Scenario Analysis: This scenario is professionally challenging because it requires the dysphagia specialist to balance the patient’s progress and functional gains with the stringent documentation requirements of payers and accreditation bodies. Misrepresenting or inadequately documenting progress can lead to claim denials, audits, and a failure to meet professional standards. The specialist must demonstrate tangible improvements that justify continued therapy and align with established benchmarks, while also respecting patient privacy and the therapeutic relationship. Correct Approach Analysis: The best approach involves meticulously documenting specific, observable functional gains achieved by the patient during therapy sessions. This includes detailing the patient’s ability to manage different food consistencies, swallow safely with reduced aspiration risk, and communicate their needs effectively. These documented gains must be directly linked to the patient’s individualized treatment goals and presented in a manner that clearly demonstrates progress towards those goals. This aligns with payer requirements for medical necessity and justification of services, as well as accreditation standards that emphasize outcome-based care and evidence of patient improvement. For example, documenting “Patient successfully swallows 100% of a teaspoon of nectar-thick liquid with no signs of aspiration (coughing, choking, or vocal changes) on three consecutive trials, compared to previous difficulty with thin liquids” provides concrete evidence of functional gain. Incorrect Approaches Analysis: One incorrect approach is to focus solely on the patient’s subjective reports of feeling better without objective, measurable data. While patient satisfaction is important, payers and accrediting bodies require evidence of functional improvement that can be independently verified. This approach fails to meet the documentation standards for medical necessity and outcome measurement. Another incorrect approach is to use vague or generalized statements about progress, such as “patient is improving” or “swallowing is better.” These statements lack the specificity required to demonstrate functional gains and do not provide the detailed information needed for reimbursement or accreditation review. They do not clearly articulate what has improved or how it impacts the patient’s functional status. A third incorrect approach is to document only the frequency and duration of therapy sessions without detailing the specific skills addressed or the patient’s response. While attendance is necessary, it does not, by itself, demonstrate functional gains or justify the continued need for services. This approach neglects the core requirement of proving therapeutic effectiveness and patient progress. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes objective data collection and clear, concise documentation. This involves: 1. Understanding the specific documentation requirements of all relevant payers and accreditation bodies. 2. Establishing clear, measurable, and achievable functional goals with the patient at the outset of therapy. 3. Consistently collecting objective data during each session that reflects the patient’s performance in relation to these goals. 4. Translating this objective data into clear, descriptive statements of functional gains in progress notes. 5. Regularly reviewing documentation to ensure it accurately reflects patient progress and meets all regulatory and accreditation standards. 6. Seeking clarification from payers or accreditation bodies when documentation requirements are unclear.

This scenario presents a professional challenge due to the inherent conflict between a client’s expressed wishes and the clinician’s professional judgment regarding their safety and well-being. The need for careful judgment arises from the responsibility to advocate for the client’s best interests while respecting their autonomy, particularly when cognitive or emotional factors might influence decision-making. Navigating this requires a deep understanding of ethical principles and professional guidelines. The best approach involves a structured, collaborative process that prioritizes client understanding and informed consent. This begins with a thorough assessment to identify the underlying reasons for the client’s refusal, exploring potential barriers to adherence, and ensuring they fully comprehend the risks and benefits of the recommended dysphagia rehabilitation plan. The clinician should then engage in open dialogue, addressing concerns, and collaboratively modifying the plan to enhance compliance and effectiveness, always documenting these discussions and any adjustments. This aligns with ethical principles of beneficence (acting in the client’s best interest) and autonomy (respecting the client’s right to make decisions), as well as professional guidelines that emphasize client-centered care and shared decision-making. An incorrect approach would be to proceed with the rehabilitation plan without fully understanding the client’s refusal. This fails to respect the client’s autonomy and may lead to non-compliance, rendering the intervention ineffective and potentially causing distress. It overlooks the critical step of exploring the ‘why’ behind the refusal, which is essential for effective therapeutic alliance. Another incorrect approach would be to immediately defer to the client’s wishes without further exploration or professional judgment, even if there are clear indications of potential harm. This could be seen as a dereliction of professional duty to ensure client safety and well-being, particularly if the client’s capacity to make fully informed decisions is compromised. Finally, an incorrect approach would be to dismiss the client’s concerns as simply being difficult or uncooperative. This demonstrates a lack of empathy and a failure to engage in a therapeutic relationship, hindering progress and potentially damaging the trust necessary for successful rehabilitation. Professionals should employ a decision-making framework that begins with active listening and empathetic inquiry to understand the client’s perspective. This should be followed by a comprehensive assessment of the clinical situation and the client’s capacity for decision-making. Next, the professional should clearly communicate their professional judgment, including risks and benefits, in a manner understandable to the client. Collaborative problem-solving and plan modification should then be attempted. If a consensus cannot be reached and safety remains a significant concern, consultation with supervisors or ethics committees may be necessary, always prioritizing client dignity and safety.

Scenario Analysis: This scenario is professionally challenging because it requires the dysphagia specialist to balance the patient’s immediate functional needs with the long-term implications of their neurological condition. Accurately assessing neuromusculoskeletal function, setting realistic and measurable goals, and selecting appropriate outcome measures are critical for effective rehabilitation and patient safety. The complexity arises from the need to integrate subjective patient reports with objective clinical findings, all within the context of a progressive condition, and to ensure that the chosen interventions and outcome measures are evidence-based and ethically sound. Correct Approach Analysis: The best professional practice involves a comprehensive neuromusculoskeletal assessment that directly informs the development of patient-centered, SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals. This assessment should include objective measures of muscle strength, range of motion, coordination, and sensory feedback relevant to swallowing. Outcome measures should then be selected based on their ability to objectively track progress towards these specific goals and reflect functional improvements in swallowing safety and efficiency. This approach is ethically justified as it prioritizes patient well-being by ensuring interventions are tailored to individual needs and progress is rigorously monitored. It aligns with professional standards that mandate evidence-based practice and the use of validated assessment tools to guide clinical decision-making and demonstrate efficacy. Incorrect Approaches Analysis: One incorrect approach involves setting broad, non-specific goals without a thorough neuromusculoskeletal assessment. This fails to establish a baseline or identify specific deficits, making it impossible to objectively measure progress or tailor interventions effectively. Ethically, this can lead to ineffective treatment, wasted resources, and potential patient harm if critical deficits are overlooked. Another incorrect approach is relying solely on subjective patient reports of improvement without objective clinical validation. While patient perception is important, it does not replace the need for objective data to confirm functional changes and ensure safety. This approach risks misinterpreting subjective feelings as actual functional gains, potentially leading to premature discharge or inappropriate treatment modifications. A third incorrect approach is selecting outcome measures that are not aligned with the established neuromusculoskeletal deficits or the patient’s functional goals. This can result in data that does not accurately reflect the impact of rehabilitation, hindering evidence-based practice and potentially masking the true effectiveness of interventions. This is ethically problematic as it fails to provide a true measure of patient progress and can lead to flawed clinical judgments. Professional Reasoning: Professionals should employ a systematic decision-making framework that begins with a thorough, multi-faceted neuromusculoskeletal assessment. This assessment should identify specific impairments and functional limitations. Following this, collaboratively set SMART goals with the patient, ensuring they are directly linked to the identified impairments and desired functional outcomes. Subsequently, select outcome measures that are validated, reliable, and sensitive to change in relation to the established goals and impairments. Regular re-assessment and outcome measurement are crucial to monitor progress, adjust interventions as needed, and ensure the ongoing appropriateness and effectiveness of the rehabilitation plan.

This scenario is professionally challenging because it requires a nuanced understanding of a patient’s complex needs, the available adaptive equipment, and the ethical imperative to provide evidence-based, patient-centered care within the scope of practice. The therapist must balance the patient’s expressed preferences with clinical judgment and the practicalities of integrating new technologies. Careful judgment is required to ensure the chosen equipment genuinely enhances function and quality of life without creating undue burden or risk. The best approach involves a comprehensive, individualized assessment that prioritizes the patient’s functional goals and current capabilities. This includes a thorough evaluation of their swallowing function, oral motor skills, cognitive status, and environmental factors. Based on this assessment, the therapist collaborates with the patient and their family to trial various adaptive equipment options, focusing on those that are most likely to improve safety, efficiency, and enjoyment of meals. The selection process should be guided by evidence-based practice and consider the long-term sustainability and ease of use for the patient and caregivers. This aligns with ethical principles of beneficence (acting in the patient’s best interest) and autonomy (respecting the patient’s right to make informed decisions). Regulatory frameworks for allied health professionals typically mandate individualized care plans and the use of appropriate, evidence-based interventions. An approach that focuses solely on the most technologically advanced or expensive equipment without a thorough needs assessment is professionally unacceptable. This fails to consider the patient’s actual functional requirements and may lead to the selection of equipment that is overly complex, difficult to use, or not aligned with their goals, potentially causing frustration and non-adherence. Ethically, this prioritizes novelty over patient well-being and may violate the principle of non-maleficence if the equipment proves detrimental. Another professionally unacceptable approach is to rely solely on the patient’s initial requests for specific equipment without clinical validation. While patient preference is crucial, it must be integrated with professional expertise. Ignoring clinical findings or contraindications for certain equipment could lead to ineffective or unsafe interventions, contravening the professional’s duty of care and regulatory requirements for competent practice. Finally, an approach that neglects to consider the integration of adaptive equipment with existing orthotic or prosthetic devices, or the patient’s overall functional status, is also flawed. Dysphagia often co-occurs with other physical impairments. A holistic approach is necessary to ensure that new equipment does not interfere with existing supports or create new functional barriers. This oversight can lead to suboptimal outcomes and a failure to address the patient’s needs comprehensively, which is a breach of professional responsibility. Professionals should employ a decision-making framework that begins with a thorough, multi-faceted assessment. This should be followed by collaborative goal setting with the patient and family. Evidence-based research should inform the selection of potential interventions, and a trial period with adaptive equipment is essential to evaluate efficacy and usability. Ongoing monitoring and adjustment of the intervention plan are critical to ensure continued effectiveness and patient satisfaction.

Scenario Analysis: This scenario presents a professional challenge related to the interpretation and application of certification body policies, specifically concerning blueprint weighting, scoring, and retake policies. Professionals must navigate these policies to ensure fair and accurate assessment of candidates, while also upholding the integrity and standards of the certification program. Misinterpreting or misapplying these policies can lead to candidate dissatisfaction, legal challenges, and damage to the credibility of the certification. Careful judgment is required to balance the need for consistent application of rules with the potential for individual circumstances. Correct Approach Analysis: The best professional practice involves a thorough review of the official certification body’s handbook and published policies regarding blueprint weighting, scoring, and retake procedures. This approach ensures that all decisions are grounded in the established framework, promoting fairness and consistency for all candidates. Specifically, understanding the rationale behind the blueprint weighting (e.g., reflecting the importance of specific domains in practice), the scoring methodology (e.g., pass/fail criteria, psychometric considerations), and the retake policy (e.g., waiting periods, number of attempts, re-examination requirements) is paramount. Adherence to these documented policies is ethically mandated to maintain the validity and reliability of the certification process and to provide a transparent and equitable experience for all individuals seeking certification. Incorrect Approaches Analysis: One incorrect approach involves making subjective decisions about blueprint weighting or scoring based on personal experience or anecdotal evidence from colleagues. This undermines the standardized nature of the certification and can lead to biased assessments, violating principles of fairness and equity. Another incorrect approach is to disregard or loosely interpret the retake policy, allowing candidates to retake the exam immediately or without adhering to specified waiting periods. This compromises the integrity of the examination process, potentially allowing individuals to pass without demonstrating sufficient mastery of the required competencies. Furthermore, failing to consult the official documentation and instead relying on informal communication or outdated information about the policies can lead to significant errors in judgment, resulting in inconsistent application of rules and potential challenges to the certification’s validity. Professional Reasoning: Professionals should adopt a decision-making framework that prioritizes adherence to established policies and guidelines. This involves: 1) Consulting official documentation: Always refer to the most current version of the certification body’s handbook, policies, and procedures. 2) Seeking clarification: If any policy is unclear, contact the certification body directly for official interpretation. 3) Applying policies consistently: Ensure that all decisions regarding blueprint weighting, scoring, and retakes are applied uniformly to all candidates. 4) Documenting decisions: Maintain records of how policies were applied, especially in cases that might be considered exceptions or require interpretation. 5) Upholding ethical standards: Prioritize fairness, integrity, and transparency in all aspects of the certification process.

Scenario Analysis: The scenario presents a common challenge for candidates preparing for specialized certification exams: balancing comprehensive study with time constraints and the need for effective resource utilization. The professional challenge lies in guiding candidates to make informed decisions about their preparation strategy, ensuring they meet the certification’s standards without succumbing to inefficient or inadequate study methods. This requires an understanding of effective learning principles and the specific demands of the Comprehensive Caribbean Dysphagia and Swallow Rehabilitation Specialist Certification. Correct Approach Analysis: The best approach involves a structured, multi-modal preparation strategy that prioritizes official certification materials, reputable professional literature, and practical application, spread over a recommended timeline. This strategy acknowledges that effective learning for a specialized certification requires more than rote memorization; it demands comprehension, critical thinking, and the ability to apply knowledge in clinical contexts. The recommended timeline ensures adequate time for deep learning, review, and practice, reducing the likelihood of superficial understanding or burnout. This aligns with the ethical obligation of professionals to pursue and maintain competence, ensuring they are adequately prepared to provide safe and effective patient care as certified specialists. The Comprehensive Caribbean Dysphagia and Swallow Rehabilitation Specialist Certification implicitly expects candidates to engage with a robust and well-rounded preparation process. Incorrect Approaches Analysis: Relying solely on informal online forums and anecdotal advice from peers, without cross-referencing with authoritative sources, presents a significant risk. This approach lacks the rigor and accuracy required for specialized certification, as information from informal sources can be outdated, inaccurate, or incomplete. It fails to meet the implicit standard of evidence-based practice expected of certified professionals and could lead to the acquisition of misinformation, which is ethically problematic when it impacts patient care. Focusing exclusively on memorizing past examination questions without understanding the underlying principles is another inadequate strategy. While familiarity with question formats can be helpful, it does not guarantee comprehension or the ability to apply knowledge to novel clinical scenarios, which is a core requirement for specialized certification. This approach prioritizes test-taking skills over genuine expertise and could result in a candidate passing the exam without possessing the necessary competence, posing a risk to patient safety. Cramming all study material in the final weeks before the examination is a high-risk strategy that often leads to superficial learning and poor retention. This method does not allow for the assimilation of complex concepts or the development of critical thinking skills necessary for specialized practice. It is an inefficient use of time and increases the likelihood of exam failure or, if successful, a lack of true mastery, which is contrary to the professional commitment to competence. Professional Reasoning: Professionals preparing for specialized certifications should adopt a decision-making framework that prioritizes evidence-based learning strategies and aligns with the ethical imperative of competence. This involves: 1) Identifying official certification requirements and recommended resources. 2) Developing a realistic study timeline that allows for progressive learning, review, and practice. 3) Integrating diverse learning materials, including textbooks, peer-reviewed journals, and practical case studies. 4) Regularly assessing understanding through practice questions and self-evaluation. 5) Seeking guidance from experienced professionals or mentors when needed. This systematic approach ensures comprehensive preparation and upholds the standards of the profession.

The review process indicates a scenario where a specialist is faced with conflicting information regarding a patient’s dysphagia management plan, necessitating a structured decision-making framework. This situation is professionally challenging because it requires balancing patient autonomy, evidence-based practice, and the specialist’s professional judgment while adhering to ethical guidelines and potentially local health authority protocols for patient care. The specialist must navigate potential communication breakdowns and ensure the patient’s best interests are paramount. The best approach involves a thorough, multi-faceted assessment and collaborative discussion. This begins with a comprehensive re-evaluation of the patient’s current swallowing function, considering all available objective and subjective data. It then necessitates an open and honest discussion with the patient and their family, clearly explaining the findings, the rationale behind the initial recommendations, and any new information or concerns that have arisen. This dialogue should actively involve the patient in decision-making, respecting their values and preferences. If discrepancies persist or further clarification is needed, consulting with other relevant healthcare professionals (e.g., physician, dietitian, speech-language pathologist) to form a consensus on the most appropriate and safest course of action is crucial. This collaborative, patient-centered, and evidence-informed approach aligns with ethical principles of beneficence, non-maleficence, and respect for autonomy, and is supported by professional standards that emphasize interdisciplinary teamwork and shared decision-making in healthcare. An approach that solely relies on the initial assessment without re-evaluation, despite new concerns, fails to uphold the principle of beneficence and may lead to suboptimal or even harmful care. It disregards the dynamic nature of a patient’s condition and the importance of adapting treatment plans based on evolving information. Another incorrect approach would be to proceed with a plan that is not fully understood or agreed upon by the patient and their family, without adequate explanation or opportunity for their input. This violates the principle of patient autonomy and informed consent, potentially leading to non-adherence and dissatisfaction. Furthermore, making a unilateral decision without seeking input from other healthcare professionals when there is significant uncertainty or conflicting information demonstrates a failure in professional responsibility and teamwork. This can result in fragmented care and an increased risk of medical error, contravening ethical obligations to provide competent and collaborative care. Professionals should employ a decision-making process that prioritizes patient safety and well-being. This involves: 1) Recognizing and acknowledging any discrepancies or uncertainties in the patient’s care plan. 2) Conducting a thorough and up-to-date assessment. 3) Engaging in transparent and empathetic communication with the patient and their family, ensuring they understand the situation and are active participants in decision-making. 4) Collaborating with other members of the healthcare team to achieve a consensus on the best course of action. 5) Documenting all assessments, discussions, and decisions meticulously.

This scenario presents a common challenge in dysphagia rehabilitation: balancing the desire for rapid patient progress with the need for safe and evidence-based interventions. The professional challenge lies in discerning which therapeutic modalities are supported by robust evidence for the specific patient’s condition and stage of recovery, while also adhering to ethical principles of patient autonomy and non-maleficence. Careful judgment is required to avoid premature or inappropriate application of techniques that could be ineffective or even harmful. The best professional practice involves a systematic approach to selecting therapeutic exercises and interventions. This includes a thorough assessment to identify the underlying physiological deficits contributing to the dysphagia, followed by the selection of exercises and manual therapy techniques that are specifically indicated for those deficits and have demonstrated efficacy in peer-reviewed literature. Neuromodulation techniques should only be considered when there is clear evidence supporting their use for the patient’s specific presentation and when implemented by a clinician with appropriate training and expertise. This approach aligns with the ethical imperative to provide care based on the best available evidence, ensuring patient safety and optimizing outcomes. An incorrect approach would be to rely on anecdotal evidence or personal preference when selecting interventions. For instance, implementing a novel neuromodulation technique without understanding its specific indications, contraindications, or the evidence base for its effectiveness in the Caribbean context would be professionally unacceptable. This could lead to wasted resources, patient frustration, and potentially adverse effects, violating the principle of providing competent care. Similarly, employing manual therapy techniques without a clear understanding of their physiological rationale or evidence of benefit for the patient’s specific swallowing impairment would be a failure to adhere to evidence-based practice. This could also be considered a breach of professional responsibility if it delays or replaces more effective interventions. The professional reasoning framework for such situations should begin with a comprehensive patient assessment. This assessment should guide the selection of interventions, prioritizing those with strong evidence of efficacy for the identified deficits. Clinicians should continuously engage in professional development to stay abreast of the latest research in dysphagia rehabilitation, particularly within the relevant regional context. When considering novel or less established techniques, a cautious and evidence-informed approach is paramount, often involving consultation with peers or seeking further specialized training. The decision-making process should always prioritize patient safety, functional improvement, and adherence to ethical guidelines.

This scenario is professionally challenging because it requires balancing the client’s immediate needs and desires with the long-term implications of their dysphagia and swallow rehabilitation, particularly concerning their ability to participate fully in their community and potentially return to vocational pursuits. The specialist must navigate the complexities of individual client goals, available resources, and the legal framework designed to ensure equitable access and support for individuals with disabilities. Careful judgment is required to avoid imposing personal biases or overlooking crucial legal obligations. The best professional approach involves a comprehensive assessment that directly addresses the client’s stated vocational goals and community reintegration aspirations, integrating these with their dysphagia and swallow rehabilitation plan. This approach prioritizes the client’s autonomy and right to participate in society by actively seeking out and recommending accessible community resources and vocational support services. This aligns with the spirit and intent of accessibility legislation, which aims to remove barriers and promote inclusion. By focusing on functional outcomes that enable participation, the specialist is directly upholding the client’s right to access opportunities and live a fulfilling life, which is a core ethical principle in rehabilitation and is supported by legislation promoting equal opportunity. An incorrect approach would be to solely focus on the medical aspects of dysphagia and swallow rehabilitation without actively exploring or facilitating community reintegration and vocational rehabilitation. This failure to consider the broader impact of the client’s condition on their life and participation in society neglects the holistic nature of rehabilitation and the legislative intent to promote independence and inclusion. It risks leaving the client with improved swallowing function but still significantly limited in their ability to engage with their community or pursue employment, thereby failing to uphold their rights to accessibility and equal opportunity. Another incorrect approach would be to recommend vocational rehabilitation or community reintegration strategies that are not evidence-based or are not tailored to the client’s specific swallowing abilities and limitations. This could lead to frustration, setbacks, and potentially exacerbate the client’s condition or create new challenges. It also fails to meet the professional standard of care, which mandates that interventions be appropriate and effective, and it may not fully comply with accessibility legislation if the recommended solutions are impractical or inaccessible. A final incorrect approach would be to assume that the client’s dysphagia and swallow rehabilitation will automatically lead to community reintegration and vocational success without proactive planning and intervention. This passive stance overlooks the significant barriers that individuals with swallowing difficulties may face and the necessity of targeted support to overcome them. It fails to acknowledge the proactive role specialists must play in advocating for and facilitating access to resources that enable full participation in society, as envisioned by accessibility legislation. Professionals should employ a decision-making framework that begins with a thorough understanding of the client’s individual goals and aspirations, followed by a comprehensive assessment of their functional abilities and limitations related to dysphagia and swallowing. This assessment should then be used to inform a rehabilitation plan that explicitly incorporates strategies for community reintegration and vocational rehabilitation, with a constant awareness of relevant accessibility legislation and available resources. Collaboration with the client, their family, and other relevant professionals is crucial throughout this process.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in patient response to dysphagia rehabilitation and the ethical imperative to provide evidence-based, individualized care. The clinician must balance the patient’s stated preferences with their clinical assessment of progress and potential risks, all within the framework of professional responsibility and patient autonomy. The challenge lies in discerning when to advocate for continued therapy versus when to acknowledge limitations and explore alternative strategies, ensuring the patient’s well-being and functional outcomes are prioritized. Correct Approach Analysis: The best professional approach involves a comprehensive reassessment of the patient’s swallowing function, integrating objective findings with subjective reports of improvement and functional impact. This includes reviewing the effectiveness of current therapeutic strategies, considering any new contributing factors (e.g., changes in medical status, medication), and collaboratively discussing findings and potential adjustments with the patient and their family. This approach is correct because it adheres to the principles of patient-centered care, ensuring that treatment plans are dynamic and responsive to individual needs and progress. It aligns with ethical guidelines that mandate ongoing evaluation and informed consent, empowering the patient in decision-making while upholding the clinician’s responsibility for safe and effective practice. This systematic review allows for evidence-based adjustments to the rehabilitation plan, maximizing the likelihood of positive outcomes. Incorrect Approaches Analysis: One incorrect approach would be to discontinue therapy solely based on the patient’s subjective statement of feeling “stuck,” without a thorough clinical reassessment. This fails to acknowledge the clinician’s professional responsibility to objectively evaluate progress and identify potential underlying reasons for a plateau. It overlooks the possibility that the patient may not fully perceive subtle improvements or understand the long-term benefits of continued therapy. Another incorrect approach would be to rigidly adhere to the original treatment plan despite a lack of demonstrable progress, ignoring the need for adaptation and potentially leading to patient frustration and suboptimal outcomes. This demonstrates a lack of clinical flexibility and a failure to respond to the patient’s evolving needs. A third incorrect approach would be to unilaterally decide to terminate therapy without a detailed discussion of findings and alternative options with the patient, undermining patient autonomy and the collaborative nature of rehabilitation. This disregards the patient’s right to be informed and involved in decisions about their care. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough assessment of the current situation, including objective data and subjective reports. This should be followed by an analysis of the effectiveness of current interventions and consideration of any new factors influencing the patient’s condition. The next step involves collaborative discussion with the patient and relevant stakeholders to explore options and make informed decisions. This process emphasizes continuous evaluation, adaptation, and shared decision-making to ensure the rehabilitation plan remains aligned with the patient’s goals and best interests.