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Please note, this PREFERRED PRACTICE GUIDELINE is · PDF filePreferred Practice Guideline for Cognitive-Communication Disorders · Approved September 2002 College of Audiologists and

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  • Preferred Practice Guideline for Cognitive-Communication Disorders Approved September 2002

    College of Audiologists and Speech-Language Pathologists of Ontario 2

    Please note, this PREFERRED PRACTICE

    GUIDELINE is currently being revised. Please

    follow the guidelines in this document, but be

    aware that they will soon change.

    CASLPO Sept 2014

    PREFERRED PRACTICE GUIDELINE FOR

    COGNITIVE-COMMUNICATION DISORDERS

    TABLE OF CONTENTS

    A. PURPOSE OF THE GUIDELINE/PREAMBLE ...................................................................... 2 B. DEFINITIONS, TARGET POPULATION ............................................................................... 3

    C. SCOPE OF PRACTICE ............................................................................................................. 4

    D. PREVALENCE OF ABI AND COGNITIVE-COMMUNICATION DISORDERS 4

    E. COLLABORATION REQUIREMENTS...5

    F. PRACTICE SETTINGS & CONTINUUM OF SERVICE ...6

    G. ACCESS TO SERVICES .......................................................................................................... 7

    H. SCREENING ............................................................................................................................. 7

    I. ASSESSMENT............................................................................................................................ 9

    J. MANAGEMENT/TREATMENT............................................................................................. 12

    K. DISCHARGE CRITERIA/PLANNING.................................................................................. 20

    L. REPORTING REQUIREMENTS............................................................................................ 20

    M. CLINICAL COMPETENCIES ............................................................................................... 20

    N. RESOURCE REQUIREMENTS ............................................................................................. 22

    O. PRECAUTIONS ...................................................................................................................... 23

    APPENDIX A: Treatment Efficacy.............................................................................................. 26

    APPENDIX B: Glossary............................................................................................................... 28

    APPENDIX C: Practice Guidelines Summary Statements........................................................... 32

  • Preferred Practice Guideline for Cognitive-Communication Disorders Approved September 2002

    College of Audiologists and Speech-Language Pathologists of Ontario 3

    APPENDIX D: References ........................................................................................................... 35

  • Preferred Practice Guideline for Cognitive-Communication Disorders Approved September 2002

    College of Audiologists and Speech-Language Pathologists of Ontario 4

    A. PURPOSE OF THE GUIDELINE/PREAMBLE

    The purpose of this preferred practice guideline is to define best practice for speech-language pathologists

    providing service to individuals with cognitive-communication disorders following acquired, non-

    progressive brain injury. Best practice must include the patient/client perspective in order to maintain the

    individuals dignity and independence in their environment. This guideline would apply to those

    individuals whose cognitive impairments underlie their communication disorders. This guideline will

    assist in: Establishing consistent practice within the profession for this population

    Guiding continuing education endeavours for this area of practice

    Reducing risk of harm

    Ensuring competent service delivery

    Advocating for conditions to promote best practice

    Informing others of the role of speech-language pathology services in assisting those with acquired brain injuries

    B. DEFINITIONS, TARGET POPULATION

    The term cognitive-communication disorders is commonly used to define the needs of the acquired brain

    injury population in Canada (Freund, Hayter, MacDonald, Neary, & Wiseman-Hawkes, 1994; Wiseman-

    Hakes, Steward, Wasserman, & Schuller, 1998) and throughout the world (Levin, 1992, Serio, Kreutzer,

    & Gervasio, 1995; Spivak, Spettell, Ellis, & Ross, 1992). A detailed description of the interface between

    communication and cognition is imperative for effective rehabilitation (McDonald, Togher, & Code,

    1999).

    Cognitive-communication disorders are communication impairments resulting from underlying cognitive

    deficits due to neurological impairment. These are difficulties in communicative competence (listening,

    speaking, reading, writing, conversation and social interaction) that result from underlying cognitive

    impairments (attention, memory, organization, information processing, problem solving, and executive

    functions). These disorders are distinct from other neurological communication disorders (e.g., aphasia,

    dysarthria etc.) and require specific techniques (ASHA, 1987; Freund, et al., 1994; Gillis, 1996; Heilman,

    Safran & Geschwind, 1971; Sarno, 1980; Ylvisaker & Szekeres, 1986).

    Cognitive-communication disorders are commonly associated with traumatic brain injury (TBI) but can

    also occur as a result of other acquired brain injuries (ABI)1

    such as haemorrhages, stroke, meningitis,

    encephalitis, anoxia, or tumours.

    This guideline focuses on traumatic brain injury, as this is the largest and most documented population

    with acquired, non-progressive, brain injury resulting in distinct cognitive communication disorders. It is

    recognized, however, that there are other subpopulations with acquired brain injury for which these

    guidelines will be applicable and reference will be made where research is available. Regardless of

    aetiology, this guideline will apply to individuals with cognitive disturbances resulting from ABI that

    result in communication problems.

    1 Acquired brain injuries (ABI) are insults to the brain, which have the following characteristics:

    1. They are not congenital in that they do not occur as part of the developmental process;

    2. They have a rapid onset related to sudden trauma or disease process;

    3. They are non-progressive in that degeneration is not expected.

  • Preferred Practice Guideline for Cognitive-Communication Disorders Approved September 2002

    College of Audiologists and Speech-Language Pathologists of Ontario 5

    The philosophy of this guideline is intended to be consistent with the World Health Organizations

    (WHO) International Classification of Functioning, Disability and Health ICF (2001) to support the use

    of unified terminology across health related disciplines (Eadie, 2001; Threats, 2002). Any discussion of

    cognitive-communication difficulties should be framed using WHO terminology as illustrated below:

    Dimension Definition Cognitive-Communication Examples

    Impairment Problems in body structures and/or body functions such

    as significant deviation or

    loss

    Examples of specific cognitive impairments that may affect language: Impaired attention, inflexibility, impulsivity, inefficient processing of

    information (rate, amount and complexity), difficulty processing

    abstract information.

    Activity /

    Participation

    Aspects of functioning from

    an individual or societal

    perspective

    Examples of limitations and restrictions: difficulty in conversations,

    limitations in expressing ideas, opinions, choices, wants and needs,

    social isolation, dependence on others for functional communication

    such as medical, legal, and financial transactions

    Contextual Environmental

    Factors

    Factors which impact disability ranging from the

    individuals immediate

    environment to the general

    environment

    Examples of difficulties imposed by the environment: lack of family and friendship support, reduced social acceptance, financial

    constraints, impairment of complex cognitive functioning required to

    fulfill employment and family responsibilities, inflexible work or

    academic environment.

    Contextual

    Personal Factors

    Individual factors which

    influence performance in

    the environment

    Examples of relevant individual factors: Race, gender, age, lifestyle,

    habits, upbringing, coping styles, social background, education,

    profession, past experiences, character style.

    C. SCOPE OF PRACTICE

    The Audiology and Speech-language Pathology Act, 1991 states: The practice of speech-language

    pathology is the assessment of speech and language functions and the treatment and prevention of speech

    and language dysfunctions or disorders to develop, maintain, rehabilitate or augment oral motor or

    communicative functions. CASLPO maintains that the assessment and treatment of cognitive-

    communication disorders falls within the definition of communicative functions, as it is a well-defined

    and internationally accepted area

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