Adult Language: Cognitive Communication Disorders

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability

Definition of Cognitive Communication Disorders

• Cognitive-communication disorders involve communication difficulties due to disruptions in cognition.

• Communication includes listening, speaking, gesturing, reading, and writing.

• Cognition involves attention, memory, organization, and executive function.

• Cognitive impairments impact self-regulation, social interaction, daily living, learning, academic, and job performance.

Areas of Cognition Impacting Communication

• Attention

• Memory

  • Working Memory

  • Short-term memory

  • Long-term memory

  • Declarative Memory (Episodic and Semantic)

  • Procedural Memory

  • Prospective Memory

• Perception

• Insight and judgment

• Organization

• Orientation

  • Person

  • Place

  • Time

• Language

• Processing speed

• Problem solving

• Reasoning

• Executive functioning

• Metacognition

• Cognitive impairments affect communication by impacting attention, topic maintenance, memory, accurate responses, understanding jokes/metaphors, and following directions.

Perception

• Perception: Integration of sensory information.

Attention Types

• Visual

• Auditory

• Sustained

• Selective

• Alternating

• Divided

Higher Level Cognitive Functions

• Organization

• Insight and Judgement

• Problem Solving

• Reasoning

• Executive Function

• Metacognition

Social Communication and Behavior

• Social Cognition

  • Perceptions of facial expressions and emotions of others.

  • Perspective taking and empathy.

  • Social inferencing (interpreting sarcasm, lies, irony, humor).

  • Theory of Mind (understanding others’ thoughts, beliefs, intentions).

• Pragmatics

  • Rules of social interaction.

  • Self-regulation and control of behaviors and emotions.

Putting the Pieces of Communication Together

• Communication integrates language, cognition, and social communication/behavior.

• Language: Auditory Comprehension, Oral Expression, Reading Comprehension, Written Expression

• Cognition: Attention, Memory, Executive Function

• Social Communication/Behavior

Key Neurophysiological Principles

• Hemispheric specialization (cerebral dominance)

  • Brain sides have specialized abilities.

  • Left vs. right hemisphere.

• Intra-hemispheric specialization

  • Specific structures within hemispheres relate to specific abilities.

  • Broca’s vs. Wernicke’s area.

• Interconnectivity throughout the brain

  • Brain acts as a system.

  • Exceptions to structure-function correlations.

• Neuroplasticity

  • Brain’s ability to change and adapt.

  • Heart of recovery and learning.

Cognitive and Behavioral Impacts by Location of Injury

• Frontal lobe

  • Affects emotional control, initiation, motivation, inhibition.

  • Creates frustration and aggressiveness.

  • Promiscuity and lethargy are common.

  • Inability to execute complex movements.

• Temporal lobe

  • Creates sudden aggression.

  • Results in short and long term memory loss, learning difficulty.

  • Could lead to persistent talking.

• Parietal lobe

  • Creates inability to process body information.

  • Results in difficulty identifying objects via touch.

  • Decreases body coordination.

  • Leads to directional problems.

• Occipital lobe

  • Affects vision.

  • Creates degrees of blindness, hallucinations.

  • Results in problems identifying colors, words, objects.

  • Leads to issues reading and writing.

• Limbic System

  • Affects emotional and physical desires.

  • Creates difficulty with organization, perception, balance.

  • Could lead to decreased breathing capacity.

• Cerebral Cortex

  • Outer layer of cerebral lobes.

  • Could lead to issues processing emotions and behavior.

• Cerebellum

  • Affects coordination of fine movement.

  • Results in impairment of walking, reaching, and grabbing.

Acquired Neurological Conditions

• Traumatic Brain Injury

• Right Hemisphere Disorder

• Dementia

• Other Progressive Neurological Conditions

  • Parkinson's Disease

  • Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)

  • Huntington's Disease

  • Multiple Sclerosis

Principles of Attention #1

• Involves focus on stimuli.

  • Internal (planning, remembering).

  • External (listening, reading, conversing).

• Note the modality of stimuli.

  • Auditory, Visual, Combined, Sensory.

• Connected to language and cognition.

  • Attention is foundational.

Principles of Attention #2

• Capacity limitation

  • Limited stimuli at once.

• Selection

  • Focus on relevant stimuli.

• Capacity and selection work together.

Movie Theater Example

• Scene: Movie theater with distractions.

  • Selection: focusing on the movie.

  • Capacity limitation: filtering distractions.

Theories and Models of Attention (Selection)

• The “cocktail party problem” (Cherry, 1953): attending to a target talker in a complex environment.

  • Requires selective auditory attention.

  • Difficult with irrelevant sounds.

  • May cause listener confusion.

• Work on the cocktail party problem led to these theories:

  • Early filter theory (Broadbent, 1958): irrelevant stimuli are filtered out early on.

  • Filter attenuation model (Treisman, 1960): irrelevant stimuli are attenuated but still monitored.

  • Late filter theory (Deutsch & Deutsch, 1963): selection occurs later.

• Other models:

  • Spotlight Theory (Posner, Snyder, & Davidson, 1980): enhanced processing in visual field.

  • Object formation (Desimone & Duncan, 1995): form perceptual “objects”.

Theories and Models of Attention (Capacity)

• General models of attention relating to capacity limitations:

  • Resource allocation theory (Kahneman, 1973): resources allocated from a single cognitive pool.

  • Central bottleneck model (Pashler, 1994): resources allocated sequentially.

Sohlberg & Mateer’s model

• Sohlberg & Mateer’s model (1987, 2001, 2010):

  • Sustained attention.

  • Executive control (working memory, selective attention, suppression, alternating attention).

Sohlberg and Mateer Clinical Attention Framework

• Sustained Attention

  • Maintain attention for a continuous period.

• Executive Control

  • Working Memory: Hold and manipulate information.

  • Selective Attention: Process target information while inhibiting distractions.

  • Suppression: Control impulsive responding.

  • Alternating Attention: Shift focus between activities.

Attention Networks

• Alerting Network

  • Producing and maintaining alertness.

• Orienting Network

  • Prioritize incoming sensory input.

• Executive Network

  • Detect targets and respond.

Alerting Network (Reticular Activating System)

• Arousal and Sustained Attention.

• Related to the reticular formation.

• Network involves frontal areas, cingulate gyrus, posterior parietal areas, limbic system, thalamus, basal ganglia.

Orienting Network (Posterior Attention System)

• Sustained and Selective Attention of visual stimuli.

• Network involves temporoparietal junction, thalamic lateral pulvinar nucleus, thalamic superior colliculus, frontal eye fields, superior parietal lobe.

Executive Control Network (Anterior Attentional)

• Sustained, Selective Attention, and Divided Attention

• This network involves prefrontal cortex and anterior cingulate cortex.

Glasgow Coma Scale

• Developed by Teasdale and Jennett in 1974

• Consciousness = arousal and awareness.

  • Arousal: eye-opening.

  • Awareness: motor and verbal responses.

• Standardized measure of impaired consciousness.

• Outcome measure for brain injury recovery.

Glasgow Coma Scale Scoring

• Severe = 3-8 points

• Moderate = 9-12 points

• Mild = 13-15 points

• Eye Opening (Arousal)

  • Spontaneous: 4 points

  • To loud voice: 3 points

  • To pain: 2 points

  • None: 1 point

• Verbal Response (Awareness)

  • Oriented: 5 points

  • Confused: 4 points

  • Inappropriate words: 3 points

  • Incomprehensible sounds: 2 points

  • None: 1 point

• Best Motor Response (Awareness)

  • Obeys: 6 points

  • Localizes: 5 points

  • Withdraws: 4 points

  • Abnormal flexion: 3 points

  • Extension: 2 points

  • None: 1 point

Limitations of the GCS

• Problems with reliability