The Lingraphica Blog

Just Say "No" to Plateau

Oct 10, 2016 | by Faye Stillman, MS, CCC-SLP/ATP


There are clinical terms that speech-language pathologists (SLPs) use in their daily practice. Diadochokinetic rate may be our “supercalifragilisticexpialidocious.”  

A term many clinicians use internally that carries a difficult connotation is “plateau.” When a patient in speech therapy “plateaus,” it means that it is the SLP's clinical judgment that the patient has made maximum anticipated gains in therapy, and that the continuation of therapy is no longer indicated. At this point a patient is typically discharged; even if his or her goals have not been met.  

Recently, I had the opportunity to meet the caregiver support group at Voices of Hope for Aphasia. I was there to provide them with an in-service about the products and services Lingraphica offers to help persons with aphasia (PWAs) improve their communication skills.  

One part of our presentation is a summary review of a research study completed by Dr. Richard Steele*. A component of the study looked at the mean Aphasia Quotient (AQ) on the Western Aphasia Battery (WAB) and scores of the Communication Effectiveness Index (CETI). Measures at the start of the study were compared to those same scores following an average of five months of speech therapy combined with the use of a Lingraphica AAC device.  

The 28 clients who participated in the study, all presented with an AQ on WAB indicative of severe to very severe expressive aphasia, and all of them were discharged from speech therapy as having plateaued. Also, all of them, demonstrated progress at the end of the study; with a mean improvement on the WAB AQ of 11.8 points, and 12 points on the CETI. This level of improvement is statistically significant. Or, in Dr. Steele’s own words, “This is huge!”  

As this slide came up in the PowerPoint presentation, I began to describe the study to the caregiver group. While trying to avoid the use of clinical jargon, I was surprised the caregiver group not only recognized the word “plateau” in this context, but they also told me that the “p-word (plateau) is a bad word in this group! 

The results of this study were so meaningful to a room of non-clinical people; many of whom were told that their loved one was being discharged from speech therapy as having plateaued. This experience truly made me more aware of the lasting impact the “p-word” has on our clients and caregivers. An SLP colleague once told me that she teaches her university student clinicians that, “clients do not plateau, we do!” and I’ve taken this message to heart. As Nancy Helm-Estabrooks wrote in her blog on the subject, “Treating aphasia is like scaling a mountain but, unlike Everest, no one has been able to reach the peak. Still, let’s not any of us talk about 'plateaus.' Let’s all just keep on climbing! 

*Steele, R.D. (2004). “Benefits of Advanced AAC Technology Uses to Adults with Acquired Aphasia.” Augmentative and Alternative Communication. (pp. 3-7)

Tell me in the comments about your experience with the word plateau!