By Dave DeFusco
At the Katz School’s 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).
“Veterans with PTSD often experience subtle to profound challenges with executive function—things like decision-making, self-regulation and cognitive flexibility,” said Smith. “These 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’s a missed opportunity for speech pathologists to intervene.”
Smith’s research, “Cognitive Crossroads: PTSD, Executive Function, and the Role of the Medical Speech-Language Pathologists,” 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.
“These tasks assess the brain’s ability to adapt, inhibit automatic responses and organize information,” said Smith. “In PTSD, we see breakdowns in these abilities, often tied to changes in key brain regions like the prefrontal cortex and hippocampus.”
Neuroimaging studies she reviewed revealed disruptions in brain networks responsible for emotional regulation and executive control—findings that correlate with everyday cognitive challenges reported by veterans.
But Smith’s work didn’t 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.
“MedSLPs are uniquely equipped to support these veterans,” said Smith. “We can provide functional skill-based learning, compensatory strategies and metacognitive training that helps individuals understand and manage their thinking processes.”
Dr. Marissa Barrera, assistant dean of health sciences and Smith’s ¶¶Ňőapp mentor, said Smith’s work is a powerful call to action.
“Too often, cognitive rehabilitation in PTSD is treated as a psychological issue alone,” said Barrera, who is director of the Katz School’s speech-pathology program. “But 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.”
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—all of which can further impair executive function.
“Left unaddressed, these cognitive deficits can erode independence and quality of life,” said Smith. “The need for interdisciplinary collaboration among MedSLPs, neurologists and mental health professionals is urgent.”
Still, Smith acknowledged the challenges ahead: a lack of MedSLP-led research, inconsistent assessment tools and variability in study populations.
“We need more rigorous, standardized approaches,” she said, “but we also need a trauma-informed lens. Veterans don’t just need cognitive support, they need empathy, trust and care that acknowledges what they’ve been through.”
Smith’s 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.
“This is exactly the kind of research that changes lives,” said Barrera. “Brooke is helping redefine what it means to care for the whole veteran.”
