Upon completion of this chapter, the learner should be able to:
List and describe characteristics of cognitive disorders, perceptual impairments, aphasia, and dysarthria.
Infer the effects of communication deficits on clinical intervention for physical impairments and the ability to meet therapeutic goals.
Identify ways to promote successful communication with patients with neurological disorders.
Introduction: Becoming an Effective Partner in Communication
Although the focus of this textbook is on the physical impairments (characteristics, evaluation, and intervention) of people with neurological conditions, the reality is that many of these individuals present with related disorders that are outside the scope of physical therapy (PT) and occupational therapy (OT) practice and create unique challenges in service delivery by the therapist. Speech-language pathologists (SLPs) evaluate and diagnose disorders of communication and design intervention programs to enhance the communication abilities of many of the patients described in this textbook. Various medical professionals, including SLPs, PTs, and OTs, address cognitive and perceptual deficits in some manner. Knowledge and skills related to definitive communication interventions are not the focus of this chapter; instead, the emphasis is on strategies that promote functional communication and optimize cognitive abilities and perceptual skills in patients to enhance clinical intervention for physical impairments. As a result, the focus and goals for this chapter are much different from those of other therapeutic intervention chapters and include strategies and tips rather than specific communication or language interventions.
A critical aspect of this chapter is understanding the importance of interacting effectively with patients with communicative impairments. Communication is broadly defined as the exchange of ideas using both verbal and nonverbal modes. Successful communication includes accurate “encoding” of messages by the speaker (sender) and “decoding” of messages by the listener (receiver). Communication supports enhanced interpersonal exchanges and patients’ participation in activities of daily living (ADLs). In addition, effective use of communication strategies adds to a patient’s sense of competence and accomplishment (Simmons-Mackie, 2013). Well-prepared health-care providers contribute to patients’ overall quality of care by accommodating their communication needs and recognizing factors in the environment that affect clinical exchanges.
Like most healthy adults, health-care professionals successfully apply the processes of communication (speaking, listening, gesturing, reading, and writing) in an effortless manner each day. In contrast, patients with communication impairments may be overwhelmed by routine aspects of clinical interactions such as asking them to describe their level of discomfort with an exercise or directing them to “lock the wheelchair brakes.” Imagine the frustration of patients who are unable to verbally express their pain or who struggle to comprehend a simple request.
You are apt to hear the expression that “no two brain injuries are alike,” which certainly applies to the unique characteristics of patients who are communicatively impaired. It is important to keep in mind that the disorders described in subsequent sections are quite different ...