Cognitive-Communication Disorders After Stroke & TBI: What Families Should Know
When someone experiences a stroke or traumatic brain injury (TBI), families often expect recovery to happen quickly. In the early days and weeks, there may be noticeable improvements. Speech may become clearer. Movement improves, strength returns. As those early changes happen, it’s easy to assume that the person will simply continue to "bounce back" until they are completely back to their old selves.
But recovery doesn't always work that way.
Some people experience cognitive-communication difficulties that aren't immediately obvious. Others may continue to experience changes long after the initial injury—even when they appear to be doing well on the outside.
What Is Cognitive-Communication?
Cognitive-communication refers to the relationship between our thinking skills and our ability to communicate and function in everyday life. When we communicate, we're using much more than our ability to speak. We need to pay attention to what someone is saying. We need to understand and remember information. We need to organize our thoughts, make decisions, solve problems, and adjust our behavior based on the situation.
These difficulties might look like:
Having difficulty recalling and following multistep directions
Reading something once, twice, or several times and still having difficulty understanding it
Forgetting information that was just discussed
Making impulsive decisions that seem out of character
Having difficulty recognizing when something isn't going as planned
Becoming overwhelmed by tasks that used to feel routine
Needing significantly more time to complete familiar activities
These changes can be easy to mistake for carelessness, lack of effort, or simply "not trying." But these are likely residual deficits that are remaining after the brain injury. Some individuals will experience residual cognitive-communication deficits that last for months, years, or even throughout their lifetime. That can be difficult to hear.
But a lasting deficit does not mean that there is nothing left to work on. People can continue to make progress, learn strategies, build new routines, and find ways to compensate for areas that remain difficult long after the initial injury.
The goal may not always be to return to exactly how things were before the stroke or TBI. Sometimes the goal is to find a new way to accomplish the things that matter most.
How Does an SLP Evaluate Cognitive-Communication?
When someone comes to speech therapy with concerns about cognitive-communication, the first step is understanding what is actually happening.
Depending on the individual, an SLP may use formal assessments to look at areas such as attention, memory, executive functioning, language, and problem-solving.
At Life Speech Services, formal assessments such as the Cognitive Linguistic Quick Test (CLQT) or Functional Standardized Task Assessment (FSTAC) may be used when appropriate.
But standardized testing is only one piece of the puzzle. I also want to understand the individual's perspective.
Patient-reported outcome measures (PROMs) can provide valuable information about how someone feels their communication and cognitive abilities are affecting their everyday life. And sometimes the most useful information comes from functional tasks.
What happens when you ask the person to follow a set of directions? Can they organize information? Can they solve a problem? Can they manage something they need to do in their daily life? Looking at these different pieces together helps create a more complete picture of the person's strengths and challenges.
What Does Cognitive-Communication Therapy Actually Look Like?
This is where I believe therapy becomes especially meaningful.
Cognitive-communication therapy shouldn't just be about completing worksheets.
Therapy should connect to real life. If someone is having difficulty with memory and organization, we might work on managing their actual medications or appointments.
If someone needs to return to work, we may practice skills related to their actual job responsibilities. If writing emails is difficult, we can work on writing emails.
If following multistep directions is a challenge, we can practice completing meaningful multistep tasks. If problem-solving is difficult, we can work through realistic problems that the person may encounter at home, at work, or in the community.
The goal is to take the skills being addressed in therapy and connect them to the things the person actually needs and wants to do.
How Can Caregivers Help?
Supporting someone after a stroke or TBI can be difficult. It can be tempting to step in and do something for your loved one because it is faster or easier. Sometimes, of course, that's necessary, especially when safety is a concern.
But when it is safe and appropriate, giving the person an opportunity to try first can be incredibly valuable.
Be patient. Give them extra time to process.
Ask yourself: Do they need me to do this for them, or do they need a little more time to figure it out?
If possible, allow your loved one to attempt the task before stepping in. Give them the opportunity to ask for help.
And when they do need help, try working through the problem with them rather than automatically taking over.
A Final Thought
Recovery after a stroke or TBI can be complicated.
There may be improvements that happen quickly and changes that take much longer. There may also be deficits that remain even when everyone around the person expects them to be "back to normal." Try to remember that progress doesn't always mean eliminating every deficit. Progress might mean remembering a medication schedule with the help of a strategy.
If you recognize these challenges in yourself or someone you love after a stroke or TBI, reach out to an SLP for additional support.
You don't have to navigate the changes alone.
