By: Kiley Como with Shane Smith Law
At Mind Matters: Navigating Head Injuries and Concussions, we’re committed to shedding light on the complex and deeply personal journey of brain injury recovery. From survivors to neurologists, our guests offer insights that help families, providers, and patients better understand what recovery really looks like.
In this episode, we were honored to welcome Dr. Zach Smith, a seasoned speech-language pathologist and the Clinical Director at Constant Therapy Health. With over a decade of experience treating individuals with neurologically based communication and swallowing disorders, Zach brought a compassionate, innovative perspective to the conversation; one that blends clinical expertise with cutting-edge digital tools designed to bridge gaps in rehabilitation.
🎧 This is part one of a two-part episode—because this topic deserves more than a single conversation.
What Is Constant Therapy, and Why Does It Matter?
Zach explains that Constant Therapy is an app-based platform designed to deliver personalized cognitive-linguistic and speech therapy exercises. It includes the largest digitized library of evidence-based tasks used in neurological rehab.
What makes it different? It’s adaptive.
“Your performance directly changes how the program interacts with you,” Zach says. “It evolves with you.”
That means:
- If you’re improving, the system levels up the challenge.
- If you’re struggling, it recalibrates to support you at that moment.
For patients who live in areas with limited access to speech-language pathologists or who face long waitlists, this tool can become their primary form of therapy.
The team is currently expanding access even further by launching a web-based version for desktop and laptop users, aiming to remove even more barriers for patients in need.
Aphasia: What It Is, What It Isn’t and Why It Matters
Zach dives deep into the concept of aphasia, an often misunderstood but profoundly life-altering condition.
“Aphasia is an acquired language disorder,” he explains. “It affects speaking, understanding, reading, or writing; sometimes all four.”
Caused by brain injuries (most often strokes or TBIs), aphasia doesn’t affect intelligence. It affects a person’s ability to access and express language. The frustration can be overwhelming for both the person experiencing it and the people trying to communicate with them.
Zach breaks down several types of aphasia using the Boston Classification System, focusing on:
- Fluency of speech
- Auditory comprehension
- Repetition skills
Some patients might speak fluently but make no grammatical sense. Others may understand everything but struggle to get words out. It’s not always easy to spot, especially with milder forms like anomic aphasia, where someone struggles to find the right word but otherwise appears fine.
Why Brain Injuries and Recovery Are Never One-Size-Fits-All
As a former neuro ICU nurse, I’ve seen firsthand how unpredictable brain injuries are. Zach confirms this:
“Every brain injury is different. You could have two people with identical injuries on an MRI, and they’ll present completely differently.”
That’s why personalized therapy plans are essential.
Zach explains how Constant Therapy and other evidence-based strategies must meet patients where they are, not just rely on where their injury appears on a scan. The approach is interdisciplinary, integrating speech therapy with physical and occupational rehab, and even mental health support when needed.
Where in the Brain Does Aphasia Originate?
Zach offers a quick neuroanatomy lesson to help us understand why language breakdowns occur:
- Broca’s area (front left side of the brain): responsible for speech production
- Wernicke’s area (back left, near the ear): responsible for comprehension
- Arcuate fasciculus: the connection between the two
Damage to these areas creates different types of aphasia depending on what’s impacted; production, comprehension, or both.
And though these are general regions, there are always exceptions. For instance, left-handed individuals may process language on the opposite side of the brain.
The Emotional Impact of Aphasia in the Hospital Setting
Zach paints a vivid picture: Imagine waking up after a stroke or TBI in a hospital room surrounded by unfamiliar faces and being unable to speak or understand what’s happening.
“They may know what they want to say but can’t get it out,” Zach says. “Or worse, they think they’re making sense, but they’re not. That leads to confusion and isolation.”
This can delay progress in other areas, too, like physical or occupational therapy, because if the patient can’t understand directions, it slows the entire rehab process.
Transitioning from Hospital to Home: What Happens Next?
Zach highlights a critical discharge question:
“Can this person call 911 on their own if needed?”
That’s a simple but powerful test of how functional someone’s communication ability is after a brain injury.
Some patients will need intensive rehab in a facility. Others might be safe to go home with support. Either way, ongoing speech therapy and sometimes digital tools like Constant Therapy play a vital role in helping them rebuild communication skills and regain independence.
Common Cognitive Impairments After TBI
Zach rounds out the episode by addressing cognitive symptoms beyond aphasia:
- Short-term memory loss
- Difficulty focusing
- Impaired emotional regulation
- Reduced executive functioning
These symptoms often tie back to frontal lobe injuries or diffuse axonal shearing, where the brain essentially gets “shaken” inside the skull during trauma.
Zach uses the metaphor of TV static: After a brain injury, the brain is working through noise. It’s processing slowly, missing details, and sometimes losing context altogether.
Can You Fully Recover from a Brain Injury?
Zach’s answer is honest and hopeful.
“Some people do. Others improve significantly. And some will need to learn how to adapt to their new normal.”
Factors that influence recovery include:
- The severity of the injury
- The patient’s motivation
- The quality of support from family, friends, and clinicians
- Access to the right therapeutic tools
“I bring the tools,” Zach says. “But the patient has to pick them up and use them.”
A Powerful Final Message: People with Aphasia Are Still People
Zach closes with a reminder we all need to hear:
“Just because someone has difficulty speaking doesn’t mean they have nothing to say. Give them time. They deserve to be heard.”
🔗 Learn More
You can learn more about Zach’s work at www.constanttherapyhealth.com
To catch the next part of our conversation on cognitive recovery, rehab tools, and more, subscribe to Mind Matters on YouTube or your favorite podcast app.
📞 In pain? Call Shane. 980-999-9999
💼 Shane Smith Law – Fighting for Brain Injury Survivors Every Step of the Way
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