A Look at Cognitive Therapy from an Adult Rehab Perspective

Mark A. Ittleman
The Teaching of Talking 

March 20, 2014

A colleague asked that I make a comment about “cognitive therapy”  that may be necessary following injury, surgery, advancing age, or medication therapies.

Personally, the question I would always address would be:  “What are the goals for cognitive therapy which would give the patient the most value in these days of rehabilitation caps?
What would be the intervention and implementation that would make the most difference for the well being and safety of the patient?

During the earlier years of practice I would tend to comb through cognitive manuals looking for the exercise that would be appropriate.  Today there are new apps which are providing clinicians and people with cognitive difficulties useful exercises and activities to stimulate thinking, memory, problem solving, etc.  During the early stages of recovery from strokes, aphasia and brain injury our goals and approaches deal predominantly with safety.

Physical and Occupational therapists and Rehab. docs call upon speech language pathologists to help Mr. Jones who keeps falling, or Mrs. Smith who can’t seem to transfer on her own bed or chair due to her diminishing memory, especially to recall the sequence of transferring safely.  The rehab doctor, and colleagues look to the speech language pathologist with one thing in mind:  safety.  Family members are also concerned about their loved ones falling, or forgetting to lock the wheel chair brakes, or remembering to use the walker when getting up in the middle of the night; or forgetting to turn the stove or the space heater off.

These concerns are vital to the rehabilitative process, and what is more important than assuring patient safety?  It then became important for me to put the notebooks aside and visit the patient in his room, or do team treatments with PT’s an OT’s to really observe, first hand, their cognitive and safety concerns.  It was an educational experience to watch how cognitive deficits were interfering with the ability to get out of bed, walk, talk, and perform even the most basic activities of daily living.

We as speech language pathologists have the training to simplify the giving of directions, and realize how the speed and complexity of instructions affect comprehension and learning.  Speech Language Pathologists look at how to present information so that it can be comprehended readily and sometimes the verbal instructions for many patents do not work as well as the written form, or realizing that some patients learn faster when they are shown visually, or “walked through the principles of what needs to be addressed kinesthetically. Language dialects and the ability to comprehend directions are often greatly affected by speed of instructions and the simplicity of directions.

The speech language pathologist is the perfect person to help with cognitive and safety goals that will really make the most difference for many patients who are recovering in a hospital, extended care facility or at home.  We can make such a major contribution when we ask a few simple questions such as “Is your loved one safe? Are they oriented to where they are living currently?  or Have you noticed anything in their behavior that could possibly put them at risk of an accident?"

When the answers are forthcoming we need to observe those specific behaviors or concerns and figure out a way to help the patient “remember” to do them in a safe manner.  This will frequently require that the Speech Language Pathologist learn the sequence of those maneuvers from the OT or PT and then apply the principles of learning which would include comprehension, problem solving, home safety issues, simplicity in instruction, order, sequence, repetition, integration and carry over.  Once a patient’s safety is relatively assured, the speech language pathologist can address other cognitive issues which may not be as critical.


Mark Ittleman, M.S., CCC/SLP
Senior Speech Language Pathologist
Kindred Rehabilitation Hospital
Humble, Texas


Mark Ittleman is a speech language pathologist with over 40 years of clinical experience addressing speech, communication and cognitive defecits.  He has written a book:  The Teaching of Talking which is available on our website in print or audio format at http://www.teachingoftalking.com to help speech pathologists, caregivers and family members learn methods to stimulate speech and language for those who are not talking or for those who have lost the ability to talk.  Please visit our website at teachingoftalking.com for useful information and you can become friends on Facebook at Teaching of Talking.  We are also available to mentor speech language pathologists and family members in the Teaching of Talking Methods.