Cognitive Therapy for Mild Traumatic Brain Injury

I’ve had the opportunity to observe several speech therapy sessions for a client with a mild traumatic brain injury (TBI).  This client happens to be a family member, so I have the unique experience of seeing therapy from both sides of the isle.  This family member was referred to a Speech-Language Pathologist who specializes in treatment for mild TBI’s, so I took the opportunity to attend these sessions in order to gain hands-on experience, and be a help and support to my family member.  The following are some therapy activities and thoughts that I have learned from this experience.

Cognitive Therapy Activities

The following are some cognitive therapy activities that the SLP used to treat my family member’s mild TBI.  I really like them because many of them are functional and complicated enough for a person with a mild brain injury.

At the beginning of every session:

  • Discuss client’s pain level and monitor pain level throughout the session.
  • Review progress at home with homework program.
  • Review any changes (good or bad) client notices in cognitive functioning.

Therapy activities:

Start training with or with  These are great websites that have lots of games geared to improving cognitive function.  They both make for a great homework program because the client simply needs a computer with internet access.  They both have a monthly or yearly membership fee, but they are inexpensive and well worth the cost if the client’s goal is to improve enough to return to work.

Discuss with the patient ways to reduce cognitive load.  Individuals with TBI’s often become fatigued very quickly, so it is important for the therapist to brainstorm ideas to help the patient reduce their cognitive load so that they can save their mental energy for important tasks.  This is going to differ for each patient, but here are some ideas:

  • Write down steps of getting ready in morning and post on mirror
  • Use a pill box for your medications
  • Shower at night
  • Schedule naps during day
  • Limit auditory and visual distractions
  • Move magnets down a task list to help you keep track of completed tasks.
  • Use post it notes: use specific colors as cues to return to tasks.  Ie: Pink = email, Green = spreadsheet, etc.

Play Familiar Faces game on to help client remember names.  Teach client to make associations to help them remember names:

  • Think of someone you know or someone famous with that name
  • Think of something the name sounds like
  • Practice saying the name out loud after you hear it.

Therapists lists 3 errands the client is to remember.  The client, with help from the therapist, thinks of associations to help them remember the errands.  The client is asked to recall the errands after a 5 minute distraction.  The amount of time and number of errands increases as therapy progresses.

Word Associations and Naming Tasks:

  • The therapist gives the client a word, and the client thinks of 5 other words (nouns, verbs, adjectives, etc) that are associated with the given word.  For example, the therapist may say “celebration.”  Possible associations include, anniversary, birthday, promotion, birth of child, happy, balloons, etc.
  • The therapist gives a category and the client names items in the categories.

Reading: Have the client read at home.  The type of reading will depend on the client, but can include articles, newspaper, novels, classic literature, etc.

Memory and Attention Task with Numbers: Have the client start with a number.  Set a timer for 5 minutes.  When the timer goes off, the client adds 30 to the original number, then says the new number out loud.  Reset the timer for another 5 minutes and repeat for the duration of the session.

Word Associations and Memory Tasks: 

  • Provide the client with a list of 20 words separated into 4 categories.  The client is to memorize the words in the categories using associations (as done with the Familiar Faces game).  The client can take as long as needed to memorize.  The therapist asks for the words after a 5-10 minute distraction.
  • As the client improves, verbally give the client 20 words.  Allow the client to separate the words into categories and memorize.

Auditory Attention Tasks:

  • The client listens to a short paragraph and answers questions about it.
  • The therapist reads a paragraph.  After, the client tells the therapist about the paragraph.
    • As the client improves, add complexity.  For example, while the client is listening, have them make a check mark every time they hear the word “and.”
  • The therapist reads a short paragraph, and then reads 3 statements.  The client chooses the statement that best completes the paragraph.
  • Follow 2-3 step complex directions.  Example: “Before you put the blue triangle above the yellow square, put the red circle under the white triangle.  Then, put the white circle under the blue square.”

Visual Attention and Memory Task: Have the client read a newspaper article, and then tell you about it.

Deductive Reasoning Task: Have the client solve puzzles.  These are great to help improve reasoning skills and processing speed.  Some great ones are from Mind Benders.

Divided Attention Tasks: ATP II has some great divided attention tasks.  For example, the therapist reads off a list of fruits and clothing.  In the beginning, the client is to push a buzzer whenever a fruit is mentioned.  After the therapist says “switch,” the client pushes the buzzer after clothing is mentioned.  The therapist randomly says “switch” throughout the reading of the list.  When the client is ready, do the same exercise with auditory distractions added.

Divided Attention and Memory Task:  At the beginning of the session, the client is told that he is responsible for keeping track of the time.  He is to tell the therapist what time it is every 5 minutes.  The purpose of this task is to help with long term divided attention and memory.

Working Memory and Attention Task: Therapist reads a paragraph and the client takes notes.  After, the client uses his notes to give details about the paragraph.

Things I’ve Learned About Cognitive Therapy

One of the biggest lessons I’ve learned is that much of cognitive therapy is simply helping the individual make new connections in their brain.  Because the purpose is to improve over-all brain function, not all therapy activities have to be functional and apply to the person’s daily life.  Memory, attention, and processing speed tasks are often games that help the individual gradually improve those skills.  I learned this in grad school, but it made a difference seeing these tasks make real-life improvement in my family member.

Until next time,

Aersta Acerson

A Utah Speech Therapist