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Cognitive Speech Therapy: How to Improve Communication After Brain Injury

Communication is a complex function that involves various skills such as attention, comprehension, speech, memory, and more. When cognitive skills become affected by a brain injury, cognitive speech therapy can help survivors improve their communication and overall cognitive function.

This article will discuss the causes and symptoms of cognitive-communication disorders, as well as numerous cognitive speech therapy exercises you can try at home.

Causes of Cognitive-Communication Disorders

Many of the cortical and subcortical structures in the brain responsible for cognitive processes can become damaged after a traumatic brain injury. This can result in a cognitive-communication disorder that causes symptoms such as difficulty paying attention, recalling information, or following instructions. Cognitive-communication disorders can occur individually or in combination with other conditions such as aphasia, dysarthria, or apraxia of speech depending on the areas of the brain affected.

For example, damage to the Wernicke’s area can lead to fluent aphasia, a language disorder where a person can speak fluently but words have no meaning. Wernicke’s area is located in the left hemisphere of the brain, near the back of the temporal lobe. Injury to this region can affect an individual’s understanding of spoken and written language.

Another region of the brain that contributes to speech and language is Broca’s area, located in the frontal lobe. Damage to this area after a traumatic brain injury can affect speech production, language processing, and movements of the mouth. For instance, survivors with a frontal lobe injury may experience apraxia of speech, where an individual knows what they want to say but they cannot coordinate the oral muscles to produce speech and express it.

Symptoms of Cognitive-Communication Disorders

Every brain injury is different, therefore every survivor may experience different symptoms of cognitive-communication disorders depending on the type of TBI sustained. Some symptoms may be similar to other problems or medical conditions.

Symptoms of cognitive-communication disorders may include:

If you or your loved one experience any new cognitive or communication difficulty it’s important to consult with your speech-language pathologist (SLP) for a proper assessment. SLPs can distinguish between cognitive, language, and speech disorders. Thus, they can provide you with a customized plan of rehabilitation, including cognitive speech therapy exercises tailored to your condition and ability level.

What Is Cognitive Speech Therapy?

Therapist doing a cognitive speech activity with a TBI patient.

Cognitive-communication is an essential component in mental processes used for speech and language. Speech in particular is a complex communication skill that not only involves the ability to physically form words in the mouth, but other areas of the brain as well. For example, cognitive skills necessary for speech include:

  • Attention
  • Listening
  • Comprehension
  • Memory
  • Problem-solving skills

After a brain injury, many of these cognitive skills can become impaired. Fortunately, cognitive speech therapy, or cognitive-communication therapy, is designed to help improve communication skills and restore cognitive function.

When the areas of the brain responsible for speech and language sustain an injury, many of the neural pathways become damaged or destroyed. Luckily, the brain has the ability to adapt and rewire itself through a phenomenon called neuroplasticity.

Neuroplasticity strengthens the existing neural pathways in the brain and creates new ones. It is best activated through high repetition of exercises, or massed practice. Therefore, practicing cognitive speech therapy exercises is crucial in order to help the brain heal and restore function. The more you practice, the higher the chances of regaining your cognitive and communication skills.

Cognitive-Communication Therapy Activities

Caregiver helping TBI survivor with a cognitive speech therapy activity at home.

Cognitive-communication activities help survivors strengthen their communication and cognitive abilities while adapting to their ability level. It’s important to practice exercises consistently to keep neuroplasticity stimulated. Some exercises target language while others may target cognition and/or swallowing.

Here are some examples of cognitive speech therapy activities for adults:

1. Response-Elaboration Training (RET)

During response elaboration training (RET), your speech therapist will use a set of images depicting an action, such as a man pushing a lawnmower. Then they will ask a series of 5W questions (who, what, when, where, and why) to help you expand on your answer.

Response elaboration training helps survivors increase communication skills by elaborating on words with practice. RET is sometimes referred to as “loose training” because there are no correct answers. For instance, an image may elicit a response such as “girl…dog” and after clarifying questions it may lead to “the girl is walking her dog to the park.” The goal is to encourage the individual to generate their own responses.

2. Naming Therapy

Another cognitive speech therapy exercise is the naming therapy, which is often used to help individuals with aphasia recall words and improve memory. To practice this exercise, it helps to have a caregiver or therapist write down several general categories, such as animals, countries, foods, or sports. Then try to recall and name (verbally or in writing) as many items in that category as possible.

For an added challenge you can compare and contrast different items such as apples and oranges, or trumpets and clarinets. This is a great way to help you organize your thoughts and express them more clearly.

You can also ask your caregiver not to help you too much. You can also ask them to wait for you to ask for hints whenever you get stuck.

3. Task Sequencing

Task sequencing helps improve planning, comprehension, and reasoning skills. For this cognitive therapy exercise, first have a friend or caregiver write down the steps to complete a certain activity, such as turning on the TV and watching a show. Then, have them mix up the order before presenting the list to you.

For this cognitive-communication therapy activity, your goal is to rearrange the steps back into the correct order. As your skills improve, you can work on more complicated tasks, such as preparing a meal. This is a great way to stimulate your brain and working memory.

4. Spaced Retrieval

One of the best ways to improve your memory skills is through spaced retrieval, an evidence-based technique that helps individuals recall information over progressively longer intervals.

To practice spaced retrieval, create some flashcards with any new information you want to learn. Then wait two minutes and quiz yourself. If you get it right, increase your time by waiting 5 minutes then 10 minutes and more as you improve. The goal is to keep challenging yourself until the information is easier to recall.

5. Rhythm Matching

For this last cognitive speech therapy exercise, have someone tap out a simple, two-step rhythm several times with their hand on the table. Then try to match the rhythm. For an added challenge, you can face the opposite way of the caregiver or therapist to only focus on your auditory processing. This can help you improve your attention and listening skills.

Ask your speech therapist for activities based on the communication skills and cognitive abilities you want to target. They can provide you with many great exercises to do at home as well, which is essential to stimulate your brain and neuroplasticity on a consistent basis.

Practicing Cognitive Speech Therapy At Home

CT Speech and Cognitive Therapy App for TBI survivors.

Many survivors attend outpatient therapy once a week, and although helpful, it is simply not enough to achieve the repetition necessary to consistently stimulate neuroplasticity. Therefore, it’s imperative to stay engaged in cognitive speech therapy at home.

To boost your motivation at home you can try fun cognitive therapy apps such as the CT Speech and Cognitive Therapy App. The CT app provides access to over 100,000+ exercises that help improve listening, attention, comprehension, executive functioning, and more. Maintaining a consistent home exercise program for traumatic brain injury can help you achieve your goals and see results more swiftly.

Understanding Cognitive Speech Therapy

While a traumatic brain injury can affect many cognitive-communication skills such as speech and memory, there is hope to restore function by performing cognitive speech therapy exercises.

Consistent practice is key to stimulate the brain and activate neuroplasticity. Your speech-language pathologist is a great resource for finding the most effective cognitive speech therapy activities suitable for you.

We hope this article helped you understand how to improve communication after brain injury and encouraged you to engage in cognitive speech therapy.

The post Cognitive Speech Therapy: How to Improve Communication After Brain Injury appeared first on Flint Rehab.

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