Plateau: Noun or Verb?

panoramic view of Horseshoe Bend

Plateau is one of those words that can serve as either a noun or a verb. The noun describes a flat, raised landmass found throughout the world, including spectacular vistas in the western USA. Visually pleasing, but I have no strong feeling one way or another about plateau as a noun outside the therapy arena. The trouble starts when the word is used as either a noun or a verb to describe therapeutic progress.

Medical professionals often use plateau as a verb. For example: The patient has plateaued. Or: Don’t bother trying to rehab because s/he has plateaued. Even when plateau is used as a noun, it still indicates the belief that the maximum potential for recovery has been achieved: S/he has reached a plateau. In theory, this occurs when the slope of a patient’s objective progress approaches “flat line” status. In reality, plateau is rarely so clear cut.

I don’t believe in using the word plateau as a verb or any other part of speech to suggest that further progress after a stroke or brain injury is unlikely.  Recovery occurring along a shallow slope is still improvement. Any amount of functional improvement can make a huge difference in an individual’s quality of life. If progress is not being made, then the therapy plan needs to be adjusted.

Since I like to use analogy, let’s view progress in therapy as similar to a group hike at elevation. In the picture at the right, sevEscalier du puy de Parioueral people are climbing a stairway up the side of a moderately gentle slope. There are many steps to reach the summit, where one can anticipate a payoff in the form of spectacular views! Different groups of people can be seen at various stages of the journey. Some hikers are nearing their goal, others are a bit behind but are getting close. One person is seen pausing far behind the others.

The first two groups will probably reach the peak in a reasonably short time. They will have done the work to achieve their goal, and they will experience the expected payoff as well as the intangible reward of having conquered the challenge.

The person standing far behind the others is making progress, too. The journey may take longer for her if she intends to climb to the end of the trail, but she is using the strategy of stopping to catch her breath and enjoy the views along the way. The point is, she is strongly motivated and is willing to do what it takes to reach her goal.

In modern therapy, patients may fall into categories very similar to these climbers! Some will rapidly achieve established goals. Their progress is clearly quantifiable, unlikely to require extended time to meet, and third party payors do not balk much at paying benefits. The person progressing at a slower rate will probably run into problems. S/he is likely to be pronounced as having reached a plateau and discharged from therapy before meeting her potential, even though s/he is motivated and capable of making gains that afford a better quality of life if allowed extra time and effort.

I have personally treated these types of patients when others have pronounced them at a plateau. The word is not in my professional vocabulary! Research in the area of neuroplasticity tells us that improvement following stroke or traumatic brain injury may occur for many years post onset. If we reach a point where gains slow, then we need to reassess and modify our treatment strategy to capitalize on the patient/client’s circumstances and status at that point in the recovery process. Sometimes the results of reassessment are subtle; at other times remarkable. The point is that if performance and/or quality of life are higher than when we started, that’s not a plateau. That is progress!


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