual therapy with cards and board games, because you as the clinician have to be a playing partner, plus give prompts to the patient and collecting data.
In come groups! A speech therapy group is the perfect opportunity to use cards and games with patients and give the patients the level of prompting and support they need to make the task therapeutic.
Some of my favorite games for therapy include 500 Rummy, Bananagrams, Guess Who, Memory, and Connect 4.
In aphasia therapy, it is important to address natural communication. Aphasia research over the last 20 years indicates that groups play an effective role in improving communication and can be used in addition to individual treatment.
As the clinician leading the group, you can prepare several topics to discuss over the course of the group. You could start out casually, by having the patients introduce themselves and say a little bit about themselves. Then, you can provide topics to engage conversation among group members.
Research by Lee, J., Azios, J. (2019) suggests that it is helpful to be prepared in advance with topics of conversation and multimodal communication tools for your patients with severe deficits. Also, try to provide open-ended questions that encourage communication. If you need help with conversation starters, Tactus Therapy has a conversation app and some great tips for running Aphasia group therapy sessions. Finally, make the group an open place where patients feel safe to express themselves. This study determined that the group facilitator plays a large role in whether or not persons with aphasia engage in the group or not.
Sample group chat topics:
Favorite books or movies
A favorite recipe
Favorite vacation memories of a place they would love to go
Helpful technology and apps
Who says therapy has to be all business? We can do functional tasks, like making crafts, and turn them into therapeutic activities. Craft groups are especially fun around the holidays. Here, you can make a holiday style craft for the patient to decorate their room with.
To organize a craft group, I start by determining how the directions are going to be provided. If you are working on reading comprehension or visuospatial goals, you could give written directions. If you are working on auditory comprehension, you could provide auditory directions only. The patients can then follow the directions to make the craft and the therapist is there to provide prompting.
There are a variety of goals you can address with making crafts. This includes basic direction following to more complex sequencing and executive functioning goals. You can also target reading and auditory comprehension, as well as verbal and written expression. As you set up the craft group, you can intentionally leave items out of reach. This facilitates group members asking other members to pass and share items. Then, as the patients are making crafts, it is a great time to address divided attention. You can engage in functional communication/conversation and see if the patient can perform divided attention tasks, such as having a conversation while working on the craft. You can also create environmental distractions, such as a loud TV/radio, and provide feedback to help the patient work with distractions.
To conclude, groups can be a lot of fun and a way to integrate therapy goals more functionally into your plan of care. They can facilitate communication that can be difficult to achieve in the patient-clinician dynamic.
Do you have any suggestions for speech therapy group ideas? Drop them in the comments!
Fama ME., Baron CR., Hatfield B., Turkeltaub PE. (2016) Group therapy as a social context for aphasia recovery: a pilot, observational study in an acute rehabilitation hospital. Top Stroke Rehabil. doi: 10.1080/10749357.2016.1155277.
Lee, J., Azios, J. (2019) Facilitator Behaviors Leading to Engagement and Disengagement in Aphasia Conversation Groups. American Journal of Speech Language Pathology. doi.org/10.1044/2019_AJSLP-CAC48-18-0220
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