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In communication treatment, SLPs target such skills as increased orientation to space, time, and person; paying attention to communication partners and the surroundings; improved memory for daily routines and names of family members; better narrative skills; turn taking, topic maintenance, and topic initiation in conversation; decreasing irrelevant and inappropriate responses; and improving speech intelligibility. The clinician models or prompts the correct response and reinforces it immediately; in gradual steps, modelling and promoting may be withdrawn. To improve the naming skills, the clinician frequently names the persons in the immediate environment, including herself or himself. The clinician also frequently questions the client about the surrounding events and persons and reinforces relevant responses. Writing the names of family members and matching their pictures with printed names might be useful. To improve language comprehension, the clinician may frequently draw the individual's attention to what will soon be said. The clinician can repeat statements that might help comprehension. By initially simplifying treatment tasks, the clinician positively reinforces even small improvements and systematically increases task complexity. In the case of children, activities related to schoolwork may be incorporated into therapy. For example, comprehension of material read from the child's grade-level books may be a part of treatment. Writing assignments appropriate to the child's grade also may be incorporated. Severe TBI may leave residual effects that a reasonable amount of rehabilitation cannot eliminate. In such a case, the clinician teaches a variety of skills that help compensate for the deficits with which the individual has to live. For example, to compensate for residual memory problems, a client may learn to write down directions needed to complete such activities as preparing a meal. Another person who has difficulty understanding spoken speech might be taught to ask questions seeking repetition or clarification. The clinician might teach some individuals to sue various electronic devices that remind them of activities and appointments. Working with families, teachers, and employer to educate them about the persistent special needs of the person is an important aspect of TBI rehabilitation.
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