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AJSLP
Viewpoint
Confidence and Training of Speech-
Language Pathologists in Cognitive-
Communication Disorders: Time to
Rethink Graduate Education Models?
Emily L. Morrow,
a
Lyn S. Turkstra,
b
and Melissa C. Duff
a
Purpose: The purpose of this article is to highlight the
need for increased focus on cognitive communication in
North American speech-language pathology graduate
education models.
Method: We describe key findings from a recent survey of
acute care speech-language pathologists (SLPs) in the
United States and expand upon the ensuing discussion at
the 2020 International Cognitive-Communication Disorders
Conference to consider some of the specific challenges
of training for cognitive communication and make suggestions
for rethinking how to prepare future clinicians to manage
cognitive-communication disorders.
Results: Results from the survey of acute care SLPs indicated
inconsistent confidence and training in managing cognitive-
communication disorders. We discuss the pros and cons of
several avenues for improving the consistency of cognitive-
communication training, including a standalone cognitive-
communication course, integrating cognitive communication
in all courses across the speech-language pathology
undergraduate and graduate curriculum, and using
problem-based learning frameworks to better prepare
students as independent thinkers in the area of cognitive
communication and beyond.
Conclusions: Cognitive-communication disorders cut across
clinical diagnoses and settings and are one of the largest and
fastest growing parts of the SLP’s scope of practice. Yet,
surveys, including the one discussed here, have repeatedly
indicated that SLPs do not feel prepared or confident to
work with individuals with cognitive-communication disorders.
We propose several avenues for increasing educational
emphasis on cognitive communication. We hope these
ideas will generate discussion and guide decision making
to empower SLPs to think critically and step confidently
into their roles as leaders in managing the heterogeneous
and ever-growing populations of individuals with cognitive-
communication disorders.
The scope of practice for speech-language patholo-
gists (SLPs) is wide, covering a growing range of
services (assessment, treatment, counseling, educa-
tion, advocacy) for individuals across the life span who have
disruptions in speech, language, swallowing, voice, and
communication. As the SLP’s scope of practice grows, edu-
cators have noted that it is increasingly difficult to cover all
the core areas in sufficient depth over the course of the 2-year
terminal master’s degree (Golper et al., 2010). There has
been increased attention around issues of training and con-
fidence in recognition that generalist SLP training must pre-
pare clinicians to work with a range of individuals, from
those who use augmentative-alternative communication
to those managing medical issues such as tracheostomy
care (Manley et al., 1999; Marvin et al., 2003; Ward et al.,
2012). As a result, the field is discussing changes in the scope,
timescale, or priorities of our clinical training programs
so that new SLP graduates may face the unique challenges
and opportunities of a clinical career feeling confident and
well prepared (Golper et al., 2012, 2010; Johnson et al.,
2012; Lubinski, 2003; Lubinski & Hudson, 2013; McNeil
et al., 2013).
We are particularly interested in these issues of knowl-
edge, training, and confidence as they relate to clinical
education in adult neurogenic disorders in general and
a
Department of Hearing & Speech Sciences, Vanderbilt University
Medical Center, Nashville, TN
b
School of Rehabilitation Science, McMaster University, Hamilton,
Ontario, Canada
Correspondence to Emily L. Morrow: emily.l.morrow@vanderbilt.edu
Editor-in-Chief: Margaret Lehman Blake
Editor: Louise C. Keegan
Received March 31, 2020
Revision received May 11, 2020
Accepted June 4, 2020
https://doi.org/10.1044/2020_AJSLP-20-00073
Publisher Note: This article is part of the Special Issue: Select Papers
From the International Cognitive-Communication Disorders Conference.
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
American Journal of Speech-Language Pathology •1–7•Copyright © 2021 American Speech-Language-Hearing Association 1
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cognitive communication disorders more specifically. Adult
neurogenic disorders are communication disorders that
result from neurologic impairment in adults, including the
aphasias, right hemisphere disorder (RHD), traumatic
brain injury (TBI), and the dementias (American Speech-
Language-Hearing Association [ASHA], 2020a). Cognitive-
communication disorders are impairments in any aspect
of communication that is affected by a disruption in cogni-
tion (e.g., attention, memory, executive functioning; ASHA,
2020c). For example, a memory or executive functioning
impairment may result in reduced ability to effectively
communicate needs or exchange routine information
(ASHA, 2020c).
At the 2020 International Cognitive-Communication
Disorders Conference (ICCDC), Morrow et al. (2020) pre-
sented data from a larger survey addressing the knowledge,
beliefs, confidence, and practice patterns of acute care SLPs
managing cognitive-communication deficits in individuals
with TBI (Morrow et al., in press). Knowledge and confidence
are of special consequence in the acute care setting, where
SLPs face unique constraints (e.g., limited time and patients’
fragile medical status and fluctuating alertness) but must eval-
uate, educate, and make decisions related to cognitive commu-
nication (i.e., discharge disposition) that will reverberate along
a patient’s entire continuum of care (Morrow et al., 2020).
For example, an SLP may be involved in decisions regard-
ing the level of rehabilitative care that a patient receives (or
whether a patient receives postacute rehabilitative care at
all) based on the results of an initial evaluation, making
the detection of even subtle cognitive-communication def-
icits critical.
In this survey, 182 acute care SLPs from across
the United States answered questions about their knowl-
edge, decision making, and practice patterns in working
with patients with TBI. Only 61.54% (n= 72/117) of these
clinicians indicated that they were the most knowledge-
able member of the medical team regarding cognitive-
communication skills after injury. This lower-than-ideal
confidence may be related to the fact that, although
96.61% (n= 114/118) of respondents had a master’s de-
gree (vs. 2.54% with a PhD and 0.85% with a bachelor’s
degree), they varied considerably in their graduate-level
training. Only 23.28% (n= 27/116) of respondents had
taken a specialty course in TBI as part of their graduate
training, and 16.38% (n= 19/116) had not taken any
coursework in TBI. In addition, 60.34% (n= 70/116) had
learned about TBI as part of a larger course in adult neu-
rogenic disorders (e.g., course also included aphasia). Al-
though we asked specifically about training in TBI and
not about cognitive-communication disorders as a whole,
other cognitive-communication disorders (e.g., RHD
and dementia) are frequently covered in a single course
with TBI and aphasia, as well (Ramsey & Blake, 2020).
Considering the scope and heterogeneity of cognitive-
communication deficits following TBI (even excluding
the other medical considerations necessary to working
with this population), a few lectures as part of a broader
course on adult neurogenic disorders would be insufficient
to leave a student feeling prepared and confident to work
with these individuals.
These findings of low confidence and limited special-
ized graduate training are consistent with previous studies in
TBI across other settings, such as schools and skilled nursing
facilities (Duff et al., 2002; Duff & Stuck, 2015; Hux et al.,
1996; Riedeman & Turkstra, 2018) and extend the need for
improved training to acute care settings. At the 2020 ICCDC,
these findings generated a great deal of discussion, as well as
concern, given that acute care SLPs, relative to other settings,
see a high proportion of cognitive-communication cases in
TBI and establish the continuum of SLP care. The discus-
sion at ICCDC largely focused on issues of graduate training.
In the rest of this article, we build on these discussions to
consider some of the specific challenges of training in the
area of cognitive communication and make suggestions for
rethinking how best to prepare future clinicians for working
with individuals with cognitive-communication disorders,
which are prevalent across the full range of settings and pop-
ulations that SLPs serve.
Cognitive-Communication Disruptions Cut Across
Settings, Diagnoses, and Age Groups
Before considering specific recommendations, it is
important to reconceptualize traditional views of cognitive-
communication disorders as limited to adult populations in
medical settings and instead recognize that issues of train-
ing and confidence in cognitive communication cut across
many facets of our field. Cognitive-communication disorders
are indeed highly prevalent in adult neurogenic conditions
such as TBI, RHD, and dementia. Diagnoses associated
with cognitive-communication disorders are some of the
most prevalent in an SLP’s scope, with 2.8 million emergency
department visits for TBI every year (Centers for Disease
Control and Prevention, 2019a) and an estimated 5.0 mil-
lion older adults living with dementia in the United States
(Centers for Disease Control and Prevention, 2019b). The
incidence of both TBI and dementia has been increasing
every year, suggesting that this piece of the SLP’s caseload
may only grow in years to come (Centers for Disease Con-
trol and Prevention, 2019a, 2019b).
Cognitive-communication disorders are not limited
to adult medical populations, however. Rather, they are a
part of every SLP’s caseload, including caseloads of SLPs
who work in early intervention, educational settings, and
community settings for youth with developmental disabilities
and acquired brain injuries. When practice in cognitive-
communication disorders was formally introduced to the
discipline, it was in the context of adult neurogenic disor-
ders (Adamovich et al., 1987; ASHA, 2005; Holland, 1982;
Ylvisaker et al., 2003), but SLPs in schools are as likely to
have cognitive-communication disorders in their practice.
Cognitive impairments underlie communication challenges
of youth with many diagnoses seen by SLPs in schools, such
as autism, intellectual disability, and attention-deficit disor-
der. Even when language disorder is the presenting feature,
such as developmental language disorder, cognition may
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play a role. School-based SLPs also must have a solid foun-
dation in understanding acquired cognitive-communication
disorders, as they may have the chance to identify students
for whom a history of TBI or other acquired brain injury
has been mistakenly diagnosed as another developmental
or behavioral disorder (Brown et al., 2019; Duff et al., 2002;
Duff & Stuck, 2015; Hux et al., 1996; Krause et al., 2015;
Lundine, Ciccia, & Brown, 2019; Lundine, Utz, et al., 2019;
Ylvisaker, 1998). Thus, every student in an SLP graduate
classroom will benefit from a strong foundation in under-
standing the interactions between communication and cog-
nition, and how those interactions can manifest in clinical
populations.
Training as a Source of Confidence: Need
for Improved Cognitive-Communication Training
When asked to describe why they did or did not feel
like the team’s cognitive-communication expert, acute care
clinicians who responded to our survey emphasized the im-
portance of specialized training and experience (Morrow
et al., 2020, in press). Consistent with prior survey reports
(Duff & Stuck, 2015; Riedeman & Turkstra, 2018), these
findings indicate that specialized training may be critical to
SLPs’self-perceived expertise and ability to lead the team
in cognitive communication, a key area of SLPs’scope of
practice in managing patients with neurological disorders
such as TBI. We propose that cognitive communication
should be a stronger part of any SLP’s toolkit, given the
prevalence of these disorders across populations and settings
(ASHA, 2020c; Duff et al., 2002; Duff & Stuck, 2015; Hux
et al., 1996; Morrow et al., 2020, in press; Riedeman &
Turkstra, 2018). Although we focus in this article on aca-
demic education, which represents an opportunity for con-
sistent guidelines given variable opportunities for and
structures of clinical practicum training (e.g., medical place-
ments) across programs, many of these points could also
apply to prioritization and structure of clinical training. Be-
low, we discuss several principles and methods for improv-
ing the consistency of cognitive-communication education
across SLP graduate programs.
A Note on General Principles
for Cognitive-Communication Education
One consequence of the rapid growth of our field in
terms of the impairments and populations we serve is that
graduate education has largely been organized around spe-
cific disorders (i.e., we have stand-alone courses on aphasia,
voice disorders, stuttering, developmental language disor-
ders). We even frequently hire new faculty around these dis-
order “silos”based on departmental teaching and research
needs. Yet, in disorders where cognitive-communication
impairment is present, such as TBI, heterogeneity is a hall-
mark, meaning that clinicians must think critically to se-
lect or design assessments, education, and treatment for
each individual case (Covington & Duff, 2020; Dahdah
et al., 2016). Thus, it is crucial that graduate education
provide a solid foundation for the principles of cognition,
communication, and their interactions, with an emphasis
on critical thinking and creativity over diagnosis-based
facts. This emphasis on the construct of cognitive commu-
nication, over creating silos based on diagnosis or etiology,
parallels the National Institutes of Health’s research initia-
tives (e.g., the National Institute of Mental Health’s Research
Domain Criteria project) encouraging researchers to shift
from distinct disorders (e.g., schizophrenia) to instead focus
on underlying mechanisms and symptoms (e.g., hallucina-
tions) that cut across diagnosis labels (Simmons & Quinn,
2014). This type of cross-diagnosis thinking easily extends
into the world of cognitive-communication disorders, where,
for example, deficits in memory and learning affect multiple
populations and are critical to success in therapy (Covington
& Duff, 2020; Morrow & Duff, 2020). This construct-based
approach to cognitive-communication training may fit into
graduate training as its own course, as a theme across courses,
and/or as a restructuring of instruction approach. We explore
the pros and cons of each approach below.
Stand-Alone Course in Cognitive Communication
The Council on Academic Accreditation in Audiology
and Speech-Language Pathology (2019) has updated its ac-
creditation standards to emphasize constructs (e.g., receptive
and expressive language, cognitive aspects of communica-
tion, social aspects of communication) over diagnostic labels
(e.g., TBI). However, as the results of this survey indicated,
in practice, coursework at SLP graduate programs addresses
the construct of cognitive communication in a variety of
ways. For example, just considering the 24 academic pro-
grams ranked in the top 20 by U.S. News and World Report
this year (U.S. News & World Report, 2020), 11 have a
standalone course in cognitive communication or TBI,
whereas nine combine all adult neurogenic language dis-
orders into a single course, and four offer a course in cog-
nitive communication as an elective. Covering cognitive
communication in the necessary breadth and depth to
yield well-prepared and confident clinicians is a significant
challenge in the current diagnosis-based model of graduate
level coursework.
Further, when cognitive communication is covered
only as a piece of an adult neurogenic disorders course,
students may view cognitive communication as an “adult”
problem or a “TBI and dementia”problem. If student clini-
cians who are interested in pediatrics do not view the course-
work as relevant to their future caseloads, a lack of a strong
foundation in cognitive communication can have deleteri-
ous effects for these students and their clients down the road
(Duff & Stuck, 2015). In contrast, a course focused on cog-
nitive communication as a construct, although it may seem
like another course in a busy curriculum, could appeal to
students interested in any population or setting. Such a course
would allow an instructor to focus on building a frame-
work and then ask students to apply that framework to
various diagnoses and use critical thinking in developing
skills around managing cognitive communication in their
respective settings.
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If programs cannot find room in the current curricu-
lum to add a new stand-alone course, we might reexamine
how much time we give to different disorders in an adult
neurogenic disorders curriculum. It is our experience, as
students and educators, that programs either have (a) a sin-
gle adult neurogenic disorders course that disproportionally
covers aphasia relative to TBI, dementia, or RHD, or (b) a
stand-alone aphasia course with cognitive-communication
disorders grouped together. However, incidence data from
the Centers for Disease Control and Prevention raises the
question as to whether our educational priorities should
more closely mirror disorder incidence. SLPs will see more
individuals (adult or pediatric) with cognitive-communicatio n
disorders than they will see individuals with aphasia
from stroke (i.e.,795,000 cases of stroke reported each
year; Centers for Disease Control and Prevention, 2019a,
2019b, 2020). Aphasia is an important piece of the SLP’s
scope of practice and should certainly have a strong place
in any curriculum. Indeed, aphasia can occur with other
neurogenic disorders, including TBI. However, these inci-
dence data suggest that cognitive communication should
receive at least equal consideration in the adult neurogenic
curriculum, as populations with cognitive communication
disorders comprise a larger and growing proportion of an
SLP’s caseload.
Integration of Cognitive-Communication Across Courses
Another option that would allow instructors to engage
more students around the construct of cognitive communica-
tion, as well as to reinforce underlying principles linking
cognition to communication across populations, would be
to integrate cognitive communication across existing disorder-
and setting-based classes (e.g., language acquisition and
developmental language disorders). For example, students
interested in working with children with intellectual disabil-
ity could consider how their communication disorders are
affected by cognition within a cognitive-communication
framework. This option challenges faculty to communicate
about teaching content and collaborate across disciplinary
areas, which may be new to faculty who are accustomed to
teaching within a specific disorder area. However, such in-
tegration of cognitive communication across courses could
allow for an increased emphasis and improved foundation
in cognitive communication, generalizable across clinical
groups, without adding another course to the SLP curricu-
lum. This inclusion of cognitive communication could even
extend down to the undergraduate curriculum, wherein a
strong foundation in cognition could be built into under-
graduate SLP coursework around normal cognitive and
communication processes. Refining the social and behavioral
sciences prerequisite for SLP graduate programs to specifi-
cally require a course on cognition could also help students
to enter their programs with stronger foundational knowl-
edge in this topic area.
Incorporating Problem-Based Learning in the Curriculum
Even within the context of courses siloed by disor-
der, we may improve students’ability to think critically
and move beyond diagnosis-based prescriptive frameworks
by implementing a new instructional strategy altogether.
One strategy that has gained popularity in medical school
curricula and has been adopted by a few SLP programs is
problem-based learning (PBL; Barrows & Tamblyn, 1980;
Hamilton et al., 2019; Hmelo-Silver, 2004). PBL is a peda-
gogical approach in which students learn by collaboratively
examining problems and identifying gaps in their own knowl-
edge, then developing strategies to improve their knowledge
in those areas, and critically examining their own learning
process and products (Hamilton et al., 2019; Hmelo-Silver,
2004). A PBL approach aims to nurture students’capacity
to think critically and advance their own knowledge and
skills, so they are prepared to be independent lifelong
learners. One of the principles underlying this approach
is that no graduate program can provide all the knowledge
students will need as entry-level clinicians. Thus, the curric-
ulum emphasizes cross-cutting foundational knowledge
and skills, attempts to limit memorization to facts that will
need to be recalled spontaneously in entry-level practice,
and is iterative (i.e., revisits information with progressively
increasing complexity). Because of this integrated structure,
PBL encourages the development of broader analogies and
frameworks that transfer across problems, contexts, and
disorders (Hamilton et al., 2019). Activities are designed
to achieve specific learning objectives (Hamilton et al.,
2019; Neufeld & Barrows, 1974), so including cognitive-
communication objectives across the life span is quite fea-
sible. For example, students may respond to a problem
centeredonaclientwithTBIandcomplexcognitive-
communication deficits, focused on the need to identify
appropriate assessment tools. To address this problem, stu-
dents would be expected to bring knowledge about gen-
eral principles of assessment, experience from assessment
of communication and cognition in other populations, and
their clinical experience. What these students learn about
the interactions of memory and language from working
through this problem-based learning exercise in TBI, they
are encouraged to transfer to working with a child with a
developmental language impairment. In short, adding PBL
to the curriculum, regardless of course structure, results in
better integration between theory and practice and encour-
ages curiosity and critical thinking (Hamilton et al., 2019;
Mok et al., 2008). This focus on the mechanisms of thinking
and learning will serve students well in treating not only
complex, heterogeneous cognitive-communication disorders,
but also the SLP generalists’entire scope of practice.
Access to High-Quality Continuing Education
Respondents to our acute care survey and many
SLPs who currently work with individuals with cognitive-
communication disorders have already graduated from their
clinical training programs. The research literature on
cognitive-communication disorders (e.g., TBI) is developing
rapidly, such that clinicians will benefit from continued
opportunities to build on foundational disorder knowledge
gained in graduate training with new evidence pertinent
to clinical practice application (O’Brien, 2020). Further, in
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some cases clinicians may benefit from an update to founda-
tional knowledge as the literature develops (e.g., with re-
gard to new knowledge on the long-term implications of
pediatric TBI, O’Brien, 2020). Yet, continuing education
in acquired cognitive-communication disorders is limited
relative to education available for aphasia. For example,
there was a combined average of 101 yearly presentations
regarding TBI, RHD, and dementia at ASHA Conventions
between 2014 and 2018, relative to an average of 210 yearly
presentations on aphasia alone (Ramsey & Blake, 2020).
Thus, any initiative for improving cognitive-communication
training for SLPs should include access to high-quality con-
tinuing education for practicing clinicians who are recent
or remote graduates.
For many practicing clinicians, conferences and articles
behind a paywall may be prohibitively expensive or time-
consuming. Thus, continuing and building upon existing
opportunities for continuing education, such as ASHA
webinars and webinars provided free for members of the
Academy of Neurologic Communication Disorders and
Sciences (Academy of Neurologic Communication Disorders
and Sciences, 2019; ASHA, 2020b), will also generate signif-
icant value for clinicians. Increasing access to similar re-
sources on cognitive-communication disorders that are
available for free to all ASHA members should also be
considered.
The ongoing development of continuing education
should also consider the role of knowledge translation. Find-
ings from the implementation science literature indicate that
high-quality continuing education must not only describe
findings from experiments conducted in controlled labora-
tory environments, but also guide the translation of those
findings to real-world clinical settings (Douglas & Burshnic,
2019; Douglas et al., 2015). For example, providing ready-
to-use materials and case examples allows clinicians to effi-
ciently consider how they might implement new evidence
in their practice settings (Douglas & Burshnic, 2019). This
framework also allows for ongoing researcher–clinician col-
laboration via implementation assessment protocols. By
considering how clinicians might best use knowledge from
the research literature when we develop continuing educa-
tion, we stand to make high-quality evidence more accessi-
ble, to shrink the researcher–clinician gap in our field, and
to increase clinicians’confidence in and ownership of their
practice patterns (Douglas & Burshnic, 2019; Douglas et al.,
2015). Further, a knowledge translation framework allows
for beneficial collaboration with clinicians who may share
translational materials with theircolleaguesorprovidein-
put to strengthen the implementation potential of research
findings (Douglas & Burshnic, 2019; Douglas et al., 2015;
O’Brien, 2020).
Numerous studies documenting low clinician knowl-
edge and confidence in the area of cognitive-communication
point to concomitant low levels of training and prepara-
tion in graduate school and beyond (Duff & Stuck, 2015;
Riedeman & Turkstra, 2018). We need to have more dis-
cussion around the ways we can enhance graduate and
postgraduate training around cognitive communication
so that current and future clinicians have the tools and
resources needed to provide the best and most confident
standard of care to all individuals with disruptions in cog-
nition and communication.
Need to Improve SLPs’Self-Recognition
and Demonstration of Expertise
The results of our acute care survey, as well as the
other surveys around TBI and cognitive communication
(e.g., Duff & Stuck, 2015; Riedeman & Turkstra, 2018),
reveal that clinicians often do not recognize themselves
as the experts in cognitive-communication disorders on
their teams and in their settings. This finding is troubling
for a number of reasons, including the fact that cognitive
communication has been a part of SLPs’scope of practice
for more than 30 years (Adamovich et al., 1987). These
feelings of not being the expert may be attributed, in part,
to the small group of clinicians who report having had
no graduate level training in the area of TBI or cognitive-
communication disorders. Yet, for others, this lack of self-
recognition of expertise appears to be distinct from issues
of improving training in cognitive communication (i.e.,
many clinicians who have had graduate-level training and
clinical experience in cognitive communication still believe
other health care professionals have greater expertise in
this area).
There was discussion at the 2020 ICCDC around
the need to improve self-recognition and demonstration
of expertise for clinicians practicing in the area of cognitive-
communication disorders. More research on this specific
issue is needed to understand the forces that drive this
belief among many practicing clinicians. In the meantime,
we suggest that more discussion around interprofessional
education and practice is warranted to assist clinicians in
better understanding the training and scope of practice,
as well as their limits, of the other professionals who also
serve individuals with cognitive-communication disorders
but who are not experts on cognitive communication. For
example, it is common for physicians and neuropsycholo-
gists to be part of the team delivering care to individuals
with TBI, but they have not received specialty training in
cognitive communication and its disorders. On any team,
across health care and educational settings, it is the SLP
who is the communication expert. While this expertise is
conferred through the Certificates of Clinical Competence
in the United States (ASHA, 2016), clinicians should be
empowered to take ownership of that expertise and educate
other professionals on our role in cognitive-communication
disorders. Clinicians may also benefit from training in
self-advocacy as a form of client advocacy. Improving
clinicians’specialty knowledge of cognitive communica-
tion, regardless of setting, during and after graduate
training will likely have positive effects on self-recognition
and demonstration of expertise, with cascading benefits
for cognitive-communication team leadership and client
advocacy.
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A Path Forward for Improving Confidence
and Training in Cognitive Communication
Results from our acute care survey are consistent
with prior studies across the past 2 decades and multiple
practice settings indicating that many SLPs lack confidence
and specialized training in managing cognitive-communication
deficits. Across these studies and throughout discussions
at ICCDC 2020, there have been a number of calls for in-
creasing the emphasis on cognitive-communication disor-
ders in our graduate programs (e.g., Duff & Stuck, 2015;
Riedeman & Turkstra, 2018). Doing so will not just in-
crease clinicians’preparedness to work with individuals
with adult neurogenic disorders but rather will benefit all
clients and populations. In this article, we have proposed
some avenues for increasing the emphasis on cognitive
communication, which we hope will generate discussion
and guide decision making to empower SLPs to think criti-
cally and step confidently into their roles as leaders in man-
aging the heterogeneous and ever-growing populations of
individuals with cognitive-communication disorders. As the
field grapples more broadly with issues of training and
confidence for the master’s level SLP, now is the time for
bold and innovative thinking about how best to train SLPs
in the area of cognitive communication.
Acknowledgments
We sincerely thank the very busy acute care clinicians who
participated in the survey described here. We thank the attendees at
the International Cognitive-Communication Disorders Conference
2020 for their contributions to the discussion that inspired this
article.
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