Cognitive-Communication Disorders

A cognitive-communication disorder is trouble communicating because of changes in thinking skills such as attention, memory, organization and reasoning, most often after a traumatic brain injury, a stroke or a neurological illness.⁠^1,2 Speech-language therapy that trains strategies, practices them in real life and teaches family members how to help has the strongest evidence (see speech therapy for adults).⁠^2,3

What is a cognitive-communication disorder?

Cognitive-communication disorders are problems with communication that come from disruptions in cognition: thinking processes such as attention, perception, memory, organization and executive function.⁠¹ Communication here is broad: listening, speaking, gesturing, reading and writing, verbal or nonverbal.⁠¹ The INCOG guidelines include social cognition too, the ability to recognize other people’s emotions and infer what they are thinking.⁠²

The effects reach every part of life: self-regulation, social interaction, everyday activities, learning and work, and the ability to socialize, work and study.⁠^1,2 Executive function, the group of processes that control starting and stopping, sustaining and shifting attention, organizing, setting and completing goals and planning, is often at the center.⁠⁷ Speech-language pathologists (SLPs) screen, assess and treat these problems; speech therapy explains what SLPs do.⁠¹

Cognitive-communication disorder vs aphasia: what is the difference?

Aphasia is a language disorder: it affects the language system itself, and its presence does not imply problems with thinking, because language and cognition are separate but overlapping skills.⁠⁴ In a cognitive-communication disorder the reverse is common: after damage to the right side of the brain, for example, word retrieval and grammar are usually unaffected, yet conversation, humor and inference suffer.⁠⁵ A brain injury can cause both, and aphasia describes the language side.⁠⁴

How common are cognitive-communication disorders?

• After a severe traumatic brain injury: over 70% of people have some communication disability.⁠²
• After right hemisphere damage: estimated at 50% to 90%.⁠⁵
• Executive function problems: 19% to 47% after a stroke; 48% of adults with moderate to severe TBI in the subacute phase and 38% in the chronic phase; 10% to 65% in Parkinson’s disease.⁠⁷
• Multiple sclerosis: cognitive impairment affects up to 75% of people with MS.⁠¹³
• Traumatic brain injury in the US: about 2.8 million new cases a year and about 5.3 million people living with a TBI-related disability, by the figures ASHA cites; as many as 75% of injuries are mild.⁠¹ There were over 69,000 TBI-related deaths in 2021.⁠¹⁴

What causes cognitive-communication disorders?

Any acquired injury or illness of the brain can cause one. The causes ASHA and others list:⁠^1,5

• Traumatic brain injury, including concussion, a mild TBI; most TBIs each year are mild. People most often get TBIs from falls, firearm injuries, motor vehicle crashes and assaults, and falls lead to nearly half of TBI hospitalizations.⁠^14,15,16
• Stroke, especially on the right side of the brain: right hemisphere disorder is most commonly caused by a stroke.⁠⁵
• Brain tumors and cancer, and cancer treatment: chemotherapy, some radiation to the brain and immunotherapy can cause trouble thinking, concentrating or remembering, sometimes called chemo brain.⁠^1,17
• Lack of oxygen or toxins affecting the brain (anoxic or toxic encephalopathy), infections, seizures and brain surgery.⁠^1,5
• Multiple sclerosis: problems concentrating, multitasking, learning, remembering or judging, which may come with the physical symptoms or develop gradually.⁠¹³
• Parkinson’s disease: problems thinking, remembering, paying attention and figuring things out, which can get worse over time.⁠¹⁸
• Dementia: cognitive decline is a core feature of every type, and it can bring cognitive-communication problems.⁠¹⁹

What do cognitive-communication disorders look like after a brain injury or stroke?

After a traumatic brain injury, communication can range from too little, with flat expression, word-finding trouble and difficulty starting or keeping up a topic, to too much: talking at length, wandering off topic, dominating the conversation and repeating oneself.⁠² People with TBI may seem self-focused, miss social cues and implied meanings, be overly familiar with acquaintances or stand too close.⁠²

After right hemisphere damage, the core problem is pragmatics, the social use of language: trouble using or recognizing sarcasm, jokes, figures of speech and double meanings, and trouble making inferences or grasping the overall point. Flat or misread tone of voice (aprosodia) affects an estimated 50% to 70%, spatial neglect 33% to 82% after a right hemisphere stroke, and many have reduced awareness of their own deficits (anosognosia); these problems often go unrecognized in the acute stage.⁠⁵

With dementia, memory and other thinking skills decline progressively, with word-finding pauses and word substitutions.⁠¹⁹ In MS and Parkinson’s disease, the changes are those of concentration, memory, attention and judgment described above.⁠^13,18

What are the signs of a cognitive-communication disorder?

The signs ASHA lists after a brain injury:

• Conversation: talking at length, difficulty starting a conversation or staying on topic, trouble taking turns, going off on tangents, saying inappropriate things, and missing nonverbal cues such as a shrug.⁠^1,15
• Organizing and following talk: disorganized speech, difficulty following directions and understanding abstract ideas.⁠¹
• Memory: working memory problems that disrupt following directions and finishing tasks, and forgetting planned actions, such as taking medication.⁠¹
• Attention and speed: slow processing of fast or complex speech, which brings confusion, trouble shifting attention, and feeling foggy.⁠^1,6
• Reading and writing: trouble understanding complex or figurative text and planning, organizing and editing writing.⁠¹
• Judgment: impulsivity, problem solving and safety awareness.⁠^1,5,15

The person may not see it. Reduced awareness of deficits is common: across several studies, 76.9% to 97.1% of people with a traumatic brain injury had limited awareness of their deficits when they left the hospital, and after a concussion a person may not recognize or admit problems.⁠^5,6

When do thinking or speech changes need emergency care?

Sudden changes in thinking or speech can be a stroke:

After a head injury, CDC says the people checking on you should call 9-1-1 or take you to an emergency department right away if you:⁠⁶

• have a headache that gets worse and does not go away;⁠⁶
• have weakness, numbness, decreased coordination, convulsions or seizures;⁠⁶
• vomit repeatedly;⁠⁶
• have slurred speech or unusual behavior;⁠⁶
• have one pupil larger than the other;⁠⁶
• cannot recognize people or places, or get confused, restless or agitated;⁠⁶
• lose consciousness, look very drowsy or cannot be woken up.⁠⁶

In rare cases a dangerous blood clot can crowd the brain against the skull.⁠⁶ Anyone with a concussion needs to be seen by a health care provider, and a bleed may not be obvious at first.⁠^15,16 In older adults, a TBI can be missed because its symptoms overlap with conditions such as dementia, and blood thinners can raise the risk of bleeding in the brain after a TBI.⁠¹⁴

How is a cognitive-communication disorder diagnosed?

Doctors diagnose the brain injury or illness; SLPs do not diagnose TBI, but they play a central role in screening, assessing and treating its effects on communication, alongside neuropsychologists, occupational therapists and psychologists.⁠^1,7 A brain scan such as a CT is not needed to spot a concussion, and neuropsychological tests are often used with imaging after a mild TBI.⁠^16,21 What the SLP looks at:

• Thinking skills as they affect communication: awareness of deficits, memory, problem solving and reasoning, flexibility and the ability to understand others’ thoughts.⁠⁵
• Discourse: describing pictures, telling stories and conversation samples.⁠⁵
• Real life: observation, interviews with the person and care partners, checklists, rating scales and questionnaires, because test scores can over- or underestimate everyday ability.⁠^1,7
• Research measures such as the La Trobe Communication Questionnaire and The Awareness of Social Inference Test; few standardized tests exist for these disorders.⁠^1,2

Other causes are checked first or alongside: hearing and vision, fatigue, sleep, anxiety, depression, pain, substance use and medicines can all affect attention, and depression should be ruled out in MS.⁠^2,13,22 Speech and language problems can be mistaken for memory or attention problems, so they are screened for specifically.⁠⁸ If depression is suspected, the SLP refers to a neuropsychologist, psychologist or psychiatrist.⁠¹ Assessment is repeated over time, because recovery can continue for months or longer after a severe injury.⁠¹

Does speech therapy help cognitive-communication disorders?

Yes, for many people, particularly therapy aimed at everyday function. The INCOG 2.0 guidelines for adults with moderate to severe traumatic brain injury, 80 recommendations graded A (strongest) to C, say people with lasting cognitive deficits should receive functionally oriented cognitive rehabilitation.⁠^2,23 Their main recommendations:

A wider review of 121 studies of cognitive rehabilitation after TBI or stroke, 41 of them of the highest class, supports treatment of attention, visual scanning for neglect after a right hemisphere stroke, compensatory strategies for mild memory problems, social communication after TBI, metacognitive strategy training and comprehensive holistic rehabilitation.⁠³

Does cognitive rehabilitation help after a stroke?

The evidence is thinner. Cochrane reviews found limited evidence for memory rehabilitation (13 trials, 514 people: some short-term self-reported benefit but no effect on memory tests, mood, function or quality of life), that attention training remains unconfirmed (6 trials, 223 people), and too little high-quality evidence to judge executive function training (19 studies, 907 people).⁠^26,27,28 The 2026 stroke rehabilitation guideline’s patient summary suggests practical aids such as a checklist, so you do not forget the steps of an activity.⁠²⁹

Does communication partner training help after a brain injury?

Yes; INCOG rates it level A.⁠² In TBI Express, a controlled trial of 44 people with chronic severe TBI, a 10-week program that trained their communication partners worked better than training the person alone, and the results lasted 6 months.⁠¹² Partners learn to offer support and structure, for example by asking questions in a positive way and taking turns collaboratively.⁠^1,2 Delivered by telehealth, a partner program improved casual conversation as well as in-person delivery did.⁠³⁰

Do group social skills programs help?

Yes. In a trial of 52 people at least a year after a TBI, 12 weekly group sessions of 1.5 hours improved communication skills, gains lasted, and life satisfaction rose.⁠¹¹ ASHA notes that individual and group therapy together reach functional goals better than groups alone.⁠¹

Do brain-training apps and games help?

Not on their own. INCOG does not recommend decontextualized drills, worksheets or brain training programs, because there is not enough evidence that the gains carry over to real life; the VA/DoD guideline for mild TBI suggests against self-administered computer training.⁠^2,8,25 An independent review found little evidence that brain training improves everyday thinking, and the Federal Trade Commission said Lumosity did not have the science to back up its ads.⁠^9,31 Computer practice can still have a place inside therapy a clinician directs toward real tasks.⁠²⁵

What helps after a concussion?

Most people feel better within a couple of weeks.⁠⁶ If memory, attention or executive problems persist despite managing sleep, pain, headache, mood and balance, the VA/DoD guideline suggests a short trial of clinician-directed cognitive rehabilitation; when problems last more than 30 days, a time-limited trial focused on education and strategies for daily life may help recovery.⁠⁸ A short trial of 4 to 6 sessions can show whether more would help, and long courses that do not improve daily participation are strongly discouraged.⁠⁸

How is right hemisphere disorder treated?

There are few published treatments, and limited insight often makes therapy harder.⁠⁵ Therapy often makes implicit communication rules explicit, and teaches task-specific strategies such as scanning to the left.⁠⁵

What memory aids and technology help?

External aids are among the best-supported tools. INCOG recommends environmental supports and reminders, such as smartphones, notebooks and whiteboards, especially for severe memory problems, and says the person and their caregivers must be trained to use them.⁠²⁵ Options include:

• Low tech: calendars, timers, checklists, maps, color-coded binders and small notebooks.⁠¹
• High tech: smartphones, computers, smart pens and voice recorders, with alarms and electronic reminders for medicines and appointments.⁠^1,5,7
• Familiar devices first: familiar, commercially available devices are easier to learn and less often abandoned than customized ones.⁠⁸

The evidence for reminders goes back to NeuroPage: in a randomized crossover trial of 143 people aged 8 to 83, more than 80% of those who completed the 16 weeks did significantly better at everyday activities, such as self-care, taking medicines and keeping appointments, with the pager, and most kept the gain 7 weeks after returning it.⁠¹⁰ For thinking problems after cancer treatment, the National Cancer Institute suggests a daily planner, a recorder or another electronic device.⁠¹⁷

What happens in cognitive-communication therapy, session by session?

Therapy usually starts in the hospital or inpatient rehabilitation and may continue afterward; its frequency and length depend on alertness, tolerance, stage of recovery and other therapies.⁠¹ What it involves:

• Your own goals: goal attainment scaling works best when the person helps set the goals; SMART goals are another framework.⁠^2,7
• Restorative and compensatory work: rebuilding skills where possible and compensating where not, with metacognitive training in goal setting, self-monitoring and self-regulation.⁠¹
• Practice where you live: skills practiced in the places you live, work, study and socialize, including outings in the community.⁠^2,7
• Enough practice, spread out: time and opportunity to practice, and distributed practice.⁠²⁵
• Family involvement, to carry strategies into daily life.⁠^1,7

There is no standard length. Programs in trials ran 10 weeks (TBI Express) or 12 weekly sessions (group social communication), and the VA/DoD guideline suggests 4 to 6 sessions to see whether more would help after a mild TBI.⁠^8,11,12 Telepractice is an option, and Medicare covers speech therapy by telehealth at home through December 31, 2027.⁠^7,32

How does outpatient therapy work on Medicare?

Can you drive or work with a cognitive-communication disorder?

Driving. After a concussion, ask your provider for written instructions about when you can safely return to activities such as driving.⁠³⁸ For people with cognitive impairment, NHTSA’s guidance for clinicians is a functional evaluation of fitness to drive, because problems such as slow responses to changing traffic and trouble switching attention affect driving.⁠³⁹

Work. The SLP identifies how the deficits may affect job performance and trains strategies for the workplace, such as written task instructions and time-management devices; people with TBI may be protected at work under Section 504 of the Rehabilitation Act.⁠¹ The Job Accommodation Network suggests written instructions, written short- and long-term goals, calendars and planners, and medication reminders.⁠⁴⁰ After a mild TBI, a short time off work, usually no more than 1 to 2 days, may be needed, and an Employee Assistance Program can help with the return.⁠³⁸

How can families help someone with a cognitive-communication disorder?

Communicating with someone after a brain injury can be tiring, to the point that friends and family begin to avoid them, which is one reason partner training is part of good care.⁠² What helps:

• Learn the strategies: trained partners offer support and structure and ask questions in a positive way.⁠²
• Cut distractions: turn off the TV during conversation, avoid noisy restaurants, and pick the best time of day for important tasks.⁠⁵
• Say how you feel: stating your emotions at the start of a conversation helps someone who misreads tone or expression.⁠⁵
• Change the task or the setting, to reduce the effect of attention problems on daily life.⁠²²
• Help with the aids: caregivers need training in the memory supports too.⁠²⁵

Support from family and friends helps recovery.⁠³⁸ If the person does not see a problem, that is common; therapy that builds self-monitoring with feedback is recommended.⁠^5,24

Can cognitive-communication disorders get better?

• After a concussion: most people feel better within a couple of weeks and can return to work and other activities within days or weeks, but some have symptoms for months or longer; recovery from a second or third concussion is generally slower.⁠^6,21,38 See the provider again if symptoms do not go away within 2 to 3 weeks or get worse when you return to your activities.⁠³⁸
• After a moderate or severe TBI: effects can be long-term or lifelong, but recovery can continue for months or longer, and people in trials improved their communication a year or more after the injury.⁠^1,11,12,14
• In progressive conditions such as dementia and Parkinson’s disease, problems can worsen over time, and therapy goals change with them.⁠^18,19

Does Medicare cover cognitive-communication therapy?

Yes. Medicare Part B covers medically necessary outpatient speech-language pathology, including cognitive skills and therapy to maintain function or slow decline, with no yearly limit on what it pays.⁠³⁶ Improvement is not required. Medicare covers skilled therapy to maintain function or to prevent or slow decline, not only to restore it, provided the other coverage rules are met; coverage turns on the need for skilled care, not on the potential to improve.⁠³⁷

Medicare has no cap on outpatient therapy, but once physical therapy and speech-language pathology together pass $2,480 in a year (the 2026 amount), each claim must confirm that the therapy is medically necessary, and claims past $3,000 can be picked for review.⁠⁴³

Medicaid, Marketplace plans and the VA. For adults, speech, hearing and language services are an optional Medicaid benefit, so coverage depends on your state; home health is a mandatory benefit.⁠⁴⁴ Every Marketplace plan covers rehabilitative and habilitative services and devices, though the specific services vary with each state’s requirements.⁠⁴⁵ For veterans, audiology and speech pathology are standard medical benefits for every enrolled veteran.⁠⁴⁶ With any private plan, ask about visit limits, whether a referral is needed, and whether the SLP is in network.

Which conditions are related to cognitive-communication disorders?

• Aphasia: a language disorder, which can occur with a cognitive-communication disorder after the same injury.⁠⁴
• Dementia: progressive, while a traumatic brain injury is nondegenerative.⁠^1,19
• Depression and anxiety: very common after a stroke, and they can make a concussion harder to adjust to; after a stroke, sleep apnea can also add to brain fog and fatigue.⁠^29,38
• Chronic traumatic encephalopathy (CTE): a progressive disorder linked to repeated head injuries, with symptoms that may include problems thinking, understanding and communicating.⁠²¹
• ADHD: executive function problems that begin in childhood can continue into adulthood; this page is about problems acquired later.⁠⁷

Other adult speech and swallowing problems have their own causes and treatment: dysarthria, dysphagia, voice disorders, stuttering in adults, and the changes in speech and communication that come with ALS and dementia.

What are common myths about cognitive-communication disorders?

• Myth: brain games will fix it. Guidelines do not recommend brain training on its own, because its gains do not carry over to daily life.⁠^2,8,9
• Myth: if speech sounds fine, communication is fine. Problems that look subtle in a structured test often show in conversation, and test scores can misjudge everyday ability.⁠^1,5
• Myth: nothing changes after the first year. People a year or more after a TBI improved with group therapy, and people with chronic severe TBI improved when their partners were trained.⁠^11,12
• Myth: it is the same as aphasia. Aphasia affects language itself; in a cognitive-communication disorder, the thinking skills behind communication are affected.⁠^1,4

How do you find a speech therapist for memory and thinking problems?

Look for an SLP who treats adults after brain injury or stroke; SLPs work with neuropsychologists, occupational therapists and psychologists on these problems.⁠^1,7 Every SLP needs a state license. ASHA’s Certificate of Clinical Competence (CCC-SLP) is a national credential whose holders have met standards that typically go beyond state licensure, and anyone can check an SLP’s certification on ASHA’s site.⁠^47,48

The DrSensory speech therapy directory lists practices by state and city. On a city page, set Care for to Adults and Specialty to Neuro (stroke, TBI, Parkinson’s). A specialty tag comes from the practice’s own description of its services, not from a credential, so ask whether the SLP treats memory, attention and social communication problems after brain injury when you call.

Therapy can also happen at home: Medicare home health covers speech therapy for people who are homebound, and telehealth widens access.⁠^32,41 In-home therapy explains how home visits work.

Sources

1. American Speech-Language-Hearing Association. Traumatic Brain Injury in Adults (Practice Portal). “Cognitive-communication disorders encompass aspects of communication that may be affected by disruptions in cognition”; “Cognition includes cognitive processes and systems (e.g., attention, perception, memory, organization, executive function)”; “Acquired etiologies can include stroke, brain tumor or cancer, TBI, anoxic or toxic encephalopathy, and nondegenerative and degenerative neurological diseases (e.g., dementia)”. “Currently, there are few standardized communication assessments for use with individuals TBI”; “Treatment for TBI can be restorative and/or compensatory”; external aids include “calendars, timers, checklists, maps, color-coded binders, and small notebooks”. Checked October 7, 2026.
2. Togher L, Douglas J, Turkstra LS, Welch-West P, Janzen S, Harnett A, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders. Journal of Head Trauma Rehabilitation. 2023;38(1):65–82. doi:10.1097/HTR.0000000000000835 (PMID 36594860). “Cognitive-communication disorders are common after severe TBI, with over 70% of people experiencing some level of communication disability as a result of their injury”. Recommended: “Communication partner training (level A)”, “Communication strategy and metacognitive awareness training (level A)”; practice in real-life contexts with goal attainment scaling (level A); group therapy (level A); telehealth partner training (level B); AAC (level C). “Decontextualized drill practice, worksheets, and brain training programs are not recommended”.
3. Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, et al. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Archives of Physical Medicine and Rehabilitation. 2019;100(8):1515–1533. doi:10.1016/j.apmr.2019.02.011 (PMID 30926291). 121 studies reviewed; across its reviews the task force “has now evaluated 491 articles” and makes “29 recommendations”. Practice Standards include “social-communication deficits after TBI”, “metacognitive strategy training for deficits in executive functioning” and “compensatory strategies for mild memory deficits”.
4. American Speech-Language-Hearing Association. Aphasia (Practice Portal). “Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, typically the left hemisphere, that affects the functioning of core elements of the language network”; it “involves varying degrees of impairment in four primary areas”, spoken and written expression and spoken and reading comprehension. “Language and cognition are separate but overlapping skills”; “the presence of aphasia does not imply cognitive deficits”. “Aphasia can occur because of traumatic brain injury (TBI), brain tumor, infection, dementia, or other neurodegenerative diseases. However, it is most commonly seen in individuals post-stroke”, ischemic (from a blockage) or hemorrhagic (from a ruptured blood vessel); “roughly 100,000–180,000 people acquire aphasia each year in the United States”; “2–4 million people in the United States are living with aphasia”; “roughly 25%–50% of all strokes result in aphasia”; “Fifteen percent of individuals under the age of 65 years experience aphasia after their first ischemic stroke. This percentage increases to 43% for individuals 85 years of age and older”. “Very few statistics are available regarding the incidence and prevalence of TBI-induced aphasia”; “aphasia occurred in 13%–19% of individuals with TBI”; “the incidence of aphasia as a result of primary brain tumors ranged from 30% to 50%”. “in rare instances, aphasia can occur with a right-hemisphere lesion. This happens most often in people who are left-handed”; “When a right-hemisphere lesion causes aphasia in someone who is right-handed, this is referred to as crossed aphasia”. Types: “Clinicians should be aware that a person’s presentation may not fit into a single aphasia type or subtype”; “Aphasia’s presentation may also change over time as communication improves with recovery”; “primary progressive aphasia is a subtype of frontotemporal dementia in which language capabilities become progressively impaired”. Signs: anomia, “difficulty retrieving words, is essentially universal across all individuals with aphasia”; sound and word substitutions (“These are known as phonemic paraphasias”, “These are known as semantic paraphasias”); “creating novel words that are not meaningful or recognizable to the listener”; “This is known as telegraphic speech”; “speaking haltingly or with effort”; “making syntax errors, such as putting words in the wrong order”; “requiring extra time to understand spoken messages”; “having difficulty understanding long or rapidly presented speech”; “having difficulty understanding spoken language without supporting visual information (e.g., telephone, radio)”; “having difficulty interpreting nonliteral language”; “lacking awareness of errors”; “Alexia is the term for reading comprehension difficulties, and agraphia is the term used for written expression difficulties. Alexia and agraphia can occur together or in isolation”; “individuals who speak more than one language may be affected by aphasia in different ways depending on when the language was learned, how often each language is used, and the overall degree of proficiency in each language”. Assessment: “Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with aphasia”; “Screening is a procedure for identifying the need for further assessment and does not provide a detailed description of the diagnosis, severity, and characteristics of aphasia”; “Facilitate a differential diagnosis of apraxia and dysarthria through an assessment of articulatory processes”; “Assess expressive and receptive skills in spoken/signed and written language of increasing complexity across a variety of contexts”, including comprehension of words, sentences and paragraphs, naming, repetition, spontaneous speech, discourse, writing and gestures; “endurance and fatigue (testing may need to be broken into shorter sessions)”; “presence or history of mental health disorders (e.g., anxiety, depression)”; glasses and hearing aids “should be worn during assessment if applicable prescriptions are still appropriate”; “Clinicians should gather data in all languages used to determine the degree of functional impact”; “The identification and differential diagnosis of co-occurring impairments (e.g., cognitive-communication deficits, dysarthria, or acquired apraxia of speech) aid in planning an appropriate treatment plan”. Treatment: “Aphasia treatment is individualized to address the specific areas of need identified during assessment, including goals identified by the person with aphasia and their care partners”; it “can be restorative (i.e., aimed at improving or restoring impaired function) and/or compensatory (i.e., aimed at compensating for deficits not amenable to retraining)”; service delivery covers “dosage—frequency, intensity, and duration of service”; “Treatment typically begins in the acute or rehabilitation inpatient setting and may continue in post-acute care”; “Intensive treatment/programs (e.g., intensive aphasia day treatment) may be used for a time-limited period”; “Treatment extenders—such as care partners, volunteers, and community members—may be trained to stimulate and support communication”; “Clinicians may also use technology tools, such as computer programs and apps, as part of a home program”; “Community aphasia groups can help support work that is done within the clinical setting”; “Treatment occurs in the language(s) used by the person with aphasia—either by a bilingual SLP or through collaboration with interpreters, when necessary”; “Developing person-centered treatment plans, providing treatment, documenting progress, and determining appropriate dismissal criteria in collaboration with the patient and the treatment team”; “accommodations such as large print, pictures, and aphasia-friendly formatting to support comprehension of written health materials”. Named approaches (“This information is not exhaustive, nor does inclusion of any specific treatment approach imply endorsement from ASHA”): constraint-induced language therapy, “a treatment approach that focuses on increasing spoken language output while discouraging (constraining) the use of compensatory communication strategies (e.g., gesturing and writing). CILT also involves high-intensity training via massed practice”; melodic intonation therapy, which “uses melodic concepts (i.e., pitch, rhythm, and stress) to improve expressive language by engaging the right hemisphere of the brain” and “is often used to treat individuals with severe nonfluent expressive language deficits who have relatively intact receptive language skills”; semantic feature analysis, “a word retrieval treatment in which the person with aphasia identifies important semantic features of a target word that is difficult to retrieve”; Verb Network Strengthening Treatment, “an aphasia treatment to promote lexical retrieval in sentence context”; script training, in which “the clinician and the person with aphasia develop a scripted monologue or dialogue of an activity of interest and then practice it intensely until production of the scripted speech becomes automatic and effortless”; response elaboration training, “a treatment approach designed to improve spoken language by increasing the number of content words in persons with aphasia”; conversational coaching, “a treatment designed to teach verbal and nonverbal communication strategies to individuals with aphasia and their primary communication partners”; the Life Participation Approach to Aphasia, which “considers an intervention that emphasizes achieving or reengaging in life”; gestural facilitation of naming, “an approach that uses intact gesture abilities to facilitate the activation of word retrieval”; Visual Action Therapy, “a nonverbal treatment approach that trains individuals to use hand gestures to represent items that are not present”. AAC: “AAC approaches incorporate low-tech strategies (e.g., photos, communication books) and high-tech devices to enhance communication”; “AAC focuses on using the individual’s residual language abilities”. Prognosis: “The most predictive indicator of long-term recovery is initial aphasia severity, along with lesion site and size”; “Factors that may negatively affect improvement include poststroke depression”. Checked October 7, 2026.
5. American Speech-Language-Hearing Association. Right Hemisphere Disorder (Practice Portal). “Word retrieval, syntax, morphology, and phonological processing are not typically affected by injury to the right hemisphere”; “Most people are left hemisphere dominant for language, so crossed aphasia is rare”. Checked October 7, 2026.
6. Centers for Disease Control and Prevention. Symptoms of Mild TBI and Concussion. September 15, 2025. Danger signs in adults: call 9-1-1 or go to an emergency department if the person has “a headache that gets worse and does not go away”, “Vomit repeatedly”, “Have slurred speech or unusual behavior”, “Cannot recognize people or places, get confused, restless, or agitated”, among others. “most people with a mild TBI or concussion feel better within a couple of weeks”; “A person may not recognize or admit that they are having problems”. Checked October 7, 2026.
7. American Speech-Language-Hearing Association. Executive Function Deficits (Practice Portal). Executive function deficits by condition, among them “Stroke —19% to 47%” and, after moderate-to-severe TBI, “48% of adults with moderate-to-severe TBI in the subacute phase”; adults may struggle with “paying bills, managing medications, or engaging appropriately in social situations”. Treatments listed include goal management training, metacognitive strategy instruction and “Low-tech aids (e.g., written notes, pictorial checklists/schedules, reminders, calendars, alarms)”. Checked October 7, 2026.
8. U.S. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury: Provider Summary (PDF, Version 3.0, June 2021). Recommendation 10 (weak for): people “who present with memory, attention, or executive function problems despite appropriate management of other contributing factors” should be “referred for a short trial of clinician-directed cognitive rehabilitation services”; Recommendation 11 (weak against): “We suggest against the use of self-administered computer training programs”. “Short-term trials of evidence-based cognitive rehabilitation (e.g., 4 – 6 sessions) may provide sufficient information to determine potential benefit”. Checked October 7, 2026.
9. Simons DJ, Boot WR, Charness N, Gathercole SE, Chabris CF, Hambrick DZ, et al. Do “Brain-Training” Programs Work? Psychological Science in the Public Interest. 2016;17(3):103–186. doi:10.1177/1529100616661983 (PMID 27697851). “we find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance”.
10. Wilson BA, Emslie HC, Quirk K, Evans JJ. Reducing everyday memory and planning problems by means of a paging system: a randomised control crossover study. Journal of Neurology, Neurosurgery, and Psychiatry. 2001;70(4):477–482. doi:10.1136/jnnp.70.4.477 (PMID 11254770). NeuroPage: a crossover trial “with 143 people aged between 8 and 83 years”; “More than 80% of those who completed the 16 week trial were significantly more successful in carrying out everyday activities (such as self care, self medication, and keeping appointments) when using the pager”.
11. Dahlberg CA, Cusick CP, Hawley LA, Newman JK, Morey CE, Harrison-Felix CL, et al. Treatment Efficacy of Social Communication Skills Training After Traumatic Brain Injury: A Randomized Treatment and Deferred Treatment Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2007;88(12):1561–1573. doi:10.1016/j.apmr.2007.07.033 (PMID 18047870). “Volunteer sample of 52 people with TBI who were at least 1 year postinjury”; “Twelve weekly group sessions (1.5 h each) to improve social communication”; “TBI subjects who received social communication skills training had improved communication skills that were maintained on follow-up”.
12. Togher L, McDonald S, Tate R, Power E, Rietdijk R. Training communication partners of people with severe traumatic brain injury improves everyday conversations: a multicenter single blind clinical trial. Journal of Rehabilitation Medicine. 2013;45(7):637–645. doi:10.2340/16501977-1173 (PMID 23803687). TBI Express: a “Three arm non-randomized controlled trial” (not an RCT); “Forty-four outpatients with severe chronic traumatic brain injuries were recruited”; a “Ten-week conversational skills treatment program”. “Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone”; “Results were maintained at six months post-training”.
13. National Institute of Neurological Disorders and Stroke. Multiple Sclerosis (MS). “Cognitive impairment—a decline in the ability to think, learn, and remember—affects up to 75% of people with MS”; “Sometimes, depression causes cognitive impairment in people with MS, and it’s important to rule out depression, first”. Checked October 7, 2026.
14. Centers for Disease Control and Prevention. Facts About TBI. “There were over 69,000 TBI-related deaths in the United States in 2021”; “Falls lead to nearly half of the TBI-related hospitalizations”. “a person with a mild TBI or concussion may experience short-term symptoms and feel better within a couple of weeks or months. And a person with a moderate or severe TBI may have long-term or life-long effects from the injury”. Checked October 7, 2026.
15. Communication Health Support Association (consumer site powered by the American Speech-Language-Hearing Association). Traumatic Brain Injury (TBI). “Concussion is a less severe kind of TBI called a mild traumatic brain injury”; problems with thinking can include “paying attention”, “remembering things” and “solving problems”; an SLP may help you “learn what memory strategies work best for you, like using calendars, alarms, and to-do lists”. Checked October 7, 2026.
16. Centers for Disease Control and Prevention. About Mild TBI and Concussion. September 15, 2025. “People with a mild TBI or concussion need to be seen by a healthcare provider”; tests of learning, memory, concentration and problem solving “can help your healthcare provider identify the effects of a mild TBI or concussion”; “A person with a history of multiple or repeated mild TBIs or concussions may experience a longer recovery or more severe symptoms”. Checked October 7, 2026.
17. National Cancer Institute. Memory or Concentration Problems and Cancer Treatment. “Cancer treatments such as chemotherapy may cause difficulty with thinking, concentrating, or remembering things” (“sometimes described as a mental fog or chemo brain”); “Use a daily planner, recorder, or other electronic device to help you remember important activities”. The specialists it names are a neuropsychologist, an occupational therapist and a vocational therapist; it does not mention speech-language pathologists. Checked October 7, 2026.
18. National Institute of Neurological Disorders and Stroke. Parkinson’s Disease. “Some people with PD develop problems thinking and remembering things. These types of problems can get worse over time”; “They may also have trouble paying attention, speaking, and figuring things out”. Checked October 7, 2026.
19. American Speech-Language-Hearing Association. Dementia (Practice Portal). “individuals with frontotemporal dementia may develop primary progressive aphasia, a gradual loss of language function with relatively well-preserved memory”; “Within the United States, an estimated 50,000–60,000 people are currently living with the two types of frontotemporal dementia: primary progressive aphasia and behavioral variant frontotemporal dementia”. Checked October 7, 2026.
20. Centers for Disease Control and Prevention. Signs and symptoms of stroke (May 19, 2026). Signs include “Sudden confusion, trouble speaking, or difficulty understanding speech”; “Call 9-1-1 right away if you or someone else has any of these symptoms”; in the B.E. F.A.S.T. test for speech, “Ask the person to repeat a simple phrase. Is the speech slurred or strange?”; “The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms”; “Note the time when any symptoms first appear”; “Do not drive to the hospital or let someone else drive you”; a TIA “is a sign of a serious condition that will not go away without medical help”, so “tell a health care team about the symptoms right away.” Checked October 7, 2026.
21. National Institute of Neurological Disorders and Stroke. Traumatic Brain Injury (TBI). Last reviewed March 13, 2026. TBI can cause “problems with how a person thinks, understands, moves, communicates, and acts”; “While most people recover fully from a first concussion within a few weeks, the rate of recovery from a second or third concussion is generally slower”; after severe TBI, therapy “may be needed on a short- or long-term basis”. Checked October 7, 2026.
22. Ponsford J, Velikonja D, Janzen S, Harnett A, McIntyre A, Wiseman-Hakes C, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part II: Attention and Information Processing Speed. Journal of Head Trauma Rehabilitation. 2023;38(1):38–51. doi:10.1097/HTR.0000000000000839 (PMID 36594858). “Clinicians should screen for and address factors that impact attention including hearing, vision, fatigue, sleep-wake disturbance, anxiety, depression, pain, substance use, and medication” (level C); “Metacognitive strategy training using functional everyday activities should be considered” (level A); “Computer-based de-contextualized attentional tasks for individuals with TBI are not recommended because of lack of demonstrated impact on everyday attentional functions” (level B).
23. Bayley MT, Janzen S, Harnett A, Teasell R, Patsakos E, Marshall S, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles. Journal of Head Trauma Rehabilitation. 2023;38(1):7–23. doi:10.1097/HTR.0000000000000838 (PMID 36594856). “In total, the INCOG update contains 80 recommendations (25 level A, 15 level B, and 40 level C) of which 27 are new”; “Individuals with persistent cognitive deficits due to TBI should receive functionally oriented cognitive rehabilitation”. INCOG covers adults with moderate to severe TBI.
24. Jeffay E, Ponsford J, Harnett A, Janzen S, Patsakos E, Douglas J, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions. Journal of Head Trauma Rehabilitation. 2023;38(1):52–64. doi:10.1097/HTR.0000000000000834 (PMID 36594859). “Metacognitive strategy instructions (eg, goal management training, plan-do-check-review, and prediction performance) should be used with individuals with TBI for difficulties with a range of executive functioning impairments” (level A); self-monitoring and feedback, including “self-awareness training such as video feedback” (level A); group-based interventions (level A). An erratum was published in 2024 (doi:10.1097/HTR.0000000000000906).
25. Velikonja D, Ponsford J, Janzen S, Harnett A, Patsakos E, Kennedy M, et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. Journal of Head Trauma Rehabilitation. 2023;38(1):83–102. doi:10.1097/HTR.0000000000000837 (PMID 36594861). “Environmental supports and reminders (eg, mobile/smartphones, notebooks, and whiteboards) are recommended for individuals with TBI who have memory impairment” (level A); internal strategies (level A); techniques “that constrain errors (eg, errorless, spaced retrieval)” (level A); “There is little evidence for using restorative techniques such as computerized cognitive training (CCT) alone” (level B).
26. das Nair R, Cogger H, Worthington E, Lincoln NB. Cognitive rehabilitation for memory deficits after stroke. Cochrane Database of Systematic Reviews. 2016;(9):CD002293. doi:10.1002/14651858.CD002293.pub3 (PMID 27581994). “We included 13 trials involving 514 participants”; benefit on subjective memory in the short term only; “There was, therefore, limited evidence to support or refute the effectiveness of memory rehabilitation”.
27. Loetscher T, Potter KJ, Wong D, das Nair R. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database of Systematic Reviews. 2019;(11):CD002842. doi:10.1002/14651858.CD002842.pub3 (PMID 31706263). “six RCTs with 223 participants”; “The effectiveness of cognitive rehabilitation for attention deficits following stroke remains unconfirmed”; divided attention may improve right after treatment (low-quality evidence).
28. Chung CS, Pollock A, Campbell T, Durward BR, Hagen S. Cognitive rehabilitation for executive dysfunction in adults with stroke or other adult non-progressive acquired brain damage. Cochrane Database of Systematic Reviews. 2013;(4):CD008391. doi:10.1002/14651858.CD008391.pub2 (PMID 23633354). “Nineteen studies (907 participants) met the inclusion criteria for this review”; “We identified insufficient high-quality evidence to reach any generalised conclusions about the effect of cognitive rehabilitation on executive function”; background: “around 75% of stroke survivors, will experience executive dysfunction”.
29. American Heart Association/American Stroke Association. Key Patient Messages: The 2026 Stroke Rehabilitation and Recovery Guideline (PDF). “Stroke recovery occurs over months to years and does not end when you leave a structured program”; “Depression and anxiety are very common conditions that can develop after a stroke”. Checked October 7, 2026.
30. Rietdijk R, Power E, Attard M, Heard R, Togher L. Improved Conversation Outcomes After Social Communication Skills Training for People With Traumatic Brain Injury and Their Communication Partners: A Clinical Trial Investigating In-Person and Telehealth Delivery. Journal of Speech, Language, and Hearing Research. 2020;63(2):615–632. doi:10.1044/2019_JSLHR-19-00076 (PMID 32078409). TBIconneCT: “an in-person intervention group ( n = 17), a telehealth intervention group ( n = 19), and a historical control group ( n = 15)”; “Telehealth delivery produced similar outcomes to in-person delivery”; effects “were not maintained at follow-up for two of eight measures”.
31. Federal Trade Commission. Lumosity to Pay $2 Million to Settle FTC Deceptive Advertising Charges for Its “Brain Training” Program. January 5, 2016. The FTC alleged unfounded claims that the games would “reduce cognitive impairment associated with health conditions, including stroke, traumatic brain injury, PTSD, ADHD, the side effects of chemotherapy, and Turner syndrome”; “Lumosity simply did not have the science to back up its ads”. Checked October 7, 2026.
32. Centers for Medicare & Medicaid Services. Telehealth (Medicare.gov). “Through December 31, 2027, Medicare covers telehealth services that you can get from anywhere in the U.S., including your home”; the examples listed include speech therapy, cognitive assessments and “Caregiver training services”; after the Part B deductible you pay 20% of the Medicare-approved amount, and “For most telehealth services, you’ll pay the same amount that you would if you got the services in person”; Medicare Advantage plans “may offer more telehealth benefits than the basic coverage in Original Medicare.” Checked October 7, 2026.
33. Code of Federal Regulations, 42 CFR §410.61, Plan of treatment requirements for outpatient rehabilitation services. “The plan is established before treatment is begun by one of the following”, among them “A speech-language pathologist who furnishes the speech-language pathology services”; “The plan prescribes the type, amount, frequency, and duration of the physical therapy, occupational therapy, or speech-language pathology services to be furnished to the individual, and indicates the diagnosis and anticipated goals.” Text as published in the eCFR. Checked October 7, 2026.
34. Code of Federal Regulations, 42 CFR §424.24(c), Outpatient physical therapy, occupational therapy, and speech-language pathology services. When an SLP establishes the plan, “the certification must be signed by a physician or by a nurse practitioner, clinical nurse specialist, or physician assistant who has knowledge of the case”; “Recertification is required at least every 90 days”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.” Text as published in the eCFR. Checked October 7, 2026.
35. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15: Covered medical and other health services (Rev. 13889, issued July 30, 2026), section 220.3. “The progress report provides justification for the medical necessity of treatment”; “The minimum progress report period shall be at least once every 10 treatment days.” Checked October 7, 2026.
36. Centers for Medicare & Medicaid Services. Speech-language pathology services (Medicare.gov). Part B covers “medically necessary outpatient speech-language pathology services”, which “provide evaluation and treatment to regain and strengthen speech and language skills. This includes cognitive and swallowing skills, or therapy to improve or maintain current function or slow decline”; “Your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) must certify you need this care”; after the Part B deductible you pay 20% of the Medicare-approved amount; “There’s no limit on how much Medicare pays for your medically necessary outpatient speech-language pathology services in one calendar year.” Checked October 7, 2026.
37. Centers for Medicare & Medicaid Services. Jimmo settlement. The Jimmo Settlement Agreement (January 2013) “clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met)”; coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Checked October 7, 2026.
38. Centers for Disease Control and Prevention. What to Do After a Mild TBI or Concussion. September 15, 2025. “With proper care, most people can return to work, school, and many other activities within a few days or weeks after a mild TBI or concussion”; “Some people will have symptoms for months or longer”; talk with a provider if symptoms “Do not go away within 2 to 3 weeks”; “Ask your health care provider for written instructions about when you can safely return to work, school, or other activities, such as driving a car”. Checked October 7, 2026.
39. National Highway Traffic Safety Administration. Cognitive Conditions: Driving-Related Fact Sheet for Medical Professionals (PDF, DOT HS 812 888a, July 2023). Clinicians should “Conduct or refer a patient for a functional evaluation of the person’s fitness to drive if there is evidence of cognitive impairment”; attention problems can mean “Delay in timely response to changes in traffic conditions”. Checked October 7, 2026.
40. Job Accommodation Network (U.S. Department of Labor, Office of Disability Employment Policy). Brain Injury (A to Z of disabilities). “People with brain injuries may develop some of the limitations discussed below, but seldom develop all of them”; key accommodations include “Provide written instructions” and “Establish written long term and short term goals”; for memory loss, “Medication Reminders”, checklists and calendars. Checked October 7, 2026.
41. Centers for Medicare & Medicaid Services. Home health services (Medicare.gov). Home health care helps you “maintain your current condition or level of function, or slow your rate of decline”; covered services include “speech-language pathology services (if you meet certain conditions)”; you must need part-time or intermittent skilled services and be homebound: “Leaving your home isn’t recommended because of your condition or you have trouble leaving your home without help” and “You’re normally unable to leave your home and leaving takes a lot of effort”; “You can still get home health care if you attend adult day care”; a provider “must see you in person and confirm you need home health care”; “You pay nothing for covered home health services.” Checked October 7, 2026.
42. Centers for Medicare & Medicaid Services. Inpatient rehabilitation care (Medicare.gov). Part A covers care in an inpatient rehabilitation facility, including rehabilitation services such as speech-language pathology; “Your health care provider must certify that you have a medical condition requiring intensive rehabilitation, continued medical supervision, and coordinated care from your providers”; in 2026, “Days 1-60: After you pay the $1,736 deductible you pay $0 each day.” Checked October 7, 2026.
43. Centers for Medicare & Medicaid Services. Therapy services. The Bipartisan Budget Act of 2018 repealed the outpatient therapy caps and “preserves the former therapy cap amounts as thresholds above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record”; “For CY 2026 this KX modifier threshold amount is: $2,480 for PT and SLP services combined”; “the MR threshold is $3,000 for PT and SLP services”, and “not all claims exceeding the MR threshold amount are subject to review.” Checked October 7, 2026.
44. Medicaid.gov (Centers for Medicare & Medicaid Services). Mandatory & optional Medicaid benefits. “States are required to provide all mandatory benefits under federal law. States may provide optional benefits if they choose to add them through the state plan process”; mandatory benefits include home health services and nursing facility services; optional benefits include “Speech, hearing and language disorder services.” Checked October 7, 2026.
45. HealthCare.gov (Centers for Medicare & Medicaid Services). What Marketplace health insurance plans cover. “All plans offered in the Marketplace cover these 10 essential health benefits”, among them “Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)”; “Specific services covered in each broad benefit category can vary based on your state’s requirements.” Checked October 7, 2026.
46. Veterans Health Administration. VHA Directive 1170.02(1): VHA audiology and speech pathology services (December 9, 2020; amended July 19, 2022). The directive covers “disorders of hearing, tinnitus, balance, speech, language, voice, fluency, cognitive and swallowing”; “Audiology and speech pathology services are standard medical benefits available to all enrolled Veterans.” Checked October 7, 2026.
47. American Speech-Language-Hearing Association. Information about ASHA certification. The CCC is “a nationally recognized professional credential that represents a level of excellence in the field”; holders “have voluntarily met rigorous academic and professional standards, typically going beyond the minimum requirements for state licensure.” Checked October 7, 2026.
48. American Speech-Language-Hearing Association. Audiology and speech-language pathology certification. ASHA’s public tool lets anyone “Verify the status of an individual’s Certificate of Clinical Competence in Audiology (CCC-A) or Speech-Language Pathology (CCC-SLP).” Checked October 7, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation.