What is a cognitive-communication disorder?
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.
Cognitive Processes
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.
Communication Impairments
- 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:
- Traumatic brain injury
- Stroke
- Tumours
- Hypoxic brain damage
- Viral infection
- Old age
- Dementia
What can I do to help?
- 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.
