We treat people with neurological impairments that impact their ability to learn, remember, solve problems and express themselves. These disorders can be present at birth or result from an injury or other decline in skills. Therapy activities will vary widely depending on what cognitive problems are present. The main goal will be to improve the client’s ability to complete daily activities (e.g., self-care, school work, job skills) as independently as possible. The SLP will teach the client compensatory strategies to help work around cognitive problems.
The term cognitive disorders is a very broad one that means any type of problem with cognition (i.e., thinking skills). There are many types of cognitive skills, including attention and concentration, memory, reasoning, problem solving, visual-spatial skills, and a group of skills called executive functions. Executive functions are high level thinking skills that allow a person to plan and carry out activities independently. Initiation, planning, goal setting, organization, time management, self-monitoring, and evaluation are all executive function skills.
Cognitive disorders may start at any point in life when brain damage occurs. Traumatic brain injury, stroke, tumor, dementia, Parkinson’s disease, substance abuse, or other neurological injuries and diseases can cause this damage. Other cognitive disorders are evident from birth or early childhood, such as those associated with developmental conditions like attention deficit/hyperactivity disorder (ADHD) or autism. Executive function problems, in particular, often emerge as a child moves into later elementary grades and school demands increase. Psychiatric disorders (e.g., depression) may also negatively affect cognitive functioning.
Symptoms of Cognitive Disorders
The type(s) and severity of cognitive disorders depend on how much and where damage has occurred. Symptoms might be barely noticeable and only affect ability to do very challenging mental tasks. Some people with cognitive disorders can do basic daily tasks (e.g., dressing, bathing, fixing simple meals) but cannot hold a job or go to school. And some people’s thinking skills are so impaired that they need a lot of help with even simple tasks.
Symptoms of cognitive disorders may include:
- Difficulty paying attention to a task, or switching attention from one task to another
- Confusion about date or time of day, or where they are
- Problems recalling recent events, learning new information, or remembering to do things in the future
- Rarely starts conversations, or needs cuing to get started with tasks
- Needs longer than normal to process what he hears or reads
- Misses appointments, loses items, or seems disorganized in general
- Cannot think of more than one solution to a problem
- Problems reading maps, charts and graphs
- Difficulty completing multi-step tasks
- Often underestimates how long it will take to complete a task; often late to appointments
- Poor judgment or impulsive behavior (i.e., acting without thinking)
- Not aware of his weaknesses/impairments
Assessing and Treating Cognitive Disorders
A team of professionals will often assess cognitive skills. The team includes a Speech-Language Pathologist (SLP) in addition to psychologists, social workers, teachers and/or occupational therapists. They may give formal and informal tests to check many different cognitive skills. Such tests may not fully measure how well a person might function in real-life situations, so the SLP and other team members may also observe the client during normal daily activities.
Therapy activities will vary widely depending on what cognitive problems are present. The main goal will be to improve the client’s ability to complete daily activities (e.g., self-care, school work, job skills) as independently as possible. The SLP will teach family and possibly friends, teachers or bosses about how much help the client needs with different tasks, and how best to assist him.
The SLP will teach the client compensatory strategies to help work around cognitive problems. These are systematic ways of doing things that use a person’s strengths to overcome his weaknesses. Some examples include: decreasing visual and auditory distractions in the environment; using aids such as paper or electronic organizers, calendars, alarms, and checklists; and breaking tasks down into separate steps. SLPs may also use paper/pencil or verbal activities or computer programs to improve impaired thinking skills by practicing memory drills, attentional focus, visual spatial skills, reasoning tasks, etc.