Traumatic brain injuries are complex and hard to identify without the right assessments and evaluations. However, speech-language pathologists can help individuals improve their speech, cognitive function and emotional expression.
When a loved one experiences a traumatic brain injury (TBI), life changes in an instant. Whether it is caused by a sudden fall, car accident or complex medical emergency, the aftermath may feel overwhelming.
You may notice your loved one struggling to find the right words, missing the punch line of a joke or forgetting the steps to a family recipe. These moments are more than just confusing; they are symptoms of communication and cognitive disorders resulting from TBI.
While much of the initial focus in recovery centers on physical movement — wiggling toes or sitting up — true independence starts with communication. This is where speech-language pathologists (SLPs) play an important role in brain injury rehabilitation.
The role of SLPs in communication recovery
SLPs are highly trained experts who specialize in evaluating and treating communication and swallowing disorders. Their roles go far beyond speech itself. They often look at the whole person, identifying ways to bridge the gap between a patient's current abilities and their previous level of functioning.
TBIs often impair an individual's ability to think logically and understand verbal or nonverbal cues. Performing daily activities such as walking, brushing their teeth, getting dressed or simply engaging in casual conversations with family or friends can become difficult for those with brain injuries.
As a TBI survivor, Mathew Roberts brings a unique perspective to his role as an SLP and therapy team leader at Encompass Health Rehabilitation Hospital of The Woodlands. He understands firsthand just how long — and how challenging — the road to recovery can be.
Roberts said the most important part of treatment is identifying what motivates each patient to regain as much independence as possible.
“No two patients have the same communication or cognitive challenges, which is why thorough assessments are critical,” Roberts said. “Many patients struggle to maintain attention and concentration. They may have difficulty organizing their thoughts, and their speech can be very slurred.”
Types of communication disorders
SLPs develop treatment plans and assessments to determine an individual's level of care. Common disorders they treat include:
- Dysphagia: A common disorder associated with swallowing difficulty and painful sensations. For many patients, the muscles used for speech are the same used for eating and drinking. When these neural pathways are damaged, individuals may experience aspiration (food or liquid entering the lungs), increasing the risk of pneumonia.
- Aphasia: A condition that affects the ability to understand or express language, often caused by damage to the brain's language centers after a TBI or stroke.
- Apraxia: A motor-speech condition that causes individuals to have difficulty pronouncing words or phrases. Apraxia is more of a coordination barrier, resulting in the brain struggling to tell the mouth muscles how to move to form sounds.
- Cognitive-linguistic disorders: When the thinking behind speech is disorganized, individuals may struggle with memory, attention, problem-solving and reasoning. It may appear as an overreaction to loud noises or difficulty following steps to pay bills.
What to expect in an inpatient rehabilitation speech therapy session
If your loved one has a TBI, their doctor may recommend inpatient rehabilitation. As a caregiver, understanding what to expect in recovery can help you feel more confident and prepared.
In the inpatient rehabilitation setting, patients will receive three hours of therapy a day from at least two of the following disciplines: physical, occupational and speech. SLPs collaborate constantly with physical therapists, who support posture and breath control for speech, and occupational therapists, who reinforce memory strategies during daily tasks. This multidisciplinary approach ensures every aspect of your loved one's recovery is supported.
If a patient does require speech therapy — which those with brain injuries often do — they will typically spend one hour a day, three to five days a week, with a speech therapist to practice techniques and activities suitable for their diagnosis. Whether addressing swallowing deficiencies or speech-language barriers, sessions are structured, intensive and purposeful.
Tailoring speech therapy to the individual
The most effective speech therapy taps into what the person loves. Incorporating familiar activities and personal interests can serve as a bridge to recovery.
Roberts said it helps to break down goal-related tasks into five or six different steps – similar to following a recipe.
“It's a better way of communicating the basics in inpatient rehabilitation,” he said. “By breaking down the tasks of cooking spaghetti, the patient practices sequencing, memory, safety awareness and physical coordination all at once.”
This philosophy also applies to relearning complex responsibilities.
“If a patient prior to a traumatic brain injury was driving, managing their own finances or managing their own medication, I want to make sure that the plan of care centers around their specific needs,” he said.
Speech therapy memory techniques
Roberts said one practical strategy used to help individuals improve their memory and organizational skills is the WRAP method. This approach is also helpful for caregivers to use at home to support safety and independence.
W - Write: Writing things down engages a different part of the brain and serves as an external memory aid.
R - Repeat: Repetition strengthens neural pathways. Repeating a name, a number or an instruction helps move it from short-term to long-term memory.
A - Associate: Connecting new information to something already known (e.g., "The nurse's name is Rose, like the flower in my garden.") creates a mental hook.
P - Picture it: Visualization is a powerful tool. Creating a mental image of a task or word can help retrieve it later
.The caregiver's role in recovery
While SLPs provide clinical expertise, caregivers offer emotional support, encouragement and daily continuity. Their involvement can significantly strengthen a patient's communication progress and confidence.
Here are several strategies caregivers can use at home to support communication goals and increase independence.
- Create a supportive environment: Brain injuries often make it difficult to block out distractions. Introducing a loved one to a calm environment can help them feel more relaxed and safe.
- Reduce background noise: Turn off the TV, radio or other competing sounds during conversations.
- Face them directly: Visual cues (lip reading, facial expressions) provide extra information that helps with comprehension.
- Keep it simple: In the early stages, use shorter sentences and ask yes or no questions to reduce the cognitive load.
Patience is your strongest tool
There will be moments of silence and moments when your loved one just can't get the right word out. Techniques to consider include:
Wait: Give your loved one extra time to process what you said and formulate a response. The "awkward silence" is often where the processing happens.
Don't rush to rescue: It is a natural instinct to finish their sentence when they struggle. However, allowing them to struggle slightly and find the word themselves is crucial for rebuilding those neural connections.
Creating a to-do list
Roberts recommends creating a to-do list that can help with their organization skills once they return home to continue supporting their independence.
“In the morning, put together a to-do list so they can see their accomplishments throughout the day to maintain their memory,” he said.
Validate the frustration: Acknowledge that it is hard. A simple "I know this is frustrating; take your time" can lower their anxiety and improve performance.
Moving forward with hope
Navigating life after a brain injury is a long and challenging process, but there is hope. The brain is remarkably resilient.
Speech therapy and inpatient rehabilitation can help your loved one rebuild the skills and confidence they need to reenter the community and live fulfilling lives. With each step, individuals regain independence and strengthen their ability to perform daily activities.
For additional support, education and advocacy, caregivers can turn to the Brain Injury Association of America (BIAA). The organization offers resources on TBI recovery, caregiver guidance, local support and nationwide programs designed to help individuals navigate life after brain injury.
