Reflective Log 16.04.13 – Cognitive Communication Impairments

1. Think of a recent therapy session or event.

I assessed a patient who had a right MCA infarct with a craniotomy who was 23 years old. I used the FAVORS assessment and the mount wilga assessment to look at his executive functions and language abilities.

Recommendations: Present info orally/ break down large pieces of information – support John with reading (highlighting key words), Give John a structure and explain the aim of tasks (e.g. beginning we will. Middle, end – wh are doing this task because…), repeat key information for John, give him time to process information, check his understanding.

Main difficulties aren’t with language they are with executive functioning, impulsivity, memory, attention, initiating, weighing up facts and making informed decisions. He has been able to use strategies given to him.

The assessments took a long time to complete and were not very motivating for the patient. I gained useful information to feedback to staff on the ward. Furthermore the patient had low insight into his pragmatic communication difficulties e.g. topic maintenance, appropriateness, impulsivity. The patient engaged with goals around planning meals however I did not directly address his pragmatic difficulties.

2. Describe the session/experience

During therapy sessions I feedback assessment results and made a visual aid to support the patients comprehension of his performance, strategies he could use and strategies staff could use to support his communication. The patient appeared to understand the information but was unable to remember it. He did not use the visual aid I had prepared for him and needed prompting to use any of the strategies.

3. What did this session make you feel?

I felt that my therapy session and plan was ineffective for the patient and that he did not fully understand what we were trying to achieve. I feel that I should have enabled the patient to contribute more to his goal setting and therapy plan. Because the patient had difficulties initiating his goals were suggested by me.

4. What has this session has taught you?

- Assess pragmatic skills e.g. by recording a conversation or with a patient and family communication questionnaire such as the LA trobe (one for the patient – how they have changed – what like before and now).

- Organise more group work for the patient to get feedback in.

- Involve patients’ family in goal setting/ therapy treatment plans when the patient has cognitive communication difficulties as they may be better placed to think of functional goals and may be better at giving the patient pragmatic feedback.