At its core, cognitive communication is the successful integration and co-application of cognitive skills and language skills. Language skills, as we know, refer to our skills and abilities with such areas as morphology, phonetics, syntax, and semantics. Cognitive skills, or thinking skills, refer to such skills as attention, memory, emotional regulation, executive functioning, processing speed, and organization. The use of our cognitive communication skills is what allows us to uniquely express ourselves and interact with the world around us.
Importantly, these skills do not exist in isolation. Think of them as a pyramid, with foundational executive functioning skills at the base, and more complex and specialized skills stacked on top. This means that deficits in one area can lead to difficulties across several others, if not completely toppling the pyramid altogether.
Attention
Generally, attention refers to our ability to direct our concentration and focus, both internally and externally. There are several sub-types of attention:
- Sustained Attention: The ability to attend to or focus on a task or stimulus over a singular period of time. This skill requires cognitive stamina.
- Selective Attention: The ability to attend to or focus on a specific task or stimuli while filtering out competing stimuli or distractors. This skill requires effective multi-sensory processing.
- Alternating Attention: The ability to switch attention and focus between different stimuli or tasks. This skill requires a degree of mental flexibility.
- Divided Attention: The ability to attend to different tasks or stimuli simultaneously. This skill requires the ability to sustain a large cognitive load.
Arguably, attention is the most important foundational skill in cognitive communication skill. Consider the ability to attend to one-to-one conversations in a quiet environment. After a traumatic brain injury or stroke, or in the face of chronic illnesses or neurodivergence, this skill may suffer. Attentional skills in real world contexts only grow in complexity: attending to a two hour lecture, following group conversation, attending in noisy environments, conversing while cooking, and so on. While patients may be able to attend to us and our activities in the therapy room, we have to remember that communication goes beyond this controlled environment.
Emotional Regulation
Emotional regulation refers to our ability to effectively understand, modify, and respond to our emotions. It is a learned skill and effective regulation relies on our metacognitive skills (detailed further below), for long-term processing, learning, and management.
Within the context of cognitive communication, we are consistently regulating our emotions in our daily interactions. Consider the disappointment you feel when your local coffee shop is out of your favourite pastry. You’re not going to start crying, you simply pivot to look for another pastry.
Beyond this, emotional regulation affects our ability to access and accurately implement other cognitive skills. If we are in a state of emotional dysregulation such as heightened anger or sadness, it will make it more difficult to access our attentional skills. It will also affect our ability to organize and formulate ideas and responses, thus leading to friction in the interaction.
Memory
Memory refers to our ability to acquire, store, and access information. Memory is complex and involves multiple stages: encoding, consolidation, retrieval, and reconsolidation. Disruptions can occur anywhere along this chain and intervention will differ depending on what is most affected.
Beyond the memory chain, there are several sub-types of memory:
- Episodic Memory: This is a form of long-term memory and refers to the consolidation and retrieval of specific past events
- Semantic Memory: This refers to long-term storage of general knowledge, facts, and information.
- Procedural Memory: This is a form of long-term memory and refers to your ability to know how to do things, be it physical or mental.
- Short-Term Memory and Working Memory: Short term memory is essentially a short term storage system in the brain. Working memory refers to our STM with the shortest duration, lasting only seconds. This is where we store and actively manipulate a small amount of information for a short amount of time during daily interactions and tasks.
- Prospective Memory: This refers to our forward-thinking ability to set an intention and recall the need to do something in the future.
After an ABI, patients may continue to have appropriate episodic memory for childhood and long term memories through autobiographical memory, but may have difficulty with retaining memories surrounding the incident or in the time following. Procedural memory often remains intact and is often a strength that I use to pair with specific challenges in prospective memory for patients.
Organization
Within the scope of cognitive communication, organization refers to our ability to sort, sequence and/or arrange, and select information. This skill often relies on working memory.
Verbal organization refers to our ability to structure our thoughts and ideas into a cohesive structure that can be understood by our communicative partners. This is often targeted through verbal expression or pragmatics tasks. Beyond verbal organization, SLPs may also target organizational skills such as scheduling and task sequencing, which require linguistic knowledge and comprehension.
Reasoning & Problem Solving
Reasoning and problem solving refer to our ability to identify a problem and sort through information to arrive at a sound solution. Research findings suggest that language skills support complex reasoning abilities. These skills involve organizational skills, generation and ideation skills, abstract thinking and flexibility, and short term memory skills.
patients may benefit from structured practice in implementing reasoning frameworks and insight building activities to identify deficits in their reasoning skills, such as short sightedness, memory impairments, and poor detail-orientation.
Processing Speed
Processing speed refers to the brain’s ability to receive, interpret, and respond to presented information. You can differentiate it from working memory by considering working memory the sticky note on which you have your information and processing speed as the time required to jot the information down.
Slowed processing speed may be seen after TBI or stroke as the brain requires increased time to process presented information. This often impacts conversational skills, but can also impact our ability to take in information presented visually or in the written form.
Social Communication
Social communication refers to our ability to integrate and use verbal, non verbal, and gestural language to interact with others. It encompasses social cognition, our ability to understand and respond to social cues; pragmatics, our understanding of the rules of interactions; and language processing, our comprehension and expression abilities.
This is a complex skill that is high up on that pyramid and that requires the successful integration of several complex skills and social knowledge in real time. Pragmatics refers to the set of rules and customs assigned to an interaction, these rules differ between interaction types and purposes. Most importantly, though, they differ amongst cultures and backgrounds. There is no universal set of pragmatics and successful treatment of social communication must be culturally responsive and aware.
Metacognition
Metacognition refers to our ability to ‘think about how we think’, which requires insight, self-awareness, and flexibility. It is essentially your ability to reflect on your performance during and after a task, such that you can modulate the skills and strategies required for success. Metacognition is often impacted through reduced insight—sometimes the first step is helping patients recognize their difficulties!
As we know, deficits in any of these areas can lead to a cognitive communication disorder. These difficulties may not always appear on formal, standardized assessments. It is important to first be able to recognize the differences in these areas and their unique complexities so that we are better able to identify functional difficulties in our patients. With this knowledge, we can move forward in identifying personalized and appropriate goals to help our patients get back to what they love.
Additional Resources
Baldo, J. V., Paulraj, S. R., Curran, B. C., & Dronkers, N. F. (2015). Impaired reasoning and problem-solving in individuals with language impairment due to aphasia or language delay. Frontiers in psychology, 6, 1523. https://doi.org/10.3389/fpsyg.2015.01523
Callahan, P. M., & Terry, A. V., Jr (2015). Attention. Handbook of experimental pharmacology, 228, 161–189. https://doi.org/10.1007/978-3-319-16522-6_5
Sridhar, S., Khamaj, A., & Asthana, M. K. (2023). Cognitive neuroscience perspective on memory: overview and summary. Frontiers in human neuroscience, 17, 1217093. https://doi.org/10.3389/fnhum.2023.1217093