Reflective log: Cognitive communication impairments and aphasia

1. Think of a recent therapy session or event.

A patient with comprehension impairments and cognitive communication impairments was due to be discharged soon and I needed to review their progress in SLT and consider whether to refer them to further community SLT.

2. Describe the session/experience

I used the cognitive screen of the CAT to assess the patient’s ability to access SLT in the community and completed the comprehension parts of the CAT to look for any improvements in function over their stay. The patient had completed much of the CAT when they had initially come in. The patient was fluent and used complex language but was very distractible and found it difficult to follow/ understand instructions resulting in very low CAT scores. I decided not to refer the patient to community services since they achieved very low scores on the CAT cognitive screen e.g. recognition memory and had not shown any improvements on the CAT despite intensive therapy.

3. What did this session make you feel?

I felt that I needed to have structured some of my initial informal assessments better in order to assess outcomes for a patient with cognitive communication impairments. Some of my SMART goals were hard to outcome e.g. being able to summarise a news article, being able to stay on topic in a one to one conversation about a familiar topic when minimally prompted.  It was difficult to assess for change. I felt it was good that I had done the CAT initially because I could use this to measure change.

4. What would you want to change, and why?

- Consider giving therapists a cognitive communication questionnaire to measure change in ability to access therapy.

 - Consider an MDT baseline e.g. the patient performed similarly in other therapies and was unable to participate fully in therapy sessions/ show any carry over.

5. What has this session has taught you?

- Use more outcome measures/ gain a clearer baseline of functioning.

- consider a patients cognitive ability to engage with therapy and make gains.

- poor performance on the CAT cognitive screen may be a negative prognostic indicator for change.

6. What do you need to learn or find out before the next event?

- Create a questionnaire on access to therapy which can be used as an outcome measure.

- record a conversation with the patient as a baseline to look at how many times they need re-directing as an outcome measure.

- continue to use the CAT cognitive screen to consider whether a patient can access therapy.

Questionnaire

Measure
Able to follow one-stage instructions in context	With modelling, prompting, repetition and tactile prompting	With prompting	With repetition
Able to maintain attention during a 10 minute session	With frequent prompting and re-directing	With occasional prompting and re-directing.	Independently
Able to remember a strategy/ instruction form a previous session	With repetition and prompting.	With prompting	Independently