Modifying EBP

the Start

For the longest time, I wasn’t sure how to effectively address alexia or agraphia. I didn’t feel like I had any tools to direct decision making for treatment. That made me rely on workbooks a bit too much. As in, the only thing I had to offer patients who complained of changes to their ability to read, write, or spell after a neurological injury. Like, ew, Leigh Ann, gross. Don’t worry, I’m not here to tell you to burn your workbooks. They serve a purpose (a small one). But I will caution against allowing workbooks to be the only, or the majority, of what you offer in therapy sessions.

the next step

It became apparent that I had to do some digging. I had to learn how to offer more to my patients. Honestly, workbooks weren’t cutting it. I wasn’t seeing terrific outcomes for my patients. They were frustrated, I was frustrated. And often, we were bored with therapy that relied heavily on worksheets. Through multiple avenues, I’ve found some great resources that got me started in applying research-based tools to my practice.

the process

It’s been a lot of trial and error. It’s been a lot of “ugly” therapy sessions where I’m awkwardly learning how to implement something new. It’s been uncomfortable for me to look uncertain. One thing I’ve realized is that my patients don’t really care about how polished my sessions are. They have a speech, language, voice, cognition, or swallowing concern and they want to GET BETTER. So they will take my awkwardness, my trial and error, and my attempts to try something new because they want to GET BETTER.

the fear

I’ve hesitated from sharing how I implement evidence-based practice (EBP) because I thought I was doing it wrong when I’ve had to modify the protocol to fit my patient’s needs. I thought that by changing it, I was stripping the integrity and effectiveness of the tool and somehow making it “less.” Like I was breaking copyright or something. Reading this, I realize how ridiculous that thought pattern was... But that’s really how I felt! I was embarrassed that I was “copping out” of implementing a rigorously designed treatment method and somehow that made me less of a clinician. Once again, reading that, I see how that train of thought is wild and inaccurate… But that’s really how I felt! Ironically, feeling that way didn’t stop me from modifying all kinds of EBP tools to better fit my patients and the particular skill they wanted to work on. I just wasn’t telling anyone about it.

Write to dictation task at baseline and at post-treatment.

the change

I was able to emerge from that thought pattern after using heavily modified versions of ACT, CART, and MOR with a patient experiencing alexia and agraphia. After 12 sessions, this patient achieved all their goals and feels confident to return to work with functional reading and writing skills. When I compared their baseline writing sample with their discharge writing sample, they were so impressed with the improvement of their skills in just 2 short months. They were honestly shocked at how “bad” their skills were at baseline. They couldn’t believe that writing words like “airplane” and “computer” used to be so challenging.

the result

I absolutely love when neuroplasticity, EBP, and a patient’s motivation combine to result in such great functional gains. As a clinician, it is so rewarding when you are able to track these improvements and changes over time to show your patient how far they’ve come.

I will continue to use EBP tools in my practice, and I will continue to modify and adapt them to meet the unique needs of my patients. As long as my patients are improving and increasing their targeted skills, then the tools are working.