Cognitive Communication

Communication is a highly complex skill which forms part of what we call cognition.

Cognitive-communicative disorders affect the ability to communicate by the social rules of language.

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COGNITIVE PROCESSES ARE:

Orientation e.g. knowing the date, recognising your name, recognising where you are
Attention e.g. being able to concentrate and not get distracted
Perception e.g. recognising objects and what they are for
Memory e.g. remembering recent events
Problem solving e.g. how to deal with every-day and non-routine problems
Impulsivity e.g. Not being aware of danger and consequences
Planning & sequencing e.g. being able to change a tire
Social behaviour e.g. being able to react appropriately with other people
Emotional lability e.g. not being able to control laughing/crying
Reduced insight e.g. having limited insight into any or all of these problems. They believe they are acting 'normally'. It makes change difficult because it is hard to deal with a problem if they don't know there is one.

ALTERED TURN-TAKING SKILLS (either overly talkative or not realising that it is their turn to speak)
VERBOSITY (talking too much, interrupting)
TALKING IN AN EXPLICIT WAY or swearing at inappropriate times
ALTERED ABILITY TO TALK AROUND A SHARED TOPIC (changing topic frequently or having a reduced range of topics)
SPEAKING ONLY ABOUT THEMSELVES and fixating on certain subjects
GETTING STUCK ON A TOPIC (wishing to leave hospital)
ALTERED ABILITY TO GIVE INFORMATION IN AN ORGANISED WAY (assuming the other person shares knowledge about the topic when they don't)
NOT USING OR 'READING' NON-VERBAL CUES ACCURATELY, such as facial expressions and body language.

Cognitive communication difficulties can often co-occur with language difficulties such as aphasia.

Cognitive-communicative difficulties occur with the following conditions:

Minimising distractions. Remove background noise – a television or radio can be very distracting
Ensuring you talk directly to the person and not talk over them. Try to sit at the same level as the person, and make eye contact
Establishing a consistent routine and environment where possible
Gaining the person’s attention before speaking to them
Talking about familiar topics
Encouraging the person to communicate
Explaining what is happening e.g. “your brother has come to visit”
Only asking one question at a time
Don’t change the topic suddenly - it’s much easier to talk about one topic at a time
Taking a break if the conversation is “going round in circles”
Keeping written reminders of important information e.g. writing key names and dates in a diary
Use simple language, as this can be easier to understand
Repeat key words or phrases to help the person to understand more
Allow enough time for the person to respond
Give forced alternatives (e.g. would you like tea or coffee?)
Use visual references where possible – for example show a cup when asking whether the person requires a drink
Use gesture to help the person to understand
Give feedback and confirm that you have understood
Activities like looking at photos and magazines or playing simple games are often a nice idea.