The Speech Therapy Centres of Canada offers speech language pathology services in Toronto, GTA and surrounding areas. They have a team of dedicated speech-language pathologists (commonly known as speech therapists), each focusing on a particular area of speech therapy. Line of services we are providing at The Speech Therapy Centres of Canada are Autism, Speech Delay, Language Delay, Stuttering, Accent Modification, ABA and much more. Contact at 65B West Beaver Creek Road, Richmond Hill, ON L4B 1K4, 905.886.5941.

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THE SPEECH‐LANGUAGE PATHOLOGIST REPORT:
HOW THEY MAKE A DIFFERENCE
“COMMUNICATION IS MORE
THAN WORDS”
WRITTEN BY: JEANETTE PODOLSKY
SPEECH‐LANGUAGE PATHOLOGIST, REG: CASLPO
CLINICAL DIRECTOR
THE SPEECH THERAPY CENTRES OF CANADA
SEPTEMBER 2010 (REVISED APRIL 2011)

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When assessing a client following a Traumatic Brain Injury (TBI) there are many areas
addressed by a speech‐language pathologist (S‐LP). These areas include: attention,
memory, auditory comprehension, speech, swallowing, expressive language including
social communication (pragmatics), discourse, verbal reasoning, and executive
functioning.
The concept of “permanent serious impairment” is an important one for the S‐LP to
consider when completing an assessment report. While S‐LPs cannot determine
whether a person meets the requirements for Catastrophic Impairment, the detailed
assessment and subsequent reports when conducted and written properly, taking the
American Medical Association Guides to the Evaluation of Permanent Impairment, 4th
Edition into consideration, can play a significant role in contributing to this Catastrophic
(CAT) determination.
WHAT TO LOOK FOR IN AN S‐LP’s REPORT
1. The S‐LP’s knowledge of cognitive‐communication and in particular the
subtle changes that occur following a TBI. The College of Audiologists and
Speech‐Language Pathologists of Ontario (CASLPO) states that “Cognitive‐
communication disorders are communication impairments resulting from
underlying cognitive deficits due to neurological impairment. These are
difficulties in communicative competence (listening, speaking, reading,
writing, conversation and social interaction) that result from underlying
cognitive impairments (attention, memory, organization, information
processing, problem solving and executive functions). These disorders are
distinct from other neurological communication disorders (e.g. aphasia,
dysarthria etc.) and require specific techniques.” (ASHA, 1987 Freund, et al.,
1994; Gillis, 1996; Heilman, Safran and Geschwind, 1971; Sarno, 1980;
Ylvisaker& Szekeres, 1996).
2. The detailed pre‐ and post‐accident cognitive‐communication, speech and
language functioning. This aspect must be included in all reports.
Knowledge of social functioning pre‐ vs post‐ injury can provide extremely
significant information with regard to level of impairment.
3. A framework that must include the International Classification of
Functioning (ICF). The International Classification of Functioning (ICF) is the
World Health Organization’s (WHO) framework for health and disability. “It

3. is a conceptual basis for the definition, measurement and policy
formulations for health and disability. It is a universal classification of
disability and health for use in health and health related sectors.” (Towards
a Common Language for Functioning, Disability and Health: ICF, Geneva,
2002).
The ICF specifies higher‐level cognitive functions, attention, memory,
language, and voice and speech functions to be considered under Analysis
of Impairment of Body Functions (ICF Checklist Version 2.1a, Clinician Form,
2003). In addition, under Activity Participation and Participation Restriction
(AP&PR) it specifies communication as its own domain which includes:
receiving and producing both verbal and nonverbal messages as well as
conversations. Interpersonal interactions and relationships (which involve
social communication skills) are also addressed within their own domain
under AP&PR.
4. Formal standardized testing methods. The CASLPO Preferred Practice
Guideline (PPG) for Cognitive Communication Disorders (2002) states,
“There is an obligation on the part of the speech‐language pathologist to
be aware of the standardized tests that are available and to use and
interpret them appropriately.” (p.10) The combination and type of
standardized measures used need to be carefully selected by the S‐LP.
These need to target both the obvious and subtle changes which frequently
occur following a TBI.
5. Non‐standardized testing methods. In order to assess areas for which
there are not standardized tests available, the CASLPO PPG lists as
“Required”, the use of such items as checklists, interviews, disability
measures, behavioural observation charts, and questionnaires. (p.22) S‐LPs
are trained to use these required items and thoroughly examine the client’s
communication both qualitatively and quantitatively.
The importance of using both standardized and non‐standardized testing
methods is particularly significant when it comes to pragmatics (i.e. social
communication) and discourse (i.e. conversation) where both of these
areas need to be assessed in order to formulate an accurate conclusion
about impairment.
Pragmatics – “Is the knowledge, awareness, and use of the rules of
conversation; for example, listener’s perspective, turn‐taking, topic

4. selection, and topic introduction. (Freund, Hayter, MacDonald, Neary,
Wiseman‐Hakes, 1994)
Discourse (conversation) –This includes conveying information, sharing
an experience and arguing or persuading. “These disturbances in TBI are
more prevalent and longer lasting then specific language problems.
Seventy‐five percent of individuals with TBI are found to have discourse
problems.” (MacDonald, 2007)
6. An in‐depth knowledge and awareness of the functional impact that
result from cognitive‐communication difficulties. One of the methods of
value used to assess functional communication is the American Speech and
Hearing Association’s (ASHA) National Outcome Measures Systems
(NOMS). The NOMS for pragmatics, for example, include a scale that
ranges from least functional (Level 1) to most functional (Level 7).
Somebody with a pragmatic difficulty may do fairly well in a structured
one‐on‐one setting but not in a busier environment, such as a workplace or
school.
CONCLUSION
At the Speech Therapy Centres of Canada Ltd. we use a combination of standardized
and non‐standardized methods, evidence‐based practice and clinical experience to
provide thorough assessment reports that identify communication impairments and
their functional impact on daily life. Our reports are an extremely valuable tool in
determining the cognitive‐communication and speech and language functioning of a
client with a TBI. The reports can play a significant role in contributing to a CAT
determination.
If you would like more information regarding SLP reports or our services, please do
not hesitate to contact me at: 905.886.5941

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REFERENCES
 American Speech and Hearing Association (ASHA), (2003). National Outcome
Measures System (NOMS): Adult Speech‐Language Pathology User’s Guide
 College of Audiologists and Speech‐Language Pathologists of Ontario (CASLPO),
(2002). Preferred Practice Guidelines for Cognitive‐Communication Disorders.
CASLPO, Desk Reference, Toronto, Ontario www.caslpo.com
 Freund, Hayter, MacDonald, Neary & Wiseman‐Hakes (1994). Cognitive‐
communication disorders following traumatic brain injury: A Practical Guide.
Communication Skill Builders, Tucson, Arizona.
 MacDonald, S., (March 29 & 39, 2007) Assessment and Treatment of Cognitive‐
Communication Disorders (Level 1): Evidence‐Based Practice, Practice Guidelines
and Clinical Insights.
 World Health Organization (WHO), (2002) Towards a Common Language for
Functioning, Disability and Health: ICF, Geneva
phone: 905.886.5941 fax: 905.886.2362 email: info@speechtherapycentres.com web: www.speechtherapycentres.com