cognitive communication disorders

Cognitive-Communication Disorders (CCD)

Communication problems caused by impairment in one or more cognitive processes.

Perception

Awareness and understanding of info from senses.

Attention

Cognitive process that involves focusing on specific stimuli.

Memory & learning

Cognitive processes involved in retaining and acquiring information.

Organization

Cognitive process that involves structuring information and tasks.

Reasoning

Cognitive process of drawing conclusions and making judgments.

Functional integrative performance

Ability to apply cognitive skills in real-life situations.

Executive functioning

Cognitive processes that manage and regulate other cognitive abilities.

Understanding strengths/weaknesses

Key to applying cognitive skills to daily life.

Acquired CCD

Right hemisphere damage

Developmental CCD

Genetic disorders and syndromes

What is a key characteristic of Traumatic Brain Injury (TBI)?

It is multifaceted and heterogeneous, with no two cases alike.

What are some common co-occurring issues with TBI?

Hearing loss, dysphagia, and needs for occupational and physical therapy.

How does recovery from TBI vary?

There is wide variability in recovery and severity.

What similarities are observed in clients with TBI?

Similarities are seen in clients with aphasia.

Is TBI a singular problem?

No, it has multiple effects.

common symptoms of a TBI

Inconsistency

Poor judgment

Attention deficits

Inconsistent responses

Impaired memory

Disorders of taste/smell

Impaired language

Poor emotional control

Disorientation

Denial of disability

Poor organization

Poor self-care

Impaired reasoning

Restlessness

Difficulty writing/drawing

Irritability

Anomia

Distractibility

High frustration/anxiety

Aggressive behaviors

behavioral observations of a TBI

Agitation

Confusion

Inappropriate behaviors

Denial

Lethargy/lability/manic behavior

Cooperative or uncooperative

Confabulation

False beliefs

Impulsivity

Speech Deficits

Apraxia, dysarthria, disrupted fluency, voice deficits (intubation, CN damage), must rule out aphasia, may involve cranial nerve damage.

Linguistic Deficits

Anomia, poor expressive organization, poor storytelling, topic maintenance, and sequencing, writing deficits, receptive deficits (often from memory issues), difficulty following directions, reduced comprehension of longer materials, abstract language, reading comprehension.

Cognitive Deficits

Attention, arousal and alertness, preparing attention, sustaining attention, selecting focus, filtering distractions, shifting attention, divided attention (e.g., driving).

Memory & Learning

Encoding, storage, retrieval, involuntary vs deliberate memory, retrospective (past) vs prospective (new), verbal vs nonverbal, sensory-modality specific, short-term and working memory, long-term memory including retrograde (before injury) and anterograde (after injury).

Types of Memory

Working memory: holding/acting on info; capacity ±7 units, episodic: autobiographical, emotional, declarative: 'remember that', procedural: 'how to' (most impacted in dementia), remote memory: preinjury, recent memory: postinjury.

Organizational Structures

How we sort information: features (e.g., blonde hair, glasses), categories (e.g., animals), temporal sequence (order of tasks), part analysis (breaking into pieces), integration/wholes (main ideas, themes).

Functional Integrative Performance

Efficiency of information processing, rate, amount accomplished, scope (settings, knowledge domains), manner: impulsive vs reflective, rigid vs flexible, etc., level: academic, linguistic, vocational.

Executive Functioning

Awareness of strengths/limitations and the ability to set reasonable goals, plan/organize behavior to meet goals, initiate behavior, inhibit non-helpful behaviors, monitor and evaluate performance, adjust plans flexibly, take non-egocentric perspectives, think abstractly, transfer skills to real-life settings.

Discourse (Extralinguistic) Deficits

Problems with monologues, interactive communication, narratives, conversation/storytelling.

Reasoning

General difficulties include cause/effect, problem solving, alternatives, comparing/contrasting, drawing conclusions, deductive reasoning, inductive reasoning, analogical reasoning, evaluative reasoning, convergent reasoning, divergent reasoning.

Deductive Reasoning

General → Specific; if the first statement is true, the second must be true.

Inductive Reasoning

Specifics → General rule; four stages: observation, analysis, inference, confirmation.

Analogical Reasoning

Seeing relationships; e.g., toe:foot = finger:hand.

Evaluative Reasoning

Value judgments.

Convergent Reasoning

Identifying the main idea.

Divergent Reasoning

Generating many options; clients with Down syndrome or low IQ often struggle here.

Applying Concepts

Think of examples in your own studying that show attention/memory problems, executive functioning problems, functional integrative problems, reasoning problems, discourse deficits.

Treatment Principles

Cognitive and communication skills are connected; goals focus on functional communication; improve memory & cognitive-linguistic abilities; use meaningful compensatory strategies; must be patient-focused.

Assessment of TBI Clients

Depends on severity, areas of deficit (cognition, speech, language, swallowing); main focus: cognitive-communication.

Assessment Tools

Cognitive Linguistic Quick Test, Rivermead Behavioral Memory Test, FAVRE (executive function), attention tests, quality of life measures.

Rancho Los Amigos Scale

Used in acute care to assess consciousness: no response, generalized response (e.g., HR increases), localized response (withdraws from pain), confused-agitated, confused-inappropriate, confused-appropriate, automatic-appropriate, purposeful-appropriate.

Therapy Levels

Early Stage - Maximal Support: increase alertness/arousal, improve external focus, recognition of objects, basic communication, simple comprehension and expression; Middle Stage - Moderate Support: longer attention, attention shifting, filtering distractions, perceptual scanning, using organizers, memory aids, organized discourse with support, awareness of needs/strategies; Late Stage - Relative Independence: awareness of self as thinker/learner, more independent use of strategies, better organization with fewer external supports, improved vocabulary comprehension.

3 Phases of Learning in Therapy

1. Acquisition: teach the strategy, explain benefits, model components; 2. Application: practice in structured tasks, role play, fade clinician support, if a strategy doesn't work, switch to a simpler one; 3. Adaptation: apply in real-life contexts, use across settings, adapt strategies to new situations.