Speech Therapy Guide To Treating Post Concussion Syndrome

Of the 1.5 million+ traumatic brain injuries that happen in the United States every year, 75% are classified as mild TBIs with spontaneous recovery. But some will have symptoms that linger for months or even years as post-concussion syndrome (Permenter et al., 2023).

In our speech therapy guide to treating post-concussion syndrome, you’ll learn:

• Common symptoms of post-concussion syndrome
• How to assess post-concussion syndrome
• Speech therapy treatment options for post-concussion syndrome

What Is Post-Concussion Syndrome?

Post-concussion syndrome (also known as ‘persistent post-concussion symptoms’) is a complex neurological condition in which the symptoms of a concussion linger for more than 1-3 months after a traumatic brain injury. While post-concussion syndrome is most common after a mild TBI, it can also occur in moderate or severe TBIs.

Symptoms Of Post-Concussion Syndrome

Post-concussion syndrome can cause physical, cognitive, behavioral, and emotional changes. Common symptoms of post-concussion syndrome include:

• Dizziness
• Headaches
• Mood changes (i.e., increased irritability, anger, emotional lability, depression, anxiety, apathy, and other neuropsychiatric symptoms)
• Blurred vision
• Double vision
• Fatigue
• Sleep disturbance
• Sensitivity to light and noise
• Cognitive deficits (i.e., confusion and difficulties with concentration, memory, executive functioning, and learning)
• Trouble with balance
• Social communication changes

(Bazarian et al., 1999; Rytter et al., 2021)

How Common Is Post-Concussion Syndrome (PCS)?

Post-concussion syndrome is often overlooked and underdiagnosed. Around 15% of patients diagnosed with a mild TBI will go on to experience post-concussion syndrome. 

While most will recover from their concussion symptoms within the first few weeks of the brain injury, around 20-30% will continue to experience post-concussion symptoms that persist for more than 1-3 months.

(Ontario Neurotrauma Foundation, 2018; Meehan et al., 2014). 

Why Treat Post-Concussion Syndrome?

Persistent concussion symptoms can hinder a person’s ability to work, attend school, socialize, and complete other daily activities.

Speech therapy can help in all of these areas. Specifically, ST can address difficulties with expressing and understanding language, memory, social communication, executive functioning, swallowing, motor speech, stuttering, and more.

If you suspect PCS but your patient has not yet been diagnosed, refer them to a neurologist experienced with PCS for thorough testing, diagnosis, and other appropriate medical treatments.

Speech Therapy Assessment In Post-Concussion Syndrome

1. Medical Records Review

As part of your comprehensive speech therapy assessment, start by reviewing the patient’s chart, medical records, and brain imaging for relevant information. Look for:

• Which parts of the brain were injured
• The type of brain injury. TBIs can be diffuse (widespread), focal (specific to a particular area), and/or hypoxic (characterized by a lack of oxygen; Suiter and Gosa, 2019). 
• Other trauma or injuries
• Precautions: spinal precautions, cerebral edema (Jha et al., 2019), blood pressure precautions, etc.

2. Patient Interview

During the patient interview, ask questions about their mental, physical, emotional, and overall well-being.

3. Assessments

While we as speech therapy professionals don’t diagnose concussions, we can aim to differentiate the symptoms of post-concussion syndrome from other causes in our assessments.

Questionnaires, such as the Rivermead Post-Concussion Symptoms Questionnaire (free PDF), can help guide you in your differential diagnosis.

A Patient-Reported Outcome measure (PROMS) is a questionnaire that assesses a patient’s perception of the severity and frequency of their post-concussion syndrome symptoms. ASHA offers free PROMS on its website. 

Finally, choose speech therapy assessments that provide a comprehensive understanding of your patient’s cognitive-communication and executive functioning abilities. See our list of recommended TBI assessments.

Treating Post Concussion Syndrome  

1. Establish A Strong Relationship

Once you’ve determined that a patient with post-concussion syndrome would benefit from speech therapy, focus on establishing a strong relationship. This will not only improve follow-through but also improve outcomes and prognosis!

Evidence-based ways to build strong therapeutic relationships include practicing active listening, providing person-centered care, and involving patients in setting meaningful goals (Schwabish, 2024).

See the video above for SLP and author Chung Hwa Brewer’s practical guide to person-centered care.

How to practice active listening:

• Be aware of your tone and body language. Be kind and respectful when discussing your therapy plan. 
• Give your full attention to the speaker and listen for what they’re saying (vs. what you want to hear).
• Repeat back what they said to ensure you understand their message and the intention behind it.
• Ask for clarification if you don’t fully understand their message.
• Avoid distractions and assumptions. Again, give your full attention to what they’re saying.
• Listen fully before responding.

(Tennant et al., 2023)

2. Cognitive Exercises

Introduce cognitive exercises based on the results of each patient’s comprehensive assessment. You may prepare treatment activities to improve executive functioning, memory, attention, and/or other areas of cognition.

See 21 Effective Exercises For Cognitive Rehabilitation for specific treatment ideas.

3. Compensatory Strategies 

Teach your patients how to compensate for deficits caused by post-concussion syndrome. The compensations you choose will depend on their speech therapy assessment results and goals.

For example:

• Make to-do lists and use a calendar (Jaber et al., 2019)
• Make checklists
• Use digital apps: reminders, digital calendar, notes apps, voice recording apps, etc.
• Adjust the environment for light sensitivity (wear sunglasses outside, wear blue-light blocking glasses when on a screen)
• Take mental/cognitive breaks when needed
• Break down important tasks into smaller, manageable steps
• Keep a calm, distraction-free environment when completing challenging tasks

4. Encourage Stress-Relief  

Encourage patients who have experienced a TBI to gradually increase their activity level, as tolerated. Help them find the just-right balance between resting and challenging themselves cognitively and physically to avoid overwhelm and an exacerbation of symptoms (Ontario Neurotrauma Foundation, 2018). 

Mindfulness-based interventions, such as breathing exercises, body scans, and mindful movement, can promote recovery in individuals with mild TBIs. These practices may improve coping, somatic symptoms, emotional symptoms, stress response, and attention (Lovette et al., 2022).

See our free mindfulness PDFs and treatment activities for curated activities to use with your patients.

If your patient is experiencing elevated stress, anxiety, and/or depression, encourage them to seek mental health support.

5. Educate About Post-Concussion Syndrome 

Educate patients about their speech therapy-related strengths and weaknesses, including how a TBI and post-concussion syndrome are affecting their cognition and communication. Share what they can realistically expect from their post-concussion syndrome recovery.

Also educate and share resources about post-concussion syndrome, including treatment options outside of speech therapy. The Concussion Legacy Foundation’s post-concussion webpage is a great resource to recommend.

6. Returning To Work

If your patient wants help returning to school or work, incorporate work-related therapy tasks and educate on how to obtain workplace accommodations. See our guide to Returning To Work After A TBI.

7. Collaborate With A Multidisciplinary Team

Managing post-concussion syndrome requires a multidisciplinary approach. Whenever possible, it’s best to find providers who specialize in PCS. Your PCS team may include:

• Neurology for case management and additional treatments
• Neuropsychology for in-depth assessment and treatment
• Psychology to address mental health counseling needs
• Psychiatry to address mental health medication needs
• Physical therapist for functional mobility, vestibular rehabilitation
• Occupational therapist for IADLS, vestibular rehabiliation
• Social work for help accessing community services and funding
• Neuro-optometry for post-concussion vision issues
• Otolaryngology for issues related to the ear, nose, and/or throat

(Permenter et al., 2023)

While speech therapy has a lot to offer for post-concussion syndrome, there are many other important services and treatments to help your patients. When in doubt, refer out!

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References

• Bazarian, J. J., Wong, T., Harris, M., Leahey, N., Mookerjee, S., & Dombovy, M. (1999). Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain injury, 13(3), 173–189. https://doi.org/10.1080/026990599121692
• Heslot, C., Azouvi, P., Perdrieau, V., Granger, A., Lefèvre-Dognin, C., & Cogné, M. (2022). A Systematic Review of Treatments of Post-Concussion Symptoms. Journal of clinical medicine, 11(20), 6224. https://doi.org/10.3390/jcm11206224
• Jaber, A. F., Hartwell, J., & Radel, J. D. (2019). Interventions to Address the Needs of Adults With Postconcussion Syndrome: A Systematic Review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 73(1), 7301205020p1–7301205020p12. https://doi.org/10.5014/ajot.2019.028993
• 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 (Original work published 2017)
• McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017). Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PloS one, 12(4), e0174847. https://doi.org/10.1371/journal.pone.0174847
• Meehan, W. P., 3rd, Mannix, R., Monuteaux, M. C., Stein, C. J., & Bachur, R. G. (2014). Early symptom burden predicts recovery after sport-related concussion. Neurology, 83(24), 2204–2210. https://doi.org/10.1212/WNL.0000000000001073
• Ontario Neurotrauma Foundation. Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms. (2018). [Website]. Retrieved May, 2025 from https://concussionsontario.org/concussion/guideline-section/diagnosis-assessment-of-prolonged-symptoms
• Permenter, C. M., Fernández-de Thomas, R. J., & Sherman, A. L. (2023). Postconcussive Syndrome. In StatPearls. StatPearls Publishing.
• Rytter, H. M., Graff, H. J., Henriksen, H. K., Aaen, N., Hartvigsen, J., Hoegh, M., Nisted, I., Næss-Schmidt, E. T., Pedersen, L. L., Schytz, H. W., Thastum, M. M., Zerlang, B., & Callesen, H. E. (2021). Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA network open, 4(11), e2132221. https://doi.org/10.1001/jamanetworkopen.2021.32221
• Velikonja, D., Ponsford, J., Janzen, S., Harnett, A., Patsakos, E., Kennedy, M., Togher, L., Teasell, R., McIntyre, A., Welch-West, P., Kua, A., & Bayley, M. T. (2023). INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. The Journal of head trauma rehabilitation, 38(1), 83–102. https://doi.org/10.1097/HTR.0000000000000837
• Schwabish, L. (2024). Managing Persistent Post-Concussion Syndrome: 6 Strategies for Cognitive Recovery. [Online Course]. Medbridge. Retrieved May, 2025 from https://www.medbridge.com/blog/managing-persistent-post-concussion-syndrome
• Tennant, K., Long, A., & Toney-Butler, T. J. (2023). Active Listening. In StatPearls. StatPearls Publishing.
• Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119