Cognitive Approach to Improving Auditory Comprehension

Cognitive Approach to Improving Auditory Comprehension

Aphasia is a communication disorder that results from damage to the portions of the brain that are responsible for language. It usually impairs the expression and understanding of language as well as reading and writing at different levels. Aphasia is most commonly characterized by the area of lesion, however, regardless of its localization and severity, auditory comprehension is always impacted to some degree. The biggest variables that impact sentence comprehension are sentence length and syntactic complexity (Brookshire & McNeil, 2015). Other than therapy being targeted to specifically improve auditory comprehension, it has been proven that when speakers slow down their rate of speech and add emphatic stress it can improve the individuals with aphasia comprehension abilities.

Nancy Helm-Estabrooks, Sc. D., CCC-SLP, the researcher that will be discussed, is a distinguished professor in the Department of Communication Disorders and Science at Western Carolina University in North Carolina. Among her awards are the Honors of the American Speech and Hearing Association and of the Academy of Neurologic Communication Sciences and Disorder, the Frank R. Kleffner Lifetime Clinical Career Award, and the Edith F. Kaplan Award for Invaluable Contributions of the Field of Neuropsychology. Her publications include over 100 peer-reviewed articles, seven books, 25 chapters, and seven standardized tests.

The traditional approach used to remediate auditory comprehension difficulties is the linguistic stimulation approach. It was first noted by Schuell, Jenkins, and Jimenez Pabon in 1964 which requires the patients to point to items by name, follow commands and respond to yes/no questions. The effectiveness of this approach is not well established because it suggests that underlying linguistics difficulties are the basis of auditory comprehension deficits. If this were the case, it would explain why patients can understand some stimulus and not others, but it does not. Since the linguistic stimulation approach has inconsistencies, Helm-Estabrooks and Albert conducted a study in 2004 to investigate the cognitive approach to treat all areas of auditory comprehension that the traditional approach cannot. The cognitive approach takes into account that effective language cannot take place without adequate attention, memory, executive function, and visual-spatial skills. However, in order to apply this approach clinicians have to determine the patients overall cognitive status to identify how it relates to the treatment outcomes.

This approach was inspired by the Attention Process Training Program created by Sohlberg an Mateer in 1986 to improve auditory comprehension in those with traumatic brain injuries. Since their program had great results, Helms-Estabrook created a similar program catered to those with aphasia. In the pilot study, the patient participated in a cognitive treatment titled Cognitive Linguistic Task Book that addressed attention, concentration, visual memory, counting, number facts, judgments, estimations, visuoperception, construction, and semantic/conceptual knowledge. The treatment consisted of 10 one-hour sessions that resulted in the participant’s auditory comprehension improving from the 37


percentile to the 95


percentile. Later studies with other participants with different severity levels of aphasia also demonstrated significant improvements leading Helm-Estabrooks and other researchers to believe that attention training alone might be an effective approach to treating auditory comprehension.

This treatment addresses the handicap of aphasia because auditory comprehension deficits is the disadvantage that arises after the diagnosis of aphasia. Without adequate auditory comprehension it impacts communication skills, the effectiveness of communication and the overall quality of life. Considering most individuals are not aware of what aphasia is and the setbacks that it comes with, if an individual is having difficulty understanding a message and cannot respond accordingly it is going to lead to people avoiding interactions with them. Even if an individual’s output may not be fluent or complete, if they can understand the message they can use other compensatory strategies to respond accordingly like an augmentative alternative device. Although several researchers support this strategy, the cognitive approach to improving auditory comprehension still needs further research and investigation to determine its efficacy on all the aphasias their possible severities.  The details of the current approach and the step-by-step procedures of the treatment can be found in the Manual of Aphasia and Aphasia Therapy, 2




  • Brookshire, R., & McNeil, M. (2015).

    Introduction to neurogenic communication disorders



    ed.). St. Louis, Missouri: Elsevier.
  • Helm-Estabrooks, N. (2011). Treating attention to improve auditory comprehension deficits associated with aphasia.

    Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders,21

    (2), 64. doi:10.1044/nnsld21.2.64
  • Pearson. (n.d.). Nancy Helm-Estabrooks, ScD, BC-ANCDS. Retrieved from
  • Schuell, H., Jenkins, J., & Jimenez-Pabon, E. (1964),

    Aphasia in adults.

    New York, NY: Harper & Row.