Returning To Work After TBI: 9 Proven Speech Therapy Treatments

Returning to work is an important goal for many who’ve sustained a traumatic brain injury (TBI), and speech therapy can help them get there! 

In this article, you’ll learn how to help patients return to work after TBI, including 9 ways to improve their cognitive-communication skills.

Speech Therapy’s Role In Returning To Work After TBI

After a traumatic brain injury, patients often come to speech therapy with one goal in mind: Get back to work! And depending on the extent of their TBI, returning to work can be a functional and motivating goal.

While physical recovery from a brain injury is often the first area that comes to mind, cognitive, communicative, and psychosocial recovery are equally important, especially in the workplace. This is where speech therapy comes in.

As always, you’ll start with a speech therapy assessment. It’s often best to include a standardized assessment, although this may depend on the type and extent of the brain injury (Mani et al., 2017).

Read Speech Therapy For TBI: A Beginner’s Guide for help choosing the right assessments.

Based on their individual assessment result, focus on rehabilitating the key skills your patient will need to return to work. These skills may include:

• Paying attention 
• Remembering
• Executive functioning, including information processing, planning, organization, and problem-solving
• Communication, including verbal and written
• Social communication skills
• Energy conservation, including stress and fatigue management

Returning To Work & Vocational Rehabilitation

While some may be able to return to work after speech therapy without accommodations or services, patients with more extensive challenges may benefit from a referral to vocational rehabilitation.

Vocational rehabilitation is a collection of services that helps patients with disabilities prepare for, enter, and stay in the workforce. It’s usually offered through their state of residence. Depending on your state/service, vocational rehabilitation may offer:

• Vocational assessments
• Career guidance and counseling
• An individual employment plan
• Job search, making a resume, and interview skills training
• On-the-job support
• Assistive devices

Person-Centered Goals For Returning To Work After TBI

Person-centered care is when you view your patient as a partner in their own care. To do it, make the patient’s needs, preferences, and goals a guiding light in your treatment planning.

If returning to work is your patient’s primary goal, focus their plan of care on the cognitive-communication and language requirements needed for their job. 

Things to consider when developing person-centered goals:

• What skills will their job require? For example: frequent emailing, writing, talking on the phone, multi-tasking, working in loud environments, etc.
• Identify current cognitive-communication and language strengths and deficits. Write goals that are functional and meaningful, but are also obtainable given their current deficits.
• Do they have a good support system? If not, look for resources that can offer the support they need.
• Is there workplace flexibility? For example, can they move to a less stressful or modified role within their current workplace?
• Were they in a leadership role with extensive responsibilities?

For 150 free starter goals, see the Goal Bank for Adult Speech Therapy

Treatment Activities For Returning To Work After TBI 

Early cognitive and language therapy yields the best outcomes for patients with a TBI (Naess et al., 2020). So, without further ado, here are 9 proven treatment activities to help your patients return to work!

1. Do Work-Related Therapy Tasks

This one’s obvious—but important enough to put first! Choose treatment tasks that simulate what your patient’s daily work responsibilities will be. For example:

• Practice writing emails or memos
• Simulate customer service interactions
• Practice taking inventory and restocking
• Practice food preparation
• Practice organizing and filing documents
• Practice scheduling appointments or meetings using an online calendar

Follow the principles of cognitive rehabilitation by breaking down tasks into smaller parts, repeated practice, and adding in relevant strategies and compensations.

2. Teach Executive Functioning Strategies

Work on improving executive functioning skills such as organization, planning, problem-solving, shifting attention, and working memory, which are important for all jobs. You’ll choose which skills to focus on based on each patient’s assessment results and goals.

One evidence-based way to improve executive functioning is to teach a goal-planning strategy. We developed the Game Plan Worksheet based on cognitive rehabilitation evidence to help patients more successfully plan and accomplish their goals:

• Setting My Goal. The patient sets a goal
• My Plan. They plan the steps to achieve that goal, including anticipating any obstacles and solutions
• Do The Task. They follow the plan to complete the task
• How Did I Do? They reflect on how they did, then come up with ways to do better next time (Brewer & Aparo, 2025)

Download your free Game Plan Worksheet in the Executive Functioning Bundle:

3. Teach Compensatory Strategies

Introduce patients to aids and strategies that can help them compensate for their cognitive deficits. These compensations can be internal, which are done inside the patient’s mind. Or external, like a checklist or alarm.

Patients with chronic cognitive deficits after a traumatic brain injury may benefit most from treatment focused on compensation rather than remediation (Mani et al., 2017).

Example compensatory strategies:

• Written to-do lists, checklists, and planners
• Color-coded folders for organizing tasks
• Setting phone or smartwatch reminders
• Using digital apps to manage tasks
• Breaking large tasks into smaller, manageable steps
• Use an attention strategy, such as P.A.S.E., to get back on track

4. Teach Memory Strategies

Teach patients with a TBI internal and external memory strategies to help them remember job-related information. 

Memory strategies include:

• Write it down. Take notes, voice record, or take a video of what you want to remember
• Repeat and rehearse. Say a piece of info you want to remember over and over again
• Take a mental picture. Visualize what you want to remember. Take a mental snapshot and store it in your brain
• Make associations. Connect what you want to remember with what you already know
• Sort and organize information. Organize what you want to remember into smaller groups (Brewer & Aparo, 2025)

5. Target Metacognition (Self-Awareness)

To best improve cognition, patients with a TBI need to have at least some awareness that they have a cognitive deficit.

Here are the steps to improve self-awareness of cognitive deficits:

• Predict. Before the task, have the patient predict how they’ll do
• Assess. After the task, have them assess how they did
• Compare. Discuss how their prediction compared to how they actually did

Download our free Self-Awareness Worksheet.

6. Add Social Communication Treatment

A traumatic brain injury can cause some patients to experience a significant negative change to their social behavior and social skills. 

These patients may struggle to:

• Be aware that they have a social-communication deficit
• Communicate thoughts and needs
• Listen to and understand others
• Understand and use nonverbal messages, such as facial expressions
• Regulate emotions
• Conform to appropriate social boundaries and rules
• Work with others to solve problems
• Be assertive

(Cicerone et al., 2022)

To improve these skills, focus your social communication treatment on the verbal and non-verbal communication skills they’ll need in the workplace. These may include:

• Improving metacognition (described above)
• Role-playing conversations with supervisors, coworkers, and customers
• Practicing appropriate conversational turn-taking
• Practicing staying on topic
• Addressing non-literal language, such as sarcasm, metaphors, and idioms

To learn more, read Social Communication Treatment After Brain Injury and see The Executive Functioning Workbook for curated worksheets and activities.

7. Make Environmental Modifications & Accommodations

Help patients problem-solve how to adapt their work environment, work schedule, and daily schedule, and how to advocate for their needs. 

Modifications may include:

• Asking for a quieter workspace
• Using noise-canceling headphones
• Limiting distractions (such as closing extra computer tabs, turning off notifications, and muting the computer)
• Reducing excessive lighting if it’s distracting or over-stimulating
• Scheduling cognitively demanding tasks earlier in the day
• Taking rest breaks after a set time or after finishing a task
• Establishing realistic work hours and a gradual return-to-work schedule

8. Practice Stress-Relief & Mindfulness

After a brain injury, patients often experience mental health difficulties that decrease quality of life and inhibit recovery (Chemerinski & Robinson, 2000).

Learning to self-regulate and relieve stress with mindfulness and other strategies can facilitate recovery. Benefits include:

• Lower anxiety and depression
• Better stress response
• Decreased pain and fatigue 
• Decreased mental fatigue
• Improved cognition, particularly attention
• Improved sleep

(Lovette et al, 2022; Saban et al, 2022; Rusch et al., 2019)

Stress relief strategies to teach your patients include:

• Breathing exercises
• Body scan
• Mindful movement
• Gentle yoga

Get step-by-step instructions and free PDFs in our article, 5 Mindfulness Brain Injury Exercises After TBI or Stroke.

9. Target High-Level Cognitive Skills With Tech

Software and apps that target work-related cognitive and executive functioning skills can be excellent exercises for some patients.

Evidence-based cognitive apps for people post-brain injury include:

• BrainHQ®
• Lumosity®
• Constant Therapy®

See the Cognitive Rehabilitation Bundle for curated worksheets and activities made for patients with TBI and other brain injuries.

Need More Help? Refer Out

A multidisciplinary approach to returning to work after a TBI yields better outcomes (Mani et al., 2017). Here are a few key members of the rehabilitation team for patients returning to work after TBI:

• Neuropsychologists for a more in-depth assessment of cognition and return-to-work ability
• Occupational Therapy for help with physical and cognitive work demands
• Physical Therapy for help with mobility and other physical work demands
• Case Managers/Vocational Rehabilitation Counselors for accommodations and workforce reintegration planning
• Social Work for advocacy, counseling, and sources of financial or social assistance (Struchen & Clark, 2007)
• Mental Health Professionals
• Job Coaches
• Employer Human Resource Departments

References

• Alashram, A. R. (2024). Compensatory cognitive training for people with traumatic brain injury: A systematic review of randomized controlled trial. Applied Neuropsychology: Adult, 1–9. https://doi.org/10.1080/23279095.2024.2306133
• Brewer, C., Aparo, M. (2025). The Adult Speech Therapy Starter Pack: Second Edition. Harmony Road Design Publishing
• Bozkurt, S., Lannin, N. A., Mychasiuk, R., & Semple, B. D. (2023). Environmental modifications to rehabilitate social behavior deficits after acquired brain injury: What is the evidence?. Neuroscience and biobehavioral reviews, 152, 105278. https://doi.org/10.1016/j.neubiorev.2023.105278
• Chemerinski, E., & Robinson, R. G. (2000). The neuropsychiatry of stroke. Psychosomatics, 41(1), 5–14. https://doi.org/10.1016/S0033-3182(00)71168-6
• Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
• Lovette, B. C., Kanaya, M. R., Bannon, S. M., Vranceanu, A. M., & Greenberg, J. (2022). “Hidden gains”? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: a scoping review. Brain injury, 36(9), 1059–1070. https://doi.org/10.1080/02699052.2022.2109745
• Mani, K., Cater, B., & Hudlikar, A. (2017). Cognition and return to work after mild/moderate traumatic brain injury: A systematic review. WORK, 58(1), 51-62. https://doi.org/10.3233/WOR-172597
• Meulenbroek, P., O’Neil-Pirozzi, T. M., Sohlberg, M. M., Lemoncello, R., Byom, L., Ness, B., MacDonald, S., & Phillips, B. (2022). Tutorial: The Speech-Language Pathologist’s Role in Return to Work for Adults With Traumatic Brain Injury. American journal of speech-language pathology, 31(1), 188–202. https://doi.org/10.1044/2021_AJSLP-21-00129
• Meulenbroek, P., & Turkstra, L. S. (2016). Job stability in skilled work and communication ability after moderate–severe traumatic brain injury. Disability and Rehabilitation, 38, 452–461.
• Naess, H. L., Vikane, E., Wehling, E. I., Skouen, J. S., Bell, R. F., & Johnsen, L. G. (2020). Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Archives of rehabilitation research and clinical translation, 2(4), 100070. https://doi.org/10.1016/j.arrct.2020.100070
• Rusch, H.L., Rosario, M., Levison, L. M., Olivera, A., Livingston, W. S., Wu, T., & Gill, J. M. (2019). The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Annals of the New York Academy of Sciences, 1445(1), 5–16. https://doi.org/10.1111/nyas.13996
• Saban, K. L., Tell, D., & De La Pena, P. (2022). Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. Stroke, 53(11), 3485–3493. https://doi.org/10.1161/STROKEAHA.122.038457
• Struchen, M.A. & Clark, A.N. (2007). Systematic Approach to Social Work Practice: Working with Clients with Traumatic Brain Injury. [PDF]. Retrieved from https://biausa.org/wp-content/uploads/Systematic-Approach-to-Social-Work-Practice-and-TBI-1.pdf