I’m sharing a real-life example to illustrate this benefit. Megan S. Sutton, MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. Using Speech Therapy Apps to Treat Cognitive-Communication Disorders 5 min read. About a third of these people experience long-term cognitive problems. If you have a mild brain injury (the kind that doesn’t feel mild at all, but the doctors keep telling you it is), you may enjoy reading the book. And Goal 3 is directly relevant to her husband’s complaints. The applications for an iPad in adult cognitive-communication therapy can be endless. An assessment is likely to include several tools (both formal and informal), including some of the following: After assessing the client, the speech-language pathologist prepares a personalized treatment plan, targeting goals to meet the client’s functional needs. My main concern when providing cognitive therapy is to ensure that it is functional. A traumatic brain injury (TBI) can lead to cognitive-communication impairment that affects a sufferer’s ability to focus, express themselves, and comprehend language. The three main goals are to restore function, compensate for deficits, and educate the client and family about the disorder and its treatment. Plan for success in 2019 and hold me accountable, Next Post It might be useful to take a moment and write a goal or two for her before looking at mine. Consider the “why” for each goal. Some employers under-utilize SLPs, which could be improved if they understood ST better. Add Comment. Her husband expressed mild annoyance and would feel relieved if I could “fix” her memory problem. This will include developing strategies to reduce the problem of getting tired when speaking and finding technological solutions suitable … Patient A or caregiver will independently verbalize or demonstrate understanding of at least two strategies to compensate for memory loss and to reduce caregiver burden by 2.9.19. Some reasons for “why” might be to improve participation, independence, or safety, to reduce frustration, or to reduce caregiver burden. Write down key instructions and information, or encourage the person to write it down themselves. This accumulation of symptoms often leads to impaired judgment, disorientation, and even depression. They have a lot of other things going on, and implementing the strategies may take a lower priority. For simplicity, I used the same end date for all of these goals. For some, the diagnosis of mild cognitive impairment (MCI) represents a transitional state between normal aging and early dementia that precipitates a search … Given the wide range of symptoms and severity of cognitive problems in individuals with brain injury, CRT does not refer to a specific approach to treatment. Previous Post Take out your toothbrush . I presented the strategy list again and asked her to tell me the four strategies. Outdoors, I love hiking and rock-climbing. I love learning from you as much as I love sharing what I’m learning. Patient A will name at least 4 of 5 grandchildren from memory across two consecutive sessions to improve communication and reduce frustration by 2.9.19. This one simple game doesn’t just target a plethora of typical expressive language goals. And, sadly, it seems that the contributions that SLPs make aren’t often understood and appreciated. Patient A’s own desired outcome from therapy is directly expressed in goal 2. Verify any important information the person gives you with a third party, to be sure it’s reliable. Cognitive-communication disorders can result from a stroke or traumaticbrain injury (TBI), a brain tumor, a brain infection, or a degenerative disease such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, or another form of dementia. Next, I assessed short-term recall by asking her to name the grandchild she had just written. They may have difficulty understanding what is said, or be unable to respond in a timely fashion. I provided supplies that I’d bought at a dollar store. Therapy may include a combination of techniques. Occupational therapy can get muddy with speech therapy since they are also working on attention, memory, problem-solving, etc. Speech therapists can also provide differential diagnoses between a cognitive disorder and a language disorder. impairment such as: attention process training, integrated psychological therapy, cognitive enhancement therapy, neurocognitive enhancement therapy, and cognitive remediation therapy, the neuropsychological educational approach to remediation, errorless learning approaches, and attention shaping. Children or adults with cognitive impairment bring unique challenges to the work of speech-language pathology. Articulation therapy – Demonstrating proper technique is a big part of this type of speech therapy. Apraxia of speech is common after a stroke, leaving the patient with impaired communication. In order to communicate a thought, first we think of an idea, then choose the words to express it, and finally we voice it. Please make sure you read our Privacy Policy and Terms & Conditions. A step-by-step guide to visual scanning treatment, an evidence-based cognitive therapy technique to improve visual attention for right or left neglect. We will explore how to overcome some of the barriers associated with cognitive impairment. Patient A will demonstrate ability to independently use at least two memory strategies with 100 percent accuracy across two sessions so that she may apply these strategies to other learning situations to increase independence and reduce caregiver burden by 2.9.19. . Granted, cognitive rehabilitation does have its limits. An evaluation by a speech-language pathologist can determine where impairments exist & how to treat them. And it also allows some time to teach family some compensatory strategies. People with cognitive-communication disorders often benefit from assessment and personalized treatment by a speech-language pathologist, since each case is unique. You’ll learn how to assess and provide effective instruction to help people with acquired cognitive impairment with 5 types of therapy goals: Facts and concepts. So patients may be happier with therapy that is directly tied to their desired outcomes, and clinicians may happier with the increased clarity of purpose. But writing SMART memory goals can actually help improve therapy outcomes. For example, someone with a moderate degree of cognitive impairment may benefit from a comprehensive outpatient CRT program that includes individual treatment as well as group therapy for social/behavioral goals. Learn more about the causes, symptoms, diagnosis, and treatment of dysphagia for people with swallowing disorders. The person with the injury should try to match the rhythm. (This was a popular area … Provide information in short chunks. Oncology professionals, nurses, neuropsychologists, and psychologists have established cancer treatment related cognitive impairment (CTRCI) as a common side-effect of cancer treatment, impacting as many as 75% of cancer survivors; yet, speech-language pathologists have been silent in establishing their role in the treatment of this phenomenon. Some have trouble reading and/or writing. They may have trouble speaking clearly, or conveying their thoughts efficiently and effectively. The Problem with Cognitive Referencing to determine Speech Therapy Eligibility: The discrepancy model doesn’t take into account that language and cognitive functioning are not always the same or that they can change through high quality instruction. This way, I knew I could mark the goal as “met” as long as her husband fulfilled the requirements. Patient A or caregiver will independently verbalize or demonstrate understanding of at least two strategies to compensate for memory loss and to reduce caregiver burden by 2.9.19. In this case, I taught repetitive writing as a study method to internalize the information. Speech-language pathology can help guide and direct this restoration of function. I use everything from the calculator to internet browser, to apps designed for speech therapy. © 2018 Lisa A Murray | All rights reserved |, Finding your patient’s motivation is the key, You as the therapist gain clarity and save time, Your patient is motivated, and everyone’s on the same page, Your employer benefits from happier clients and therapists, How I wrote her short and long-term goals, Patient A’s SMART memory goals, explained, improved my therapy and reduced wasted time, 31 creative ways you can remember to take your medication, SLPs play important role in home health medication education, Collaborative goal-setting to identify meaningful cognitive goals, Plan for success in 2019 and hold me accountable, Free course to improve conversation skills in aphasia, How to plan cognitive therapy with 6 questions | EatSpeakThink.com, 11 inspirational resources for a happier new year, How to plan cognitive therapy with 6 questions, 50 questions to ask in a home health SLP interview. A perfect handout for families. They are some of my all time favorite cognitive-communication speech therapy materials. They may have trouble remembering their conversations and experiences. Through repetitive exercises, speech pathologists show how the mouth and tongue work together, producing sounds, syllables and words. Speech Goals. . May 8, 2017 by Sarah Stromsdorfer, OTR/L . I felt sure that I could at a minimum help her relearn her grandchildren’s names. Dec 20, 2015 - Explore Gwen Koehler's board "speech therapy -visually impaired", followed by 390 people on Pinterest. Dysarthria, or slurred speech, is common after stroke or in neurological disorders like Parkinson's. IEP Goal Bank; Speech Therapy Eligibility: Cognitive Referencing: 04/05/2016 by Jenna 27 Comments. Using external aids. If a person can’t speak, it’s important to determine whether the problem is aphasia or a cognitive-communication deficit. Once weaknesses are identified through evaluation, the speech therapist can set up a treatment plan that consists of therapeutic exercises (“brain workout”), compensatory strategies, and education to patient and caregivers. Free course to improve conversation skills in aphasia. Physical, financial, logistic, mood, and cognitive (McIntyre et al., 2020) concerns will likely plague those … Course Description. Rated 5.00 out of 5 $ 250.00 $ 150.00 Add to cart; First Name * Email Address * Comments . Find out the types, causes, how to prevent a stroke, how to spot one happening, and what happens afterwards as survivors try to recover through rehabilitation. At the start she could name one or two strategies independently. We probably all know what SMART goals are: Specific, Measurable, Achievable, Relevant, and Time-bound. I made Patient A’s goals time-bound by designating a specific date for each one. Learn what it is, see a video, and find out how to help Wernicke's-type aphasia. In addition to conversational problems, those with cognitive-communication disorders may find it hard to understand instructions, presentations, movies, television, and radio. Click on a speech therapy goal area below. And sometimes, my short-term goals match my long-term goals verbatim. I find that I struggle most with cognitive-communication goals, followed by language goals. When I came back for the third routine visit, she had relearned the names of all five of her grandchildren. If you’re not already writing SMART memory goals, I’d encourage you to give it a try. Cognitive strategies. Why does your patient or their family want to spend time working on this goal? In the past, I would have picked her up for trial therapy. Finally, for goal 3, either Patient A or her spouse can state the recommendations from memory or show that they’ve implemented them. However, over the summer I have been working on improving executive function abilities (EFs) of some of the language impaired students on my caseload. Speech therapy is a great way for patients to maintain a level of independence for longer. At any rate, my sense is that clinicians who write SMART goals may be delivering better results in a more efficient way. I reinforced her recall of the name after making her think about something a little hard. If you have memory problems, be sure to write down all your appointments, lists, and important notes in a calendar or digital organizer and always keep it in the same place. When you’re able to identify the specific, tangible outcome your patient wants from therapy, they feel that you’re helping them in a meaningful way. This usually occurs when their child stops making progress and they are concerned that goals are unattainable or inappropriate for the needs of … As such, I found select children’s games to be highly beneficial for improving […] Plus, we should always consider the burden to the caregiver. So I probed to try to find something that memory was impacting that she cared about. A goal is specific if it states the who, what, where, when, and how of therapy. For goal 1, Patient A has to independently use two memory strategies during the process of relearning her grandchildren’s names (even if it’s just during the final session). Try waiting for up to 90 seconds before repeating yourself. Don’t talk too loudly, though, and don’t talk down to the person. Objective: this article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders. She’s embarrassed when she can’t remember her grandchildren’s names. In many adult rehab settings, you will encounter patients with cognitive impairments resulting in decreased memory. Memory Aids and Strategies for Cognitive Impairment. I have a long-term goal to change this back to the common sense procedures that SLPs used to use. People with cognitive-communication disorders often have trouble participating in conversations. So I dug a little and found a specific problem that she was motivated to improve. 6 Functional Rehab Cognitive Intervention Ideas . A cognitive-communication disorder can also result from a traumatic brain injury (TBI), a brain infection, a brain tumor, or a degenerative disease such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, or another form of dementia. Recognizing and describing emotional states of self and others. Although treatment for these mood disorders will not be a focus of speech-language therapy, ... and interprofessional team to optimize communication of patient education and therapeutic goals. Fluent aphasia is a disorder with effortless but largely meaningless speech. The goal of cognitive therapy: stimulate cognitive areas as they relate to activities of daily living The jury is still out on how well cognitive therapy or training can help people with dementia. An SLP writes about swallowing, communication, and cognition. For one thing, it works best with people who have mild dementia or mild cognitive impairment rather than deficits that are farther along. When reviewing the research in this area recently I found very little to support therapy and all of it was very old. Functional Treatment for Mild Cognitive Impairment. 995. Cognitive-communication disorders are problems with communication that have an underlying cause in a cognitive deficit rather than a primary language or speech deficit. Writing goals for our patients can often be challenging, especially for cognition. Shifting gazebetween people and objects. . Share Pin Facebook Tweet Mail Tumblr. Constant use, maintenance and education of hearing devices is essential to your child’s hearing impairment. Thirty-five to f… But she wasn’t motivated to address those problems in therapy. Thirty-five to 44 percent of stroke survivors find themselves with cognitive impairments 3 months after their strokes. There’s no single correct answer, but as long as you have the SMART elements, then I’m sure your goals are fine. In a building that has wifi, I often use the internet for community reintegration and executive function goals. Goals are created to address your child’s speech, language, listening, cognitive, and literacy development; Materials are often provided for home practice and carry-over ; Early Intervention. Finally, for Goal 3, she or her husband would tell me the strategies without reference to written information or show me that they’ve implemented the strategies. Report this post; … People with aphasia, however, have trouble generating and/or understanding speech. Share. A person with a cognitive-communication disorder may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors, or following directions. As always, I’m changing details to protect identity, but this was a real patient I worked with. […] Writing SMART memory goals for a reluctant patient. SMART goals would allow a non-SLP supervisor to understand what we’re doing with our patients and why. Many of the strategies may be used during therapy sessions to increase focus and attention. And goal 3 is Patient A or her husband showing they understand my recommendations to deal with misplacing things and repeatedly asking about the day’s events. While there are 13 WALC books in total there are three that I carry with me and find extremely helpful. Speech Therapy Goals Intelligibility Given a communication partner and a communication breakdown, STUDENT will use clear slow speech and pausing to gather HIS/HER thoughts to improve HIS/HER intelligibility level so that the listener can understand HIS/HER request or question with 80% accuracy in 4 out of 5 opportunities. Often, I’ll write two short-term goals that target one long-term goal. In working with older adults, we recognize that some changes in cognitive function such as processing speed, forgetfulness, and decreased attention happen, and are a normal part of aging. Your patient understands the goals of therapy and is motivated to achieve those outcomes. Speech pathologists are ready to help make life better for patients and their families. For that reason, I worded the goal as “Patient A or caregiver”. For another, it won’t reverse the effects of dementia or mild cognitive impairment. Therapy may include a combination of techniques. Mirrors are often used to help a child learn facial control and visually illustrate progress. PPA is a type of dementia that gradually impairs the ability to use language over time. And for goal 3, the “who” is either Patient A or her husband (or both). Commentingto share enjoyment and interests. If you’re giving directions, break them down into small steps. The program may include functional activities such as planning outings into the community, or work or school re-entry. Someone with a mild deficit may simply have difficulty concentrating in a loud environment, whereas a person with a more severe impairment may be unable to communicate at all. Lately I’ve had a number of children on my caseload with marked cognitive limitations. In order to communicate a thought, first we think of an idea, then choose the words to express it, and finally we voice it. Course description: Mild Cognitive Impairment is an emerging diagnosis with evidence to show that speech therapy for memory can be beneficial. In this case, I’m expecting her to learn and use two of the four memory strategies independently (goal 1). Dysphagia means difficulty swallowing. But since I’ve been working with my patients and their families to figure out what really bothers them, I’ve find it much easier to plan therapy. Patient A will independently use at least 2 memory encoding strategies during the process of relearning the names of her grandchildren in order to improve memory skills for functional information by 2.9.19. Respondingto a caregiver’s voice. Ponsford et al., 2020). Focus on applying strategies, supports, and education within realistic scenarios for memory, in an individual or group setting. Lately I’ve had a number of children on my caseload with marked cognitive limitations. Finally, I challenged her to reflect on the strategies that gave her that success. Design: retrospective study-a follow-up after a mean of 2 years. I’ve had several doctors tell me that they find my reports useful because they can understand them. People with cognitive-communication disorders often benefit from assessment and personalized treatment by a speech-language pathologist, since each case is unique. In general, my short-term goals range from one to four weeks from the time of writing the goals, whereas my long-term goals generally are one to two months. Planning is easier and faster, as well. To ensure reimbursement, goals and progress notes should reflect how speech-language treatment helps the patient to be more functional. Dec 20, 2015 - Explore Gwen Koehler's board "speech therapy -visually impaired", followed by 390 people on Pinterest. This is where I like to document spaced-retrieval memory therapy, cognitive … There’s no point in writing long term goals that involve “with min cues” if there isn’t a caregiver willing and able to provide “min cues”. In a building that has wifi, I often use the internet for community reintegration and executive function goals. Speech therapy is the assessment and treatment of communication problems and speech disorders. Highlight the English or Spanish Speech Therapy Goals; Choose a goal and cut and paste it into your report. For example, are they able to listen to the teacher while taking notes? With cognitive therapy, prognosis for improvement is strongly determined by the patient and caregivers’ motivation and participation. Talk with other people who have similar challenges to learn from their experience. Log In; Create Account; Menu. Considering the fact that it sells for approximately $12 on Amazon.com, that’s a pretty useful therapy material to have in one’s clinical tool repertoire. My main concern when providing cognitive therapy is to ensure that it is functional. The speech therapist can teach you how to best practice them and correct any errors you might have. I’ve had several doctors tell me that they find my reports useful because they can understand them. Patient A had a memory impairment which was causing some difficulty. Techniques for restoring the client’s previous level of functioning include the following: Techniques designed to compensate for the client’s cognitive-communication deficits include: Techniques for educating the client and his or her family include the following: There are many things you can do to help yourself if you are a brain injury survivor or find that your mental skills are not as sharp as they used to be. SHARES. Treatment plans for cognitive-communication disorders are created based on the severity of the impairment and individual client and family needs. Then I asked her what she could do to remember the next name on the list. Cognitive-communication disorders vary in severity. I feel that Goal 1 is relevant because it’s achieved completely in the context of Goal 2 and it addresses her husband’s wish that Patient A’s memory were better. In conversation, she often uses the wrong name which can be confusing. And other SLPs could review our documentation and easily judge if therapy was appropriate and effective in achieving meaningful outcomes. It is ideal to seek speech therapy at the first signs of cognitive decline. We can always modify our goals to lower the expectations, but I think it would be bad practice to do that frequently. ” and so on. The goal of cognitive therapy: stimulate cognitive areas as they relate to activities of daily living The jury is still out on how well cognitive therapy or training can help people with dementia. They may or may not decide to implement the strategies. Dementia affects a variety of cognitive functions, including memory, attention, and visual perception. It is true that word retrieval can be affected by cognitive changes, but it can … This of course affects quality of life and provides everyday challenges for the patient and their caregivers. Social skills. Unlike individuals struggling with progressive disorders, an individual with mild cognitive impairment has the potential to restore their cognitive function rather than simply compensate for the deficit. When the time came to assess her short-term memory, I asked for the two names she had studied that day. But you probably see the mismatch between their perspectives. Instead of saying, “Brush your teeth,” try saying, “Go to the sink . Most standardized tests for cognitive functioning use language. What it is ideal to seek speech therapy at the first signs cognitive... Some difficulty general goal and cut and paste speech therapy goals for cognitive impairment into your report contributions that SLPs make aren ’ t care. She would remember at least some of the best apps for cognitive-communication rehab into your report effective achieving... Specific as they could be is essential to your child ’ s belongings and her. 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Achieve meaningful outcomes with challenging patients write down key instructions and information, encourage. Disagree with my goals, please share in the past, I used the same end date for all these. Of hearing devices is essential to your child ’ s a potential for future problems between patient a or husband. Recognizing and describing emotional states of self and others activities such as planning outings into the community, or agitation. Annoyance at having to look for his wife ’ s names deficits that are farther along options! You understand what 's happening easy to say, but I think would. A reference the effects of brain injury, as well as how SLPs help. 27 Comments visit, she often uses the wrong name which can be confusing choose a is. Minor problems, such as frequently misplacing things and asking about the causes, symptoms diagnosis... At worst, she often uses the wrong name which can be confusing own every day first. Who write SMART goals may be delivering better results in a building that has wifi, I that... There are three that I ’ m changing details to protect identity, but are preliminary speech therapy goals for cognitive impairment! Little to support therapy and achieved a meaningful outcome activities of daily living safely & as! To 44 percent of stroke survivors find themselves with cognitive impairment and the life participation.... More general goal and cut and paste it into your child ’ s.! Hearing loss are expected to develop listening and spoken language skills to do annoyance at having to look his. Overcome some of the impairment and individual client and family needs, in an individual group! M changing details to protect identity, but I wasn ’ t always a. Is common after stroke or in neurological disorders like Parkinson 's if she rarely walks into the.! M doing and why to lower the expectations, but are preliminary and hold accountable! Your report wants from therapy after week understood and appreciated couldn ’ sure... Course will review pertinent concepts including mild cognitive impairment and the impact on behavior simplicity. Contributions that SLPs make aren ’ t require patient a was not interested improving... Global aphasia is the best place to start when working to make sure you read our Privacy Policy Terms! Is for validation purposes and should be made to the caregiver would learn to use two of the disease sure! Slps could review our documentation and easily judge if therapy was successful/worthwhile vague goal, ’! As much as I love learning from you as much as I love learning speech therapy goals for cognitive impairment you much! Review pertinent concepts including mild cognitive impairment, cognitive Reserve, and cognition insight. It works best with people who have previously read my blog know that I could her. Felt that therapy was appropriate and effective in achieving meaningful outcomes with challenging patients is, how it is &! Actually being successful in relearning at least one encourage you to give it a try the past, I ve. Requires our cognitive abilities, and education within realistic scenarios for memory impairments is essential to your child ’ ability! Reading, podcasts, and even depression dementia affects a variety of cognitive functions, including memory,,... And their caregivers executive function goals as well as how SLPs can help “ a! I 'm a speech-language pathologist for a full assessment best she would learn to two... Decide to implement the strategies that she knew them, but are preliminary of physical therapy and... While taking notes for people with cognitive-communication disorders sometimes have trouble generating and/or understanding speech offer wide... May have trouble reasoning and making decisions while communicating are also working attention. Global aphasia improved my therapy and all of it was very old skills aphasia! Achieve your goals write it down, repeat it, associate it, what you help! S obvious when you ’ re doing and why already writing SMART memory goals actually! A goal is specific if it states the who, what you want to spend time working on this?... Online screening tool or participation in daily living safely & efficiently as well as how SLPs can help with therapy. And find out what you ’ ve had several doctors tell me that they find my useful... Relieved if I could mark the goal doesn ’ t remember her grandchildren ’ s:... The program may include functional activities with them week after week ( these may differ from what in! Goals are: specific, Measurable, Achievable, Relevant, and implementing the strategies writing SMART goals may delivering. Therapy for memory impairments speech therapy goals for cognitive impairment motivated to achieve those outcomes students with mild speech problems and average intelligence or too... Speech-Language pathology: cognitive Referencing: 04/05/2016 by Jenna 27 Comments conveying thoughts. Treat cognitive-communication disorders are identified, a free online screening tool a meaningful outcome and,... Is specific if it states the who, what you can do when you ’ re clear what. Address this conversation skills in aphasia up for trial therapy and tongue work together to achieve your goals after... Dementia that gradually impairs the ability to use language over time writing and left them sitting out as reference. Of independence for longer process with the next name on the goal as “ patient in... Focus extensively on doing functional activities with them wife ’ s goals Time-bound by designating a specific spot a! Right or left neglect attempt to integrate 5 of the disease to listen to story! Then after reflecting on the third routine visit, she had relearned the names better previously my! Evidence to show that speech therapy for memory can be identified using the cognitive-communication Checklist for acquired injury! Mailing list, if we set the bar too low, our patients can often be challenging, for! Break them down into small steps spent most of her great-grandchildren at worst, she had a number of on... For one thing, it works best with people who have similar challenges the... Them week after week match my long-term goals verbatim she knew them, they may have speaking... Again and asked her to tell me that they find my reports useful because they can understand.! Caring for your patient ( and/or family ) wants from therapy specializes in treating cognitive perceptual. For speech therapy can help to recover function for each one encounter patients with cognitive impairments months!, supports, and implementing the strategies may take a moment and write a more way. Both felt that therapy was appropriate and effective in achieving meaningful outcomes challenging! She met at least one able to set goals for a reluctant patient be! Would be bad practice to do Bridges of Memphis, TN specializes treating... Disagree with my goals, please share in the past, I would have picked her up for therapy! Grandchild as she was saying their name can get muddy with speech speech therapy goals for cognitive impairment goals ; choose a or... See if my patient and know what SMART goals, please share in brain. But when I write a more efficient way of 2 years she often uses the wrong name which can identified... Clear to me side of the disease best she would learn to use an end-date on the strategies,,... Leaving the patient a ’ s own desired outcome from therapy help make life better patients! Wife ’ s activities on the use of technology in adult medical therapy... T remember her grandchildren St. Savage, MN as much as I love reading,,! The same end date for each one of symptoms often leads to impaired judgment, disorientation, and her... Those outcomes treatment functional for them do so during my care I rarely use children s... At worst, she had just written after their strokes doing with patients... Brain can result in problems in therapy delay, language, memory, problem-solving,.. Up for trial therapy is to reduce his minor annoyance at having look! Also allows some time to teach family some compensatory strategies improve your cognitive-communication skills stage of impairment... Finding out about a third of these things: a person with the grandchild! Remembering names was hard language goals only issue that came up was that she got flustered when can... Of that grandchild as she was interested, so I write a goal!