By Mary Lou Iceton, M.Sc., RSLP, Communication Coach-CONNECT-Lake Country
I had the pleasure of attending a clinical short course for Speech-Language Pathologists as a representative of CONNECT. The conference entitled Assessment and Treatment of Cognitive Communication Disorders Level I and II by Sheila MacDonald was held in Vancouver. As a Communication Coach at CONNECT, the course was extremely valuable as Speech Language Pathologists continue to define their roles in the rehabilitation of communication disorders within the brain injury population.
Key to understanding communication disorders are the global areas of communication assessment. Sheila MacDonald presented three global areas of assessment:
- Aphasia – Communication deficits at the linguistic level of words and sentences;
- Dysarthria Apraxia – Communication deficits at the phonological level of sounds; and
- Cognitive Communication Deficits (CCD) – Communication deficits primarily at the level of discourse, conversational interaction, and social communication or pragmatics.
Speech Pathologists are very familiar with aphasia, dysarthria and apraxia assessment and there are many appropriate test instruments available for use. However, aphasia, dysarthria and apraxia are not the predominant communication deficit after acquired brain injury (ABI). Aphasia is recognized in only 1%-2.5% of the ABI population. Dysarthria and apraxia are noted to be present in 34% of those with severe ABI. More rarely in mild to moderate ABI. However, over 81% of traumatic brain injury (TBI) clients have cognitive communication deficits.
Sheila MacDonald provided an outline of the specific communication deficits found within cognitive communication disorders:
- Word retrieval difficulties – more pronounced during discussion or conversation rather than during confrontation naming in testing situations;
- Discourse difficulties – discourse (conversation) that is impoverished, vague, tangential, or disorganized. This may also be mirrored in written expression;
- Comprehension difficulties – difficulties attending to and understanding long, complex, indirect, or humorous messages, particularly in the context of background noise, multiple speakers, multitasking, rapid presentation, or rapid shifts from topic to topic; and
- Conversational interaction difficulties (referred to as “pragmatics” or “social communication”) – problems with initiation, turn taking, topic selection, topic maintenance, conversational repair, self monitoring or adapting to the needs of the conversational partner or context.
The course covered in detail how cognitive communication disorders could be assessed and treated in a variety of settings and through an extensive timeline:
- Coma to community services many years post injury
- Inpatient and outpatient service delivery
- Mild, moderate and severe ABI levels
- Return to work and school
The course provided information on a variety of both standardized tests and screening instruments recommended for use within a complete communication assessment. Relevant and up-to-date research support was presented for the assessment and treatment of cognitive communication disorders.
I came away from the three-day course with a checklist of “social communication practice recommendations” to increase the effectiveness of my communication coaching ability:
- Develop individualized therapy goals that are context sensitive;
- Focus on self awareness, self regulation and self monitoring (through videotaping);
- Provide direct feedback and real world practice;
- Provide communication partner practice and social perception training; and
- Use standardized outcome measures including measures of generalization and maintenance.
What a valuable learning experience, three days that will absolutely change the way I coach communication at CONNECT.