What Does The Research Say About Using Generic Workbooks in Speech Therapy?

I've used them before. You've likely used them before. Let's talk about the use of generic workbooks in Speech Therapy--- specifically, Speech Therapy in neurorehab settings.

Maybe when we had our clinical externships in grad school, a workbook was handed to us.

Maybe on the first day of our new job, we saw a big bookshelf filled with workbooks.

Maybe in a Facebook SLP group, we saw SLPs sharing (illegally) photocopies of "popular workbooks"

I'm not sure when the use of workbook started for you, but let this blog post serve as encouragement that you can move away from using workbooks in Speech Therapy sessions whenever you want.

You never needed them to deliver quality care.

Your patients never needed (or wanted) them.

There is so much more FUNctional and person centered care on the other side of using workbooks.

If you need more convincing about putting down the workbooks when delivering speech therapy rehabilitation, here are just a few cited sources to support your decision making.

In the sources cited below, you will find that:

Workbook tasks don’t generalize to real-life situations
Workbook tasks hinder progress. Why waste time on something that doesn’t help?
Non-workbook tasks increase patient motivation and engagement
Non-workbook tasks improve patient outcomes & overall satisfaction
Functional therapy tasks are endorsed and recommended by:
World Health Organization
CMS (Medicare and Medicaid)
American speech language hearing association

“One of our research participants advised us that the best starting point for intervention is to ask the client, “What is the most important conversation for you?” In this gentleman’s case, he was participating in speech therapy to enhance speech intelligibility during a time in his life when he was single after a recent divorce. His “most important conversation,” or life communication situation, was meeting and dating new women. When that situation was not addressed in therapy, he felt disappointed in what he described as a “see Dick and Jane run” therapy program because of its rudimentary level of practice that bore little relevance to his daily life.”

Baylor, C., & Darling-White, M. (2020). Achieving participation-focused intervention through shared decision making: Proposal of an age- and disorder-generic framework. American Journal of Speech-Language Pathology, 29(3), 1335–1360

“A paradigm shift has occurred in cognitive-communication therapy from repetitive decontextualized drills in the clinic to training compensatory and metacognitive strategies that can be directly applied in naturalistic situations to address functional recovery goals. Rehabilitation of cognitive processes and functional skills training should be combined to facilitate application of compensatory strategies to real-life situations. Treatment should be embedded in meaningful contexts and individualized to fulfill the unique needs of each SM and veteran and to ensure generalizability from controlled situations in therapy to natural environments and daily routines”

Cornis-Pop, M., Mashima, P. A., Roth, C. R., MacLennan, D. L., Picon, L. M., Hammond, C. S., Goo-Yoshino, S., Isaki, E., Singson, M., & Frank, E. M. (2012). Cognitive-communication rehabilitation for combat-related mild traumatic brain injury. Journal of Rehabilitation Research and Development, 49(7), xi–xxxii.

“SLPs working within a rehabilitation team must develop clinical services and engage clients in individually tailored therapy sessions and activities to reach intended goals. These distinct decisions regarding the “manner” of care provision may substantially impact client performance within and across treatment sessions. Within a given treatment session, clinicians are tasked with creating scenarios that incorporate contextualized and decontextualized activities. Contextualized activities are those that are provided in the context of the real-life situation in which the individual exhibits difficulties. An example of a contextualized treatment includes going to a restaurant, ordering from a menu, and paying for a meal. Contextualized activities also include practicing customized activities of daily living in a virtual environment through information and computer technology (i.e., virtual reality). “

Guideline Development Panel, Brown, J., Kaelin, D., Mattingly, E., Mello, C., Miller, E. S., Mitchell, G., Picon, L. M., Waldron-Perine, B., Wolf, T. J., Frymark, T., & Bowen, R. (2022). American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. American journal of speech-language pathology, 31(6), 2455–2526.

“Although clinicians may not always have ready access or the time to read the latest research outlining specific training techniques, utilizing a functional, customizable, non-workbook approach to cognitive–linguistic rehabilitation will support patient goals and ideally lead to improved generalization of skills.”

Mattingly, E. O. (2018). Functional evaluation and treatment in acquired brain injury: Acute rehabilitation. Perspectives of the ASHA Special Interest Groups, 3(2), 13–20.

"Specificity: The nature of the training experience dictates the nature of the plasticity. “Specific forms of neural plasticity and concomitant behavioral changes are dependent upon specific kinds of experience”

Salience: The training experience must be sufficiently salient to induce plasticity. “In order for an organism to effectively function, there must be a system in place to weigh the importance of any given experience such that it can be encoded”

Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of speech, language, and hearing research : JSLHR, 51(1), S225–S239. https://doi.org/10.1044/1092-4388(2008/018)

“Individuals with persistent cognitive deficits due to TBI should receive functionally oriented cognitive rehabilitation. Treatment must be considered within a framework that considers the person’s preinjury characteristics, stage of development, and recovery, and personally meaningful everyday activities, life contexts, and goals”

Bayley, M. T., Janzen, S., Harnett, A., Teasell, R., Patsakos, E., Marshall, S., Bragge, P., Velikonja, D., Kua, A., Douglas, J., Togher, L., Ponsford, J., & McIntyre, A. (2023). INCOG 2.0 guidelines for cognitive rehabilitation following traumatic brain injury: Methods, overview, and principles. Journal of Head Trauma Rehabilitation, 38(1), 7–23.

"Instructional practices that enhance neuroplasticity include providing intense, repetitive practice of FUNCTIONAL targets with careful consideration of salience, potential for generalization, and personal factors"

Sohlberg & Turkstra, (2011) “Optimizing Cognitive Rehabilitation: Effective Instructional Methods. New York, The Guilford Press)

"Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial effect on outcome.....When the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used."

Bogner J, Dijkers M, Hade EM, Beaulieu C, Montgomery E, Giuffrida C, Timpson M, Peng J, Gilchrist K, Lash A, Hammond FM, Horn SD, Corrigan JD. Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year After Discharge. Arch Phys Med Rehabil. 2019 Oct;100(10):1810-1817.

Patients more engaged in therapy when there is: "embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation"

Bright F, Kayes N, McPherson K, Worrall L. Engaging people experiencing communication disability in stroke rehabilitation: a qualitative study. Int J Lang Commun Disord. 2018 Sep;53(5):981-994.

“Rehabilitation is highly person-centered, meaning that the interventions selected for each individual are targeted to their goals and preferences”

World Health Organization. (2024, April 22). Rehabilitation. WHO. Retrieved September 3, 2025, from https://www.who.int/news-room/fact-sheets/detail/rehabilitation

Speech-language pathology services may be considered reasonable and necessary when the following criteria are met:

The services shall be considered under accepted standards of medical practice to be a specific and effective treatment for the patient's condition;
The services shall be of such a level of complexity and sophistication or the condition of the patient shall be such that the services required can be safely and effectively performed only by a qualified therapist

Centers for Medicare & Medicaid Services. (n.d.). Billing and coding: Speech-language pathology (A52866). Medicare Coverage Database.

If you need inspiration for other items to use in Speech Therapy (besides workbooks), join my email newsletter OR follow me on one of my social media platforms as I highlight tutorials, speech therapy shopping hauls, resources, and more.

Why do you think some Speech Language Pathologists still using decontextualized tasks in sessions, despite the research against it? Let me know your thoughts in the comments below.

References:

Bright F, Kayes N, McPherson K, Worrall L. Engaging people experiencing communication disability in stroke rehabilitation: a qualitative study. Int J Lang Commun Disord. 2018 Sep;53(5):981-994.

Centers for Medicare & Medicaid Services. (n.d.). Billing and coding: Speech-language pathology (A52866). Medicare Coverage Database.

Mattingly, E. O. (2018). Functional evaluation and treatment in acquired brain injury: Acute rehabilitation. Perspectives of the ASHA Special Interest Groups, 3(2), 13–20.

Sohlberg & Turkstra (2011) “Optimizing Cognitive Rehabilitation: Effective Instructional Methods. New York, The Guilford Press)

World Health Organization. (2024, April 22). Rehabilitation. WHO. Retrieved September 3, 2025, from https://www.who.int/news-room/fact-sheets/detail/rehabilitation

What Does The Research Say About Using Generic Workbooks in Speech Therapy?

If you need more convincing about putting down the workbooks when delivering speech therapy rehabilitation, here are just a few cited sources to support your decision making.

If you need inspiration for other items to use in Speech Therapy (besides workbooks), join my email newsletter OR follow me on one of my social media platforms as I highlight tutorials, speech therapy shopping hauls, resources, and more.

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