By Dave DeFusco
At the Katz School鈥檚 Graduate Symposium on Science, Technology and Health, Brooke Smith, a student in the M.S. in Speech-Language Pathology, explored an overlooked frontier in veteran rehabilitation: the cognitive communication impairments that shadow Post-Traumatic Stress Disorder (PTSD).
鈥淰eterans with PTSD often experience subtle to profound challenges with executive function鈥攖hings like decision-making, self-regulation and cognitive flexibility,鈥 said Smith. 鈥淭hese are not just abstract deficits. They affect everything from managing appointments and finances to maintaining relationships and self-care. Yet intervention has largely been left to psychiatrists and neurologists. That鈥檚 a missed opportunity for speech pathologists to intervene.鈥
Smith鈥檚 research, 鈥淐ognitive Crossroads: PTSD, Executive Function, and the Role of the Medical Speech-Language Pathologists,鈥 used a mixed-methods approach, systematically reviewing literature, including a meta-analysis of 18 studies involving over 1,000 participants, including 422 individuals diagnosed with PTSD. The findings were clear: across the board, PTSD significantly impaired executive function when compared with both trauma-exposed and healthy control groups. Tasks like the Wisconsin Card Sorting Test (WCST) and the Stroop Test revealed consistent underperformance in those with PTSD.
鈥淭hese tasks assess the brain鈥檚 ability to adapt, inhibit automatic responses and organize information,鈥 said Smith. 鈥淚n PTSD, we see breakdowns in these abilities, often tied to changes in key brain regions like the prefrontal cortex and hippocampus.鈥
Neuroimaging studies she reviewed revealed disruptions in brain networks responsible for emotional regulation and executive control鈥攆indings that correlate with everyday cognitive challenges reported by veterans.
But Smith鈥檚 work didn鈥檛 stop at diagnosing the problem. She spotlighted the effectiveness of interventions, such as goal management training and metacognitive strategy instruction, as promising tools for cognitive rehabilitation. She argued forcefully for medical speech-language pathologists to take a more active role in this arena.
鈥淢edSLPs are uniquely equipped to support these veterans,鈥 said Smith. 鈥淲e can provide functional skill-based learning, compensatory strategies and metacognitive training that helps individuals understand and manage their thinking processes.鈥
Dr. Marissa Barrera, assistant dean of health sciences and Smith鈥檚 faculty mentor, said Smith鈥檚 work is a powerful call to action.
鈥淭oo often, cognitive rehabilitation in PTSD is treated as a psychological issue alone,鈥 said Barrera, who is director of the Katz School鈥檚 speech-pathology program. 鈥淏ut speech-language pathologists bring a specialized lens, particularly when it comes to communication and cognition, that is absolutely essential. Her research illuminates a critical gap in evidence-based practice.鈥
Smith also highlighted the broader implications of her findings. Veterans with PTSD are are nearly two times more likely to develop neurocognitive disorders, including dementia. Many also struggle with comorbid conditions, such as traumatic brain injury, substance use disorders and cardiovascular disease鈥攁ll of which can further impair executive function.
鈥淟eft unaddressed, these cognitive deficits can erode independence and quality of life,鈥 said Smith. 鈥淭he need for interdisciplinary collaboration among MedSLPs, neurologists and mental health professionals is urgent.鈥
Still, Smith acknowledged the challenges ahead: a lack of MedSLP-led research, inconsistent assessment tools and variability in study populations.
鈥淲e need more rigorous, standardized approaches,鈥 she said, 鈥渂ut we also need a trauma-informed lens. Veterans don鈥檛 just need cognitive support, they need empathy, trust and care that acknowledges what they鈥檝e been through.鈥
Smith鈥檚 work, grounded in both quantitative analysis and thematic exploration, is a template for how applied research can drive clinical innovation. She hopes to see a future where cognitive communication therapy is standard in PTSD treatment protocols and where MedSLPs are recognized not just as speech and language specialists, but as vital partners in cognitive recovery.
鈥淭his is exactly the kind of research that changes lives,鈥 said Barrera. 鈥淏rooke is helping redefine what it means to care for the whole veteran.鈥
