by Tamiko Teshima, M.A., CCC-SLP
Practice Owner & Speech-Language Pathologist
Duncan Lake Speech Therapy
You know I loooove talking about concussions. Not because they are trendy. Not because they are dramatic. But because, culturally, we still do not take them seriously enough. Concussions are brushed off as mild and tell people who experience them that they’ll “shake it off.” Then, we assume that if someone looks okay and scores within normal limits, everything must be back to baseline.
So on this, my birthday week, I bring to you this research review about the lasting impact of concussions. 🙂 Don’t worry. We’re going SparkNotes style on this!
A 2019 study published in the American Journal of Speech-Language Pathology asked an important question: Do individuals with a history of concussion show lasting differences when asked to complete complex language tasks that resemble real-world demands?
Article Title: Enduring Cognitive and Linguistic Deficits in Individuals With a History of Concussion
Published: 2019
Journal: American Journal of Speech-Language Pathology
Authors: Melissa D. Stockbridge and Rochelle Newman
What They Were Looking At
The researchers wanted to know whether people with a past history of concussion would demonstrate differences in written narrative tasks that require rapid integration of multiple cognitive and linguistic systems.
The researchers were not studying people who had recently experienced a concussion. They recruited adolescents and adults between the ages of 12 and 40 whose most recent concussion had occurred, on average, nearly five years earlier. Many participants had experienced multiple concussions. These were people who had long since been cleared.
The assumption in much of concussion care is that once someone performs within normal limits on traditional cognitive testing, recovery is complete. This study questioned whether that assumption captures the full picture.
Narrative writing is not a single skill. It requires working memory, organization, attention, processing speed, language formulation, and the ability to determine what information is essential. Think of all the things that are written – essays, notes, emails, and the list goes on!
If subtle inefficiencies linger after concussion, they may not show up on isolated tests. The authors wanted to see if these difficulties might emerge when the brain is asked to juggle everything at once.
How the Study Was Done
Participants first completed traditional, single-skill tasks. These included measures of working memory, attention, executive function, naming speed, and verbal fluency. These are the kinds of tasks commonly used in concussion evaluations. On those measures, individuals with a history of concussion looked similar to those without one.
Then participants completed two narrative writing tasks. In the first task, they retold the story of Cinderella while viewing a series of pictures from the story. The images remained visible, providing scaffolding and memory support. In the second task, they watched a short, wordless animated video called Pigeon: Impossible. Examiners then asked them to write a summary from memory. No pictures. No scaffolding. Five minutes on the clock.
The researchers created detailed scoring rubrics for both stories, identifying key propositions and essential plot elements. They also analyzed structural features like sentence length, vocabulary diversity, and grammatical complexity. They were not just asking, “Can you write?” They were asking, “Can you efficiently organize and communicate the important information under pressure?”
What They Found
On the traditional cognitive and language tasks, there were no significant differences between groups. On the Cinderella task, there were no significant differences either. With a familiar story and visual support, both groups included similar amounts of essential content.
However, when the examiners asked participants to summarize the novel video without scaffolding, differences emerged. Individuals with a history of concussion included fewer key story elements and fewer central plot components. The gap was especially noticeable in the final sections of the story, the complication, the resolution, and the conclusion. As demands increased and time pressure accumulated, the concussion group was more likely to omit critical information.
Importantly, their grammar, vocabulary diversity, and sentence complexity were largely similar to those without concussion. This was not a matter of “poor writing.” It was about content completeness under cognitive load.
The number of lifetime concussions also predicted performance. Participants with more concussions had fewer key elements included in the narrative. Even years after injury. Even when traditional testing looked normal.
Why This Matters
Here is the part that makes me lean forward a little. People with a history of concussion often say, “I passed the test, but I don’t feel the same.” This study gives that statement weight.
In real life, we rarely complete tasks in isolation. Instead, life tasks require us to absorb new information, hold it in working memory, organize it, decide what matters most, and communicate it clearly, often quickly. That is what this video task required. If we only measure isolated skills, we may miss subtle but meaningful differences that show up when everything has to work together.
And this is why I will keep talking about concussions. As a society we minimize them, label them mild, and discharge people when their scores look average, even if their lived experience tells a different story.
The authors suggest that assessments that reflect real-world complexity may be necessary before determining that recovery is complete. They also note that individuals with a history of concussion, particularly multiple concussions, may benefit from continued support in demanding academic or professional environments.
As speech-language pathologists, we are uniquely positioned to assess larger units of language and real-world communication demands. We have training to look at integration, organization, and content completeness, not just isolated word-level performance. “Normal” scores do not always equal normal functioning.
…and if someone tells you they are still struggling after a concussion, maybe we should just believe them.
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