5 Cognitive-Communication Therapy Activities for Brain Injury Patients

Cognitive-communication therapy is crucial for helping brain injury patients regain conversation skills.

Cognition – or thinking skills – are sometimes more subtle than overt language disorders that often are a primary focus of treatment in speech therapy. However, cognition is just as important as the physical ability to produce words.

Today you will learn what cognitive communication is plus some of the best cognitive-communication activities that you can do at home.

Let’s get started.

What Is Cognitive-Communication?

Cognitive-communication refers to the mental processes used to produce meaningful speech.

Speaking is a complex activity that involves multiple areas of the brain. Besides the ability to form words with your mouth, several other skills are needed during a conversation, including:

• Memory and recall
• Attention
• Listening
• Comprehension
• Problem-solving

The frontal lobe plays an especially crucial role in communication. In particular, it helps you understand the more subtle aspects of conversation, such as:

• Understanding when to let the other person speak
• Talking about other things besides yourself
• Knowing when to change the subject
• Not saying rude or inappropriate things
• Picking up nonverbal cues
• Understanding non-literal language

After a brain injury, all these skills can become impaired. Therefore, even if a person has no difficulty with the physical side of speech, they can still struggle to communicate effectively.

That’s where cognitive-communication activities come in.

Cognitive-Communication Therapy Activities

Cognitive-communication activities are designed to help patients strengthen the cognitive abilities that will allow them to speak more fluently.

A successful therapy activity will:

• Bring greater awareness of the problem and how to solve it
• Teach strategies to break down problems into manageable sizes
• Use repetition to engage neuroplasticity and cement the skill into the brain

The following are a few activities that accomplish these goals.

Response-Elaboration Training (RET)

This treatment approach was designed to help patients increase their elaboration skills.

It’s also sometimes called “loose training” because there are no correct answers. Rather, the goal is to encourage the patient to generate their own responses.

To practice RET, the speech therapist will use a set of images depicting an action, such as a man pushing a lawnmower. Then the therapist asks a series of wh- questions (what, where, who, etc…) to help the patient expand on their answer.

A typical RET session would look something like this:

1. Therapist shows the patient a photo of a girl walking a dog and asks what the person sees.
2. The person responds with a short sentence such as “girl…dog”  
3. Therapist congratulates the patient
4. Therapist then asks a question such as “what is the girl doing?”
5. Patient answers “girl…walking’’
6. The therapist combines the two sentences to say “girl is walking the dog” and asks the patient to repeat the sentence.
7. Patient answers with “girl walking dog” and the session continues from there.

Depending on how well the patient does, they could go from saying “girl…dog” to “the girl is walking her dog to the park” by the end of the session.

2. Naming Therapy

This therapy is often used to help people suffering from aphasia recall words, but it’s also a great way to improve cognitive-communication skills in general.

One good naming therapy exercise is to have someone else write down several general categories (such as tools, animals, plants, countries, occupations, foods, sports, etc.)

Then try to remember and name (verbally or in writing) as many items in that category as possible.

For caregivers, if the person with brain injury is stumped, you can give hints. For example, if they can’t come up with any animal names, you can tell them to think of a farm or zoo, etc.

You can also work on comparing and contrasting different items. For example, talk about how an apple and an orange are similar and how they are different. If this is too easy, try naming all the ways that a trumpet and a clarinet are different.

These exercises can help you organize your thoughts and express them more clearly.

The CT Speech and Cognitive Therapy app contains naming exercises along with 100,000 other exercises to improve these skills.

3. Rhythm matching (Intermediate)

For this activity, one person should tap out a simple, two-step rhythm several times with their hand on the table (tap-delay-tap-tap). The person with the injury should try to match the rhythm.

If this seems too easy, both of you should turn your chairs around so you are not facing each other. This way you can only focus on your auditory processing.

While this exercise might not seem related to communication, it will help you improve your attention skills, which is crucial during a conversation.

4. Task Sequencing

This activity helps you improve your planning, comprehension, and reasoning skills, which are necessary for communication.

First, have someone else write down the steps to complete a certain activity, such as watching TV. But make sure that these steps are not in the correct order.

For example, they might right down the steps to look like:

1. Watch tv
2. Choose channel
3. Sit on couch
4. Grab remote

Your job is to rearrange the steps so that they are in the correct order. As you improve your skills, you can work on more complicated tasks, such as preparing a meal. Finally, you can try writing the steps down on your own.

Again, even though this might not seem directly related to communication, it will teach you how to plan and think through a problem more clearly. And the clearer your thoughts are, the better you will be at communicating them.

5. Spaced Retrieval

If you suffer from memory loss after brain injury, it will be nearly impossible for you to follow a conversation. One of the best ways to improve your memory skills is through spaced retrieval.

Spaced retrieval is an evidence-based technique that helps people recall information over progressively longer intervals.

To practice spaced retrieval, create some flashcards with whatever information you’re trying to learn.

If you remember the info clearly, wait two minutes, and then quiz yourself. If you get it right again, wait 5 minutes, then 10 minutes, etc…

The goal is to keep challenging yourself until the information is cemented into your brain.

How to Practice Cognitive-Communication Activities At Home

When you are first learning these activities, we recommend practicing them with a speech therapist first. The speech therapist can teach you how to best practice them and correct any errors you might have.

If you would prefer to do everything at home, the CT Speech and Cognitive Therapy app is a great tool to have. It can walk you through these and hundreds of other activities that will improve your cognitive-communication skills.

Just make sure you practice your exercises every day. The more consistently you practice, the more you can reinforce these skills in your brain.

With enough persistence, you can finally regain the ability to communicate with others again.