Cognitive Communication

Cognitive Communication- the ability to use language and the underlying cognitive processes to learn and function successfully.

Aquired Brain Injury (ABI): acquired, not born with the brain injury; not traumatic; brain tumor, illness, etc.
Traumatic Brain Injury (TBI): subcategory of ABI; damage to the brain caused by some force
Closed Head Injury (CHI): subcategory of TBI; the skull is not penetrated

SYMPTOMS:

Typical Strengths or “spared” abilities:

  • language (content & form- syntax, morphology, phonology, semantics)
    • language difficulties are often subtle
    • sometimes people with Traumatic Brain Injury have aphasia and/or dysarthria
  • “Swiss cheese brain”-  the strengths and deficits found in someone with brain injury tend to be “random”

Typical areas of deficit:

  • Attention
    • real-life behaviors: looking away, makes careless mistakes, not engaged, moving constantly, incomplete work
  • Memory
    • real-life behaviors: telling the same stories over and over, difficulty recalling recent events, getting lost, forgetting to do assignments
  • New learning (strategic learning)
    • real-life behaviors: difficulty remembering names of new people, can memorize some facts but cannot apply it, inconsistent school/job performance, can’t get big picture new information
  • Processing (mental) speed
    • real-life behaviors: difficulty transitioning, slow test taking, getting lost in conversations, tries really hard but gets bad grades
  • Initiation
    • real-life behaviors: trouble getting started on homework, needing constant reminders, can verbalize what they need to do but they don’t do it, not making plans with friends
  • Planning
    • real-life behaviors: need to be told what to do, not thinking of more than one way of doing something, difficulty with time management
  • Organization
    • real-life behaviors: don’t keep a planner, stuff is out of order, tangential speech, not turning in homework
  • Mental flexibility
    • real-life behaviors: keep doing something one way even if it is not working, not switching tasks, getting stuck, often don’t consider another point of view
  • Judgement
    • real-life behaviors: cutting class, can’t keep a job, sexually promiscuous, can’t see someone else’s point of view, making unsafe decisions on the play ground
  • Social skills/pragmatics
    • real-life behaviors: can’t keep friends, chase kids, acts younger than their age, uses “baby talk,” says inappropriate things, is isolated by others, kicks/fights, prefers younger friends
  • Word retrieval
    • real-life behaviors: often uses non-specific speech, uses fillers in conversation, hard time with naming tasks, written language is sparse, pauses or restarts while talking
  • Self-regulation/impulsivity
    • real-life behaviors: makes poor choices (hits, pokes, interrupts), tempertantrums, has extreme reactions, makes unsafe decisions on playgroung, can’t calm self down, plays rough, blurts things out
  • Sensory processing
    • real-life behaviors: fidgets, picky about food textures, bothered by loud noises, always touching people/in people’s space, bumps into others when standing in line, always has something in their mouth, plays too rough

ASSESSMENT:

  • Ongoing: in the early months of a TBI, neuro improvement can change a person’s strengths and limitations; situations and expectations and demands change as a person moves through life
    • “growing into a deficit”- negative consequences of the brain injury are delayed until the injured part of the brain is expected to mature and support cognitive function.
  • Contextualized: may perform well on tests, but has functional breakdowns in everyday life (or vice-versa)
  • Multiple sources: formal testing, informal assessments, teacher/parent/student interview, observations
  • Collaborative: don’t go it alone because you need multiple sources of information, you need to build a team so the child gets consistent care, TBIs are beyond just an SLPs expertise
    • Three Types of Experts:
      • the person living with the TBI, the family, and the professional
  • Hypothesis-testing: dynamic assessment principles
    • identify a “problem” and make a hypothesis collaboratively as to the reason for the problem

Assessment Areas

  • attention: ability to focus and concentrate on different things; also the ability to ignore irrelevant things.
  • memory: ability to remember things
    • prospective (to do)
    • retrospective (what you did)
    • new learning is hugely affected in Brain Injured people
  • problem solving, reasoning, judgement, awareness, organization, regulation, etc.
  • executive functioning: set of cognitive abilities that allow us to control and regulate our behavior
    • executive functioning is necessary for goal directed behavior (i.e. brushing teeth or writing a paper)
    • involves initiation, planning, organization, goal setting, mental flexibility, insight into awareness, and judgement.

Interview Questions

  • Does the client have any other medical concerns?
  • In what situations does the client find the deficit to be most apparent?
  • What is a typical day like?
  • What activities are the most difficult?
  • Does the client have difficulty beginning tasks? Completing tasks?
    • How so?
  • Does the client experience any difficulties in communicating in everyday life?
  • What has changed since your TBI?

Formal Tests

  • Montreal Cognitive Assessment (MoCA)
  • Cognitive Linguistic Quick Test (CLQT)
  • Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES)
  • Test of Problem Solving- third edition- Elementary test (TOPS 3: Elementary (ages 6-12)
  • Measure of Cognitive-Linguistic Abilities (MCLA)
  • Ross Information Processing Assessment- second edition (RIPA-2)

Alternative Assessment Measures

  • Interview with client, caregiver, teacher, etc.
    • observe the client’s conversational skills, behaviors, etc.
  • Observation in natural settings
    • school, home, etc.

Initial Treatment Goals

  • The client will exhibit the ability to plan by identifying the time, materials, and location to plan a sleepover for her friends with moderate clinician cueing.
  • The client will maintain attention for 7 minutes per task, 3x/session with moderate clinician cueing and redirecting.

CLIENT & FAMILY EDUCATION:

  • http://www.biausa.org/living-with-brain-injury.htm
    • This webpage focuses on providing basic information about brain injury. It outlines the different parts of the brain and their functions. It also describes what injuries to specific spots may cause to a person.
  • https://caregiver.org/traumatic-brain-injury
    • This webpage describes brain injuries, the most prevalent causes, and the consequences of brain injuries. It outlines the prognosis for improvement and recovery for brain injuries. For people with TBI and their families, the page also includes tips for functioning and communication. The webpage also includes additional resources for caregivers and the families affected by TBI.
  • http://www.brainline.org/landing_pages/categories/familyconcerns.html
    • Brainline.org is a website dedicated to the prevention, treatment, and living of someone with traumatic brain injury. The specific page discusses common family concerns. The page also gives resources for family support, and tips for how caregivers should interact with the person with TBI.

PROFESSIONAL MATERIALS & RESOURCES:

  • http://www.brainline.org/landing_pages/Professional.html
    • Brainline.org is a website dedicated to the prevention, treatment, and living of someone with traumatic brain injury. The specific page focuses on providing resources for professions, including SLPs. The site has information about incorporating families into treatment, how to treat clients, and the effects of treatment.
  • Arnold, L. (2003). WALC neurological rehab: workbook of Activities for Language and Cognition. Austin, TX: LinguiSystems.
    • The WALC 5 is a workbook of activities to be used in therapy for clients with language and cognitive issues. It provides functional activities to help improve orientation, memory, organization, problem solving, reasoning, and written expression. SLPs can use the activities to help their TBI clients to improve the way they process information and respond appropriately to the world around them.
  • http://www.asha.org/public/speech/disorders/TBI/
    • From the American Speech-Language-Hearing Association, this webpage outlines traumatic brain injury and its features. The page lists the causes of TBI, as well as how it is diagnosed and the common deficits that result from TBI. The role of an SLP is outlined on the page, noting specifically what takes place within therapy.

REFERENCES:

Haynes, W. O., & Pindzola, R. H. (2012). Diagnostics and evaluation in speech pathology (8th ed., pp 215-237). Pearson.

(1997–2014) American Speech-Language-Hearing Association (ASHA)

SPAUD 501: Diagnostics notes; Heather Koole (Calvin College)

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