Goal setting in neurorehabilitation: Why it matters and how to do it
By Melissa McConaghy
It might be hard to imagine overcoming a neurological disorder or injury and achieving great physical feats. Even regaining the ability to perform the daily tasks you used to do, like going to the toilet, can seem out of reach. But many patients do just that.
Michael, who has Parkinson’s disease, had an ambitious goal of cycling the Tour de France route. But this goal helped Michael complete the physio rehab program, PD Warrior, at our clinic and go on to beat his mates up the route’s toughest climb. Another client, Elizabeth, completed the same program with the goal of travelling to Antarctica. She went on to walk and kayak in the ice fields of Antarctica.
Neuro rehab is challenging and takes hard work
Our clinicians have helped hundreds of people go through rehabilitation programs for neuro disorders, including stroke, spinal cord injury, multiple sclerosis and brain injury. I believe there is one crucial component to rehabilitation for all our clients: goal-setting.
Goals give you a road map and milestones to work towards. This helps your motivation and engagement, and that leads to better outcomes. There is a body of research that shows how to create goals that are purposeful and meaningful.
Our clinicians develop a goal plan first, and a treatment plan second. There are usually two or three overarching long-term goals, with smaller goals derived from these as milestones to tick off along the way.
We use two tools for neurorehabilitation goal-setting
You’ve probably heard of SMART goals, but you may be less familiar with another approach called DUMB goals. Let me explain the two and why they both matter in rehabilitation
SMART goals are:
SMART goals help you define your objective and measure the outcome. For example, a patient’s goal might be to walk better; but what does that mean?
The goal – to walk better – needs to quantified. Our clinicians work with our patients to articulate their goals. Where do you want to walk? How far do you want to walk? How long do you want it to take you? What do you want to do when you get there? How will you get back?
Breaking the goal down into measurable outcomes enables you to measure their success. Our clinicians — whether physio, OT or exercise physiology — usually measure the patient’s goals in each session.
However, sometimes we use DUMB goals with our clients.
DUMB goals are:
- Dream Driven
- Method Friendly
- Behaviour Triggered
These are more aspirational – like cycling the French alps or kayaking in Antarctica – and turn what seems like an impossible dream into a reality. DUMB goals may seem unachievable or ‘dumb’, but they can be highly motivating.
Not all goals need so ambitious as cycling a mountain. This is a lofty dream even for those of us who do not have a neurological disability or injury. We have had clients who wanted to walk independently down the aisle on their child’s wedding day. I remember a client, who had experienced a stroke, wanted to meet her daughter’s newborn baby. This meant regaining the ability to board and sit on an aeroplane for eight hours.
We often use DUMB goals in our rehabilitation programs for clients with Parkinson’s disease, stroke, multiple sclerosis or spinal cord injury.
Sometimes neuro rehabilitation goals fail
There are several reasons why you may not achieve your goals. Here are three of the main ones:
- You did not set the goals yourself. Family members or therapists may set the goals for you, and you’re not invested in them enough to achieve them.
- The goals are unrealistic. Goals that cannot be achieved are setting you up for failure, and this is demotivating.
- Extraneous circumstances knock you off the path. Illness or another event outside your control might mean your goal is no longer relevant or achievable. It’s common and OK to adjust goals as you go along.
Contact our clinic on 02 9906 7777 or email firstname.lastname@example.org for a no-obligation discussion on how we can help you or a loved one take the next step in setting and achieving rehabilitation goals.
* Note client names have been changed for their privacy.