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Concussions and The Basics of Cognitive-Communication Therapy

Posted June 26, 2016

Ridge Zeller Therapy's, Sarah Jordan Strong, M.S., CCC-SLP, shares an overview of cognitive-communication therapy and it's positive impact on concussions: 


Cognitive-Communication Therapy Basics & Concussions

You Want Me To Go To Speech Therapy? But I Talk Just Fine!

One of the most common misconceptions about the field of speech-language pathology is the idea that we all spend our days working with elementary school students on saying the r and s sounds or helping an individual who stutters.

In reality, speech-language pathologists target all areas of speech and language, including expressive language, receptive language, voice, and speech clarity. One additional area within the field that very few people know about is cognitive-communication therapy.

Because human cognition is so heavily dependent on language, speech-language pathologists are uniquely qualified to offer cognitive remediation to individuals who have experienced concussions, stroke, head injuries, brain tumors, or any other type of neurological trauma. Since this seems to be a well-kept secret, I’d like to share a few of the areas I typically work on in cognitive-communication therapy.

  • Short-Term Memory: This is probably the most common cognitive deficit I see. Short-term memory issues may include difficulty recalling names and dates, repeating conversations, and a reduced ability to track and complete daily tasks. I often work with people who have difficulty cooking because they forget something on the stove and walk away, can’t manage their schedules and appointments, or can’t remember new information for work.
  • Orientation: Orientation is our awareness of where we are, the time period, what we are doing, and the details of our current situation, all of which can be impaired by neurological damage. Many people I see are aware of where they are, but have significant difficulty tracking the date, including the current year.
  • Sequencing: Sequencing is the ability to plan and execute the steps to complete a task. For example, when transferring from a bed to a wheelchair, there are steps that need to be followed in order to avoid the risk of a fall. Many people with neurological trauma have difficulty completing all of these steps in an orderly fashion, which can lead to safety concerns.
  • Problem-Solving: Problem-solving is not just the ability to identify a solution to a given dilemma. It is a complex process that involves identifying all available solutions, discarding inappropriate ones, and eventually selecting the best of the bunch. Most of us complete this process in seconds without even noticing that we are doing it, but this ability can be impaired by brain trauma. Often I see people who either can’t come up with a reasonable solution or use the first one that occurs to them even if there are better options. 
  • Sustained and Divided Attention: Sustained attention is the ability to remain on-task until you’ve completed whatever it is you need to get done. Divided attention is what we commonly think of as multi-tasking. Both can be reduced following brain trauma. I see patients who can’t work or participate in activities they used to enjoy because they are constantly distracted and unable to refocus on the task at hand.
  • Synthesis: This is the ability to combine and use information from a variety of sources. Think of making a grocery list. You probably have some things you buy every week. You may have other things you’ve run out of that aren’t weekly purchases. There are probably items in your pantry and freezer that are in the recipes you want to make, but don’t need to be purchased. You may want to buy some things that are on sale, or have coupons to use. Again, most of us do this without really thinking about it, but that can change following a neurological incident.
  • Executive Functioning: Executive functioning is a broad term for the management of our processes of thinking. It may include some of the issues listed above, as well as keeping track of time, making sure tasks are completed in a timely manner, applying previously learned information to new situations or events, synthesizing information, analyzing new information, and identifying how and when to seek help. People with executive functioning impairments tend to have difficulty in a variety of these areas.

Now that we have an idea about what is targeted in cognitive-communication therapy, let’s talk a little about what therapy actually looks like. Because there is such a broad spectrum of possible cognitive deficits and a wide range of severity within each one, therapy is highly individualized.

My initial evaluation always includes a discussion of what the patient would like to be able to do better than he or she currently can. I have people who want to get back to supervising fifty-plus employees, people who are trying to home-school their children, people who want to get back to their weekly card group, and people who just want to stop ruining their pans by putting water on to boil and forgetting about them.

No matter what the concern, therapy is likely to include a combination of tasks to improve functional skills and compensatory strategies. Cognitive-communication therapy is always a collaboration between myself and the patients I work with, and the progress we make together is exciting.

So if you speak just fine but are having some cognitive difficulties and you get a prescription or a recommendation for speech therapy, don’t throw it in the trash! You may be able to find help in improving your thinking and increasing your independence.

Questions about cognitive-communication therapy?
Write them in the comments section below, and we’ll answer them!

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