Speech therapy plays an important role in recovery after a traumatic brain injury (TBI). As a speech therapy professional, you can help rehabilitate cognition, swallowing, language, motor speech, social communication, and more.
This article will guide you through the 7 steps to getting started with speech therapy for TBI.
Your First Patient With A TBI: What To Expect
A traumatic brain injury is damage to the brain caused by an external force. Common causes of TBIs include falls, motor vehicle accidents, assault, and being hit or running into an object (American Speech-Language-Hearing Association, 2024).
TBIs are not uncommon. 2.8 million Americans sustain a traumatic brain injury every year, with nearly 600 hospitalizations every day (Brain Injury Alliance, n.d.; Centers for Disease Control and Prevention, 2025).
Your first patient with a TBI’s treatment and prognosis will vary greatly depending on their cognition, medical condition, and where and how extensively their brain was injured.
TBI & Brain Function
Here is a broad overview of the deficits you may see in patients with TBI, depending on what part of the brain was injured. This information can help you better assess and treat your patient.
Do a thorough chart review, consult with your team, and, of course, complete an excellent speech therapy assessment to understand your patient’s specific strengths and weaknesses. More on all this below.
- Frontal Lobes (Orange): An injury may result in issues with language expression, attention, thought organization, motor planning, problem-solving, self-awareness (including safety), and personality.
- Temporal Lobes (Pink): An injury may result in issues with language comprehension, memory, hearing, and identifying and categorizing what they see.
- Parietal Lobes (Blue): An injury can affect visual perceptual/other sensory abilities, including reading, spatial awareness, and sensation.
- Occipital Lobes (Green): An injury can impact vision and visual processing, including reading and writing.
- Cerebellum (Red): An injury can result in issues with balance and coordination, including slurred speech.
- Brain Stem (Yellow): An injury can result in issues with breathing/respiration, sleep, heart rate, and levels of alertness
(Brain Injury Association Of America, n.d.; Moyle, S., 2023)
Speech Therapy For TBI
Here are the 7 steps to starting speech therapy with a patient who has a TBI.
1. Gather Information
When doing your chart review, review brain imaging carefully.
- Which parts of the brain were injured?
- What type of brain injury is it? TBIs can be diffuse (widespread), focal (specific area), and/or hypoxic (lack of oxygen; Suiter and Gosa, 2019).
- Check for other trauma or injuries, specifically to the mouth, larynx, and/or spine. This can impact safety when swallowing.
Also review:
- Primary reason for admission
- Past medical history
- Labs, imaging, vital signs
- Allergies
- Current diet level
- History of receiving speech therapy and speech therapy notes (deficits noted, goals, diet, recommendations)
- Precautions: spinal precautions, cerebral edema (Jha et al., 2019), blood pressure precautions, etc.
2. Multidisciplinary Care
Coordinated multidisciplinary care is key for successful TBI management and recovery (Lee et al., 2019).
Communicate with your team members as you prepare for your assessment. Plan to follow up with the team and be in communication throughout the course of speech therapy.
3. Interview The Patient And/Or Care Partner
When interviewing a patient with TBI, be sure to also:
- Assess their levels of alertness. Are they able to participate in the assessment?
- Ask about their prior level of functioning, including independence with instrument activities of living (medication management, finances, etc.) and activities of daily living (getting dressed, toileting, bathing).
- Ask about their personal goals, wants, and needs
4. Complete An Oral Motor Exam For TBI
If your patient has indications of swallowing difficulties and possible motor-speech deficits, complete an OME.
You’ll observe strength, range of motion, speed, and symmetry of the mandible, lips, tongue, velum, and reflexes.
Read How To Do An Oral Motor Exam for a step-by-step guide.
If your patient demonstrates decreased strength, range of motion, and/or symmetry of the orofacial structures, proceed with a clinical swallow examination and, possibly, a dysarthria assessment.
5. Choose An Assessment
When working with patients who have TBIs, be ready to assess multiple domains.
Since your time is limited, focus on the main weaknesses impacting your patient’s daily safety, quality of life, and communication ability.
How to choose an assessment:
- Plan to complete a cognitive assessment since TBIs often affect cognition
- Did the chart review show swallowing deficits or red flags? If yes, complete a Clinical Swallow Examination
- Based on your chart review, patient interview, and OME results, they may also benefit from a language, motor speech, voice, apraxia, resonance, and/or fluency assessment
- Screen social communication, especially with patients who have right-hemisphere brain injuries
If the chart review and interview didn’t give you enough information to choose an assessment, then plan to screen swallowing, cognition, and communication and go from there.
6. Complete Speech Therapy TBI Assessments/Screens
Here’s a handy list of speech therapy assessments that can be used for patients with TBsI:
Cognitive-Communication Assessments
- The Adult Speech Therapy Assessment Pack (created by us!)
- Montreal Cognitive Assessment (MoCA).
- Brief Cognitive Assessment Tools (BCAT) Self-Assessment Tools
- Clock Test
- Mini-Mental State Examination (MMSE)
- Addenbrooke’s Cognitive Examination (ACE)
- Mini-Cog
- Saint Louis University Mental Status (SLUMS)
- Ross Information Processing Assessment
- Brief Evaluation of Executive Function
- Brief Interview for Mental Status (BIM)
- Delis-Kaplan Executive Function Systems
- Parts of the Wechsler Adult Intelligence Scale
- Rey-Osterrieth Complex Figure Test
Expressive and Receptive Language Assessments
- ASHA’s Adult Language/Cognitive-Communication Evaluation Template
- The Adult Speech Therapy Assessment Pack
- Assessment of Language-Related Functional Activities
- Western Aphasia Battery
- Boston Diagnostic Aphasia Examination
Communication Screens
- Mississippi Aphasia Screening Test (MS Aphasia Screening Test)
- Cognitive Communication Checklist for Acquired Brain Injury
Communication Patient Reporting Outcome Measure
Voice Assessment Resources
- Voice Assessment for Adult Speech Therapy
- Praat Software
- CAPE-V
- Voice assessment norms
- Max phonation time norms
- DDK rates norms
- ASHA’s Voice Evaluation Template
- Rainbow Passage
Apraxia of Speech Assessment Resources
- Apraxia of Speech Assessment in Adults
- How To Do An Oral Mechanism Exam
- Voice, motor speech, and resonance norms
Dysarthria Assessment Resources
Stuttering Assessment Resources
- Assessment of Stuttering in Adults
- Overall Assessment of the Subjective Experience of Stuttering
- Stuttering Severity Instrument
7. Do Speech Therapy Treatments For TBI
If your assessment shows that the patient is a good candidate for speech therapy treatment, then educate the patient/their care partners about your findings, offer helpful strategies, and refer out as needed.
Treatment will vary greatly depending on the location and severity of the TBI and other patient factors.
Focus on the greatest deficits impacting the patient’s daily safety and quality of life. If, for example, swallowing is the main concern, target that first.
Research shows that a combination of cognitive rehabilitation, focus on activities of daily living, swallowing/communication therapy, and mental health support is best for TBI recovery (Lee et al., 2019). If possible, involve care partners in therapy.
See our list below for our TBI treatment guides and ideas.
TBI Treatment Articles:
More Resources
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- American Speech-Language-Hearing Association. (n.d.) Traumatic Brain Injury (TBI). Retrieved January 2025 from https://www.asha.org/public/speech/disorders/traumatic-brain-injury/
- Brain Injury Alliance. (n.d.) Fact & Statistics. Retrieved Jan 2025 from https://biact.org/understanding-brain-injury/facts-statistics/
- Brain Injury Association of America. (n.d.) Function of the Brain. Retrieved January 2025 from https://biausa.org/brain-injury/about-brain-injury/what-is-a-brain-injury/function-of-the-brain
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Centers for Disease Control and Prevention. (2025). National Center for Health Statistics: Mortality Data on CDC WONDER. Accessed December 2024 from https://wonder.cdc.gov/mcd.html.
- Jha, R. M., Kochanek, P. M., & Simard, J. M. (2019). Pathophysiology and treatment of cerebral edema in traumatic brain injury. Neuropharmacology, 145, 230-246. https://doi.org/10.1016/j.neuropharm.2018.08.004
- Lee, S. Y., Amatya, B., Judson, R., Truesdale, M., Reinhardt, J. D., Uddin, T., Khan, F. (2019). Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal. Brain Injury, 33(10), 1263–1271. https://doi.org/10.1080/02699052.2019.1641747Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal: Brain Injury: Vol 33 , No 10 – Get Access
- Moyle, S. (2023). Understanding Brain Damage Locations. [Online Article]. Ausmed. Retrieved January 2025 from https://www.ausmed.com/learn/articles/understanding-brain-damage-locations
- Suiter, D. Gosa, M. (2019). Assessing and Treating Dysphagia: A Lifespan Perspective. 1st Edition. Thieme Medical Publishers, Inc. doi:10.1055/b-006-149650