Cognitive Communication Disorder Case Study

Cognitive Communication Disorder (CCD) is a common disorder after traumatic brain injury (TBI) which results in deficits of cognitive functions and psychosocial behavior and thus communication abilities (Larkins, 2007). Under consideration is a case study involving a 34-year-old male, A. B., with a history of CCD following severe TBI (i.e., coma for 16 days post-incident, hemiplegia on his left side, significant memory deficits) due to a motor vehicle accident (MVA) two years ago. His wife reports improvements in speech intelligibility and activities of daily living (ADLs), but persistent and significant deficits in attention, concentration, memory, awareness, behavioral and emotional control (e.g., disinhibition and impulsive behaviors), and social interactions. She also reports that he gives too little or too much information, does not organize information to make sense, often repeats himself, has trouble maintaining topics in conversation, talks and processes information slowly, and does not use social cues from others such as gestures, eye contact, and emotions. He has not been able to return to his career as a car salesperson which requires communication, memory, and concentration. Thus, CCD impacts his social interactions as well as participation in activities

such as employment.
Discourse Sample Summary
Throughout the audio sample, A.B. demonstrated the deficits described by his spouse and hallmark characteristics of CCD which create the paradigm of having the ability to say things correctly, but still not make sense (Douglas, Bracy, & Snow, 2007). Specifically, the sample revealed gaps in his discourse cohesion, macrostructure, and global coherence. He excluded information such as referents which were needed to make sense of his response, and he included a relatively low amount of new or useful information reducing the overall relevance of his responses. In one example, he tried to provide details of which direction (i.e., north or south) he was walking, but it was neither clear nor critical for explaining that he was hit by a car while crossing the street.
Similarly, super structural elements lacked episodic components and cues for beginning, middle, and end. Regarding attention, processing, and awareness, he at first seemed to keep up with the conversation, but he later lost track of either the questions or his responses. He often shared details before answering a question or did not address the question until being asked again. Whereas some responses were adequate, poor organization, recall, and reasoning throughout his discourse made it difficult at times to follow and burdened his communication partner for cues, prompts, and carrying the conversation. However, there was no indication that he was aware the listener may have had in following his discourse, or that he had not answered a question the first time.
Treatment Plan Approach
In approaching assessment and treatment, the World Health Organization (2002) model of International Classification of Functioning, Disability and Health (WHO ICF) considers the impairment level, activity limitations, and participation or handicap relative to the environment.

For example, based on the audio tape and information from his spouse, CCD impairments negatively impact his interpersonal interactions such as conversations and his professional participation. However, given its breadth of impact, treatment options for CCD may include cognitive therapy, behavioral approaches, external aids, and pharmacological interventions for (e.g., depression, anxiety) (Barman, Chatterjee, & Bhide,

2016).
Indeed, orientation, attention, memory, problem solving, executive function, critical thinking, and psychosocial functioning (e.g., emotional lability) can all impact communication (Hux, 2011, p. 144). Thus, more information would be gathered during assessment via interviews, structured activities, questionnaires such as the La Trobe Communication Questionnaire (Douglas, O’Flaherty, & Snow, 2000), inventories and rating scales such as the adapted Kagan scales to assess discourse between communication partners (Togher, Power, Tate, McDonald, & Rietdijk, 2010; Kagan, Black, Duchan, Simmons-Mackie, & Square, 2004), and standardized tests (e.g., Test of Everyday Attention (Robertson, Ward, Ridgeway, & Nimmo-Smith, 1994); Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI; Adamovich & Henderson, 1992)). Assisting A.B. to identify facilitators and barriers and to employ compensatory strategies would be part of the process to generalize skills (American Speech-Language-Hearing Association, 2005, Chapey, 2008, p. 958).