Returning to Work After a Concussion, Brain Injury, or Stroke: The Role of Speech Therapy
Written by Mariya Kika, M.H.Sc., Reg. CASLPO, Speech-Language Pathologist
In my last blog post, I made the case that speech language pathology (SLP) or speech therapy has a role in post-concussion management and treatment. Today, I’m discussing the role of speech therapy in supporting adults who are returning to work after a concussion, brain injury, or stroke.
In this capacity, speech therapy extends its focus to the complex communication needs and thinking skills that workplace communication depends on: attention, memory, processing speed, organization, and word-finding.
These complex challenges are not always apparent, even during the active recovery process, due to the layered skills involved. The tasks completed in work environments are often much more complicated than the tasks you’re completing at home. As such, these challenges are not always apparent until you return to work (Libeson et al., 2020).
In short, a conversation at home can feel normal. A long meeting, a full inbox, or a task interrupted halfway through can feel very different.
Why work can feel harder after a brain injury or stroke
Work asks more of communication than daily conversations at home, with friends, or in casual social situations do. Casual conversations are naturally more forgiving: you’re comfortable with your communication partner, the topics are familiar and preferred, and you, hopefully, feel reduced pressure in word finding, repetition, and pausing.
There is no added layer of deadlines, changing topics, different communication methods, and different communication partners. In the workplace, group conversations often mean following shifting opinions across several speakers on complex topics, abstract ideas and topic generation, formulating responses under pressure, switching between tasks, organizing your thoughts on the spot, and writing clearly under a deadline.
These tasks rely on attention, memory, reasoning, regulation, processing speed, and organization working together. After an acquired brain injury, the brain is often operating with a reduced cognitive capacity, increase sensitivity, and ongoing fatigue from recovery. As a result, these skills may hold up well in quiet settings but become less reliable with increased demands (Libeson et al., 2020).
Speech-language pathologists call this a cognitive-communication disorder or difficulty. It affects the thinking skills behind communication rather than speech itself. Because everyday speech often sounds unchanged, the difficulty can be easy for employers, colleagues, and family to miss.
Signs communication at work has been affected
After a concussion, brain injury, or stroke, people often describe:
Difficulty following meetings, or feeling drained afterward
Emails and reports taking much longer to write
Difficulty shifting between tasks or returning to a task after interruption
Relying on others to remember what was decided
Difficulty remembering verbal instructions
Anxiety surrounding speaking in high-stakes situations
Challenges with organizing a coherent response on the spot
Difficulty managing the cognitive load and fatigue of returning to work
A gradual return that has stalled or feels too fast
These signs can show up before returning, during a gradual return, or months after being back full time. It is important to recognize them, as pushing through them can lead to burnout.
Practical strategies for the first weeks back at work
A few habits can make the return more manageable. They work best when adjusted to your role and your stage of recovery.
Plan what you want to say. Jot down your main points before a meeting or call. Keep a few ready phrases for common moments, such as "Could you repeat that last part?" or "Let me get back to you on that."
Lead with the main point. Say or write the key message first, then add detail if needed. Pausing between ideas gives you time to organize your next thought, and it gives listeners time to follow.
Confirm what you heard. Briefly restate decisions or instructions, such as "So the report is due Friday." This ensures everyone is on the same page and it can help the message stick.
Use external aids. Use sticky notes (either physical ones or on your desktop) to write a daily to-do list. Keep a pocket journal to write key points or instructions after important discussions.
Start small with social contact. After time away, reconnecting with colleagues can take energy. A short hello or brief chat is enough at first. It's also worth deciding in advance how much you want to share about your injury, and with whom.
Protect your energy. Keep a steady daily routine, and build short breaks into the day. Include your sensory needs into these breaks, such as dimming your lights or stepping away from a noisy space. Match the task complexity to your capacity for the moment.
Set realistic expectations. Progress during a return is rarely a straight line. Some days will be harder than others, especially early on, and planning something restful after work can help you recover for the next day.
Advocate for yourself. No one knows your needs unless you tell them. As previously stated, do not disclose anything you do not feel comfortable with, but asking for small and simple accommodations can be helpful. This can include asking for the meeting agenda beforehand so you can plan your thoughts and requesting the meeting minutes so you can confirm the decisions made and deliverables on your radar.
What return-to-work speech therapy focuses on
Return-to-work speech therapy targets the skills your job depends on. Common areas include:
Attention: staying focused through noise and interruptions
Memory: keeping track of instructions, decisions, and follow-up tasks
Processing speed: keeping up with fast conversation and changing priorities
Organization: planning what to say or write, and getting to the point
Word-finding: retrieving specific words, names, and terms when needed
Energy and pacing: arranging demanding tasks so fatigue builds more slowly
This approach is based on the model of cognitive-communication competence (MacDonald, 2017). It is a peer-reviewed framework that considers communication together with thinking, fatigue, mood, and environment.
What to expect in assessment and sessions
Assessment looks at your current strengths and challenges and frames them within the context of the communication demands of your job. This includes where and how difficulties show up, how you can leverage your current strengths and what communication accessibility accommodations might be available to you. This is all within the context of your capacity, holistically, including fatigue, mood, and distractibility. Goals are then set around what you need to do at work.
Sessions combine directly targeting your challenges with providing strategies that can be used immediately. This creates immediate support while strengthening your skills and, with time and practice, supports will fade and shift in accordance with your progress. There is no pre-determined timeline for recovery; it will depend on a number of personal factors. Your speech pathologist will be able to provide you with your own personalized goals and timeline following your assessment.
Returning to work after a stroke or brain injury can be daunting, but with the right team and support, it can also be rewarding and fulfilling.
learn more about return to work support
About the author
Mariya Kika is a CASLPO-registered speech-language pathologist and the founder of Cognicare Speech Therapy, operating virtually across Ontario. She holds a Master of Health Science from the University of Toronto. She previously worked as the sole speech-language pathologist at Altum Health, part of Toronto's University Health Network, providing outpatient neurorehabilitation that centered return-to-work care. She is a member of the Canadian Concussion Network.
For more on specific conditions, see Brain Injury & Concussion, Stroke & Aphasia, Neurological Conditions, and Social Communication & Executive Functioning.
Sources
Libeson, L., Downing, M., Ross, P., & Ponsford, J. (2020). The experience of return to work in individuals with traumatic brain injury (TBI): A qualitative study. Neuropsychological Rehabilitation, 30(3), 412–429. https://doi.org/10.1080/09602011.2018.1470987
MacDonald, S. (2017). Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Injury, 31(13–14), 1760–1780.