How Does Speech Therapy Help With Concussion Recovery?

Patients are often confused when referred to meet with a speech-language pathologist (SLP) after sustaining a concussion. As clinicians, we hear it all the time: “Why do I need speech therapy? My speech is fine.” It is not well-known that speech therapists have a wide scope of practice and can assist with much more than simply talking.

Mild traumatic brain injury (mTBI), or concussion, has been referred to as a ‘silent epidemic.” Concussions account for 75% of the more than 1.7 million TBI cases occurring in the United States every year. Symptoms such as headache, dizziness, fatigue, irritability, insomnia, and decreased tolerance for noise and light may result from metabolic or neurological changes throughout the brain.

Lesser-known complications include cognitive and communication deficits. For example, language deficits may include skills such as naming (word-finding) and verbal fluency. In conversation, patients can display difficulty transitioning between topics and using clear referents. Even auditory processing can be impacted. Cognitive impairments often include deficits in attention, working memory, delayed recall, and executive functioning or problem-solving.

SLP’s are recognized as one of the specialized groups of professionals trained to care for patients with a concussion. They often provide care as part of an interdisciplinary team by assessing and treating cognitive communicative disorders, identifying symptoms, making referrals, and providing support and encouragement.

Speech-language therapy treatment is aimed at “reducing the impairment and increasing participation.” Treatment approaches are based on neuroplasticity and include direct training of cognitive-communication skills such as attention, working memory, processing speed, executive functioning and word-finding through a high rate of practice.

Cognitive strategy training may also support patients with a mild traumatic brain injury by helping them to develop internal strategies, use assistive technology, or implement appropriate environmental modifications. Further, speech-language pathologists can train task or process-specific strategies such as goal management training, structured problem solving, or verbal rehearsal to both school-aged and adult clients.

In the concussion program at Sheltering Arms, speech services begin with a clinical interview and thorough assessment of memory, attention, and language to identify any impairments. Then, our SLP’s work closely with each patient to develop an individualized plan of care that focuses on patient goals—whether it be improving grades in school or returning to work. In every case, treatment sessions are designed to optimize patient outcomes for a successful return to daily tasks.

Resources:

• American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology. Retrieved from http://www.asha.org/policy/
• Bialunska, A., & Salvatore, A. (2017). What’s going on with auditory comprehension after sport-related concussion? Archives of Physical Medicine and Rehabilitation, 98(10), e22.  
• Biddle, K. R., McCabe, A., & Bliss, L. S. (1996). Narrative skills following traumatic brain injury in children and adults. Journal of Communication Disorders, 29(6), 447-469. 
• Brown, J., O’Brien, K., Knollman-Porter, K., & Wallace, T. (2019). The speech-language pathologists’ role in mild traumatic brain injury for middle and high school-age children: Viewpoints on guidelines from the Centers for Disease Control and Prevention. American Journal of Speech-Language Pathology, 28, 1363-1370.  
• Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.  
• Mittenberg, W., & Strauman, S. (2000). Diagnosis of mild head injury and the postconcussion syndrome. Journal of Head Trauma Rehabilitation, 15(2), 783-791.  
• Sohlberg, M. M., & Mateer, C. A. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York, NY: Guilford. 
• Stockbridge, M. D., Doran, A., King, K., & Newman, R. S. (2018). The effects of concussion on rapid picture naming in children. Brain Injury, 32(4), 506-514.  
• Vander Werff, K. R., & Rieger, B. (2019). Auditory and cognitive behavioral performance deficits and symptom reporting in postconcussion syndrome following mild traumatic brain injury. Journal of Speech, Language, and Hearing Research, 62, 2501-2518.