When I was in outpatient I had a 65 year old who was a retired data analyst and very active prior to a right hemisphere CVA. He had executive functioning deficits including mental flexibility, organization and working memory. He also had deficits in STM and insight/awareness. These deficits were impacting his daily life but the poor awareness/insight of the deficits was impacting his progress. All he wanted to do was to continue managing the family budget on spreadsheets and remember the movies he watched weekly. Normative standardized testing did not capture all of this.
Drilling memory is necessary for encoding/decoding but there is a lot to say for engagement when therapy is salient. After doing the DEX questionnaire self rater and inter-rater questionnaire (his wife provided input), we looked at the data and found the significant gap in what he thought he could do and what he actually did in the areas that focused on motivational, behavioral and cognitive factors compared to his wife.
When I focused on his main personal goals, his awareness improved.
His memory and task completion improved.
He was motivated and owned the tasks given.
I measured all of this by re-administering the DEX questionnaire with his wife as an inter-rater.
We made 5 W reports on movies, spreadsheets for budgets (added rows and columns every week), and GPDR with personal projects. I truly think that the combination of increased awareness with the help of PROMS and person centered care, he made progress.
This is my PROM story, since then I could see the value in PROMs and have used it many times since then. For dysphagia I use the EAT-10 and Reflux Symptom Index.
I must admit I didn’t know what else was out there for cognition, aphasia, communication and dysphagia until recently. Medicare/CMS strategic plan really put this on the map with focus on value-based care by “prioritizing outcome and patient reported outcomes”.
So, “I, Vanessa Botero promise to consider using PROMs with all of my patients”
I hope you will make this PROMise too.
There are excellent resources out there to help you with your PROMise:
- Medbridge offers a course taught by Sarah Baar who is excellent at explaining PROMs, benefits and how to find PROMS using www.healthmeasures.net. ,
Meaningful goals just got easier: Patient-Reproted Outcome Measures
