Cognitive-Communication Rehabilitation for Individuals With Traumatic Brain Injury This issue of Perspectives is devoted to a discussion of four areas of cognitive-communication rehabilitation (CCR) that speech-language pathologists are typically called upon to provide to individuals with traumatic brain injury (TBI). As a unique collection of interventions, CCR is relatively young, having started in the late 1960s, and “includes ... Article
Article  |   October 01, 2002
Cognitive-Communication Rehabilitation for Individuals With Traumatic Brain Injury
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Attention, Memory & Executive Functions / Traumatic Brain Injury / Articles
Article   |   October 01, 2002
Cognitive-Communication Rehabilitation for Individuals With Traumatic Brain Injury
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2002, Vol. 12, 3. doi:10.1044/nnsld12.3.3
SIG 2 Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, October 2002, Vol. 12, 3. doi:10.1044/nnsld12.3.3
This issue of Perspectives is devoted to a discussion of four areas of cognitive-communication rehabilitation (CCR) that speech-language pathologists are typically called upon to provide to individuals with traumatic brain injury (TBI). As a unique collection of interventions, CCR is relatively young, having started in the late 1960s, and “includes the assessment and treatment of underlying cognitive processes (e.g., attention, memory, self-monitoring, executive function) as they interact and are manifest in communication behavior, broadly understood (listening, reading, writing, speaking, gesturing) at all levels of language (phonological, morphologic, syntactic, semantic pragmatic)” (Kennedy et al., 2002, p. x).
The authors describe intervention approaches (and outcomes) for attention impairments, memory disorders, discourse deficits, and challenging behavior. In the first article, Sohlberg describes five approaches for managing attention impairments after TBI, including direct attention process training, the use of metacognitive strategies, the use of external aids, environmental/task modification, and collaboration. She emphasizes the use of metacognitive strategies in combination with the other approaches. In the second article, Avery and Kennedy discuss internal and external management approaches for impaired memory, including a description of how impaired self-monitoring can interfere with making strategy decisions. We conclude with a brief discussion of when, with whom, and under what conditions various approaches can be successful. In the third article, Canniz-zaro, Coelho, and Youse discuss intervention for impaired discourse, beginning with a description of micro- and macro-structural impairments in the discourse of persons with TBI. They summarize the too few empirical studies on the efficacy and effectiveness of intervention and conclude with recommendations and a call for more empirical research. In the final article, Ylvisaker reviews the challenging behaviors associated with TBI and identifies several explanations as to why consequence-oriented approaches may fail to change behavior. Using an applied behavioral analysis approach, Ylvisaker concludes with a description of positive behavior supports (PBS), a management approach that emphasizes clients’ understanding of immediate and remote antecedents of their behavior. The four areas of CCR discussed in this newsletter only begin to address the diverse targets of intervention by speech-language pathologists. For example, intervention for executive functions, such as planning and problem solving, are well within speech-language pathology’s standard of practice with this clinical population, though not highlighted here.
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