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
