When a Brain Injury Changes Communication: How Speech and Language Therapy Can Help

This article outlines how speech and language therapy supports children and young people after acquired brain injury (ABI), including changes in speech, language, social communication, executive functioning and fatigue. It explains why difficulties can be subtle or emerge over time, and shares practical supports that reduce communication demands at home and school. It focuses on real-life participation and includes approaches such as communication partner strategies, environmental adaptations, and (where helpful) AAC and teletherapy.

Supporting speech, language, executive functioning and fatigue in children and teenagers

When a child or teenager experiences an acquired brain injury, families often notice changes that are hard to describe at first.

Sometimes it’s obvious, speech is slurred, words don’t come easily, or conversations feel very different. Other times, a young person may “sound fine”, but struggle with understanding, memory, organisation, social communication, or fatigue. ABI is often referred to as a 'hidden disability.'

This can be confusing and exhausting for everyone.

Speech and language therapy can help make sense of what’s going on, support recovery, and reduce the day-to-day communication load for children, young people, families and schools.

What do we mean by acquired brain injury?

Acquired brain injury (ABI) refers to brain injury occurring after birth. It includes traumatic causes (e.g., falls, road traffic collisions) and non-traumatic causes (e.g., infection, tumour, stroke, hypoxia). 

In childhood, ABI interrupts development “while it still has work to do” — so the impact can show up differently across time and contexts. 

What communication difficulties can look like after ABI

Communication relies on many systems working together

·       language,

·       attention,

·       memory,

·       social understanding,

·       motor speech,

·       initiation

 ABI can affect any combination of these. 

Speech

A child might experience:

• reduced clarity (especially when tired)

• changes to rate, volume, or coordination

• reduced intelligibility in noise or groups

Language

Difficulties may include:

• understanding longer instructions or fast classroom talk

• word-finding (“it’s on the tip of my tongue”)

• organising sentences or narratives

• understanding abstract or figurative language

Social communication

Some young people struggle with:

• turn-taking and staying on topic

• reading tone, sarcasm, or implied meaning

• judging how much information to give

• coping with group conversations

Executive functioning: the hidden driver of communication

Executive functioning is a set of skills that helps us:

• focus attention

• hold information in mind (working memory)

• plan and organise

• shift flexibly

• inhibit impulses

• initiate tasks and responses

After ABI, executive function changes can make communication harder even when language skills are relatively intact.

In real life, this can look like:

• “I can’t start” (initiation difficulties)

• losing track mid-sentence

• difficulty explaining events in order

• saying very little because planning what to say is too effortful

• difficulty with conversation repair when misunderstandings happen

Fatigue: why skills fluctuate across the day

Fatigue after paediatric ABI is common and can be physical, cognitive, or both. For many families, the most confusing part is fluctuation: a child may cope well in the morning and unravel later.

Fatigue can affect:

• word-finding

• processing speed

• tolerance for conversation

• emotional regulation

• ability to cope with noise and group interaction

Research in children with moderate–severe ABI suggests fatigue is linked to quality of life and interacts with executive functioning. 

A useful reframe for parents and teachers is:

Communication ability isn’t just about skill — it’s about available brain energy.

What speech and language therapy does after ABI

SLTs make a unique contribution after ABI by assessing residual and emerging abilities, identifying factors that help or hinder recovery, and promoting functional communication at each rehabilitation stage. 

In practice, SLT support commonly includes:

1) Assessment that looks beyond “speech”

A good ABI-informed assessment explores:

• speech clarity and intelligibility

• understanding and expression across contexts

• narrative and discourse (storytelling / explaining)

• social communication

• cognitive-communication (attention, memory, executive impact on communication)

• the impact of fatigue (time of day, cognitive load, environment)

2) Therapy for communication access and participation

Therapy is often about making communication work again — at home, in school, with friends — not just “getting back words”.

Examples include:

• word-finding and language organisation strategies

• narrative scaffolding (how to tell what happened, in order)

• supporting comprehension with chunking, visuals, key words

• teaching “repair” strategies (what to do when misunderstood)

3) Communication partner training

One of the strongest and most practical interventions is helping adults adjust how they communicate with the young person:

• slower pace and extra wait time

• fewer questions when overloaded

• one idea at a time

• confirming meaning without over-correcting

4) Executive function supports through communication routines

SLTs often embed Executive Function supports into communication, for example:

• planning templates for speaking and writing (“First… then… because…”)

• checklists for homework communication demands

• visual schedules and routines that reduce language load

• pre-teaching vocabulary and concepts before lessons

5) Fatigue-aware communication planning

Practical fatigue strategies may include:

• scheduling demanding conversations earlier in the day

• allowing breaks before language-heavy tasks

• reducing background noise and group load

• building “communication recovery time” after school

Where AAC fits in ABI

Communication is not limited to speech.

Some children may benefit from AAC:

• temporarily (during recovery, fatigue spikes, or periods of overload)

• longer-term (if communication disability is significant)

AAC may include:

• gesture/sign

• communication books/boards

• symbol supports

• speech-generating devices/apps

Teletherapy and ABI: when it can help

Teletherapy can be a useful option for ABI work, particularly for:

• parent coaching and communication partner strategies

• language and narrative work

• school liaison / functional goal planning

• teenagers who prefer familiar environments

Working with school: reducing the language load without lowering expectations

For schools, it’s often helpful to translate ABI needs into practical supports:

• reduced verbal instructions + written/visual backup

• checking understanding privately (not in front of peers)

• chunking tasks and allowing extra processing time

• explicit teaching of classroom language and expectations

• planned rest breaks and quiet spaces to manage fatigue

 

A reminder for families

Progress after ABI is rarely linear.

Abilities might fluctuate. That doesn’t mean a child is being lazy, difficult, or not trying, it often means the communication system is working under higher load than it can manage in that moment.

Support that reduces the load and increases predictability, time, and understanding  is often what supports communication.

A note about experience

This is an area of work I care deeply about. I spent seven years working for a charity supporting children and young people with acquired brain injuries, including time as Head of Children and Youth Services. I have also volunteered for a charity supporting people with ABI.

This experience continues to shape how I think about communication after brain injury particularly the importance of listening, reducing demands, and supporting participation across home, school, and everyday life.

If your child or teenager has experienced an acquired brain injury and communication feels harder than it used to, or you’re unsure whether speech and language therapy could help, you’re welcome to get in touch. Talking things through can help clarify what support might be helpful now, or simply offer reassurance.

References

Bayley, M.T. et al. (2023) ‘INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, Part V: Memory’, Journal of Head Trauma Rehabilitation, 38(1), pp. 83–102. https://doi.org/10.1097/HTR.0000000000000837

Jeffay, E. et al. (2023) ‘INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, Part III: Executive function’, Journal of Head Trauma Rehabilitation, 38(1), pp. 52–64. https://doi.org/10.1097/HTR.0000000000000834

Mazzone, O. et al. (2025) ‘The assessment and management of fatigue following paediatric acquired brain injury: A qualitative study’, International Journal of Language & Communication Disorders. https://doi.org/10.1080/09602011.2024.2383337

Ponsford, J. et al. (2023) ‘INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, Part II: Attention and information processing speed’, Journal of Head Trauma Rehabilitation, 38(1), pp. 38–51. https://doi.org/10.1097/HTR.0000000000000839

Proschowsky, M.L.S. et al. (2024) ‘Fatigue among children and adolescents with acquired brain injury undergoing neurorehabilitation’, Frontiers in Neurology. 

Riccardi, J.S. et al. (2024) ‘Fatigue, executive functioning, and quality of life after paediatric traumatic brain injury’, American Journal of Speech-Language Pathology. https://doi.org/10.1044/2023_AJSLP-23-00106

Royal College of Speech and Language Therapists (RCSLT) (n.d.) Brain injury – overview. Available at: https://www.rcslt.org/speech-and-language-therapy/clinical-information/brain-injury/

The Children’s Trust (n.d.) Talking with children with an acquired brain injury. Available at: https://www.thechildrenstrust.org.uk/brain-injury-information/info-and-advice/parents-and-carers/talking-to-children-with-acquired-brain-injury

Turkstra, L.S. et al. (2015) ‘Cognitive–communication disorders in children with traumatic brain injury’, Developmental Medicine & Child Neurology, 57(3), pp. 217–222. https://doi.org/10.1111/dmcn.12600

Togher, L. et al. (2023) ‘INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury, Part IV: Cognitive-communication and social cognition disorders’, Journal of Head Trauma Rehabilitation, 38(1), pp. 65–82. https://doi.org/10.1097/HTR.0000000000000835