Reading Comprehension and Employment After Traumatic Brain Injury: Preliminary Findings From Clinical Practice

PURPOSE: Reading comprehension is critical for workplace success but rarely assessed in adults with traumatic brain injury (TBI). This preliminary study examined the prevalence of reading impairments in adults with TBI and explored associations between reading difficulties, cognitive-linguistic abilities, and employment outcomes to inform speech-language pathology and rehabilitation assessment practices. METHOD: We conducted a retrospective chart review of 44 adults with TBI (Mage = 38 years; 64% moderate-to-severe injury) who completed neuropsychological evaluation at an outpatient brain injury rehabilitation clinic. Reading comprehension was assessed using the Woodcock-Johnson IV Passage Comprehension test, with impairment defined as scores ≥ 1.33 SDs below the normative mean. Associations were examined between reading performance, Wechsler cognitive indices, and employment status. RESULTS: Reading comprehension impairment was identified in 25% of participants. Among those with reading impairment and available employment data (n = 8), all were unemployed or receiving disability benefits, compared to 52% (11/21) of those without reading impairment. Verbal comprehension demonstrated the strongest association with reading performance (r = .84, p < .001), whereas declarative memory, working memory, and perceptual reasoning showed moderate correlations (rs = .54-.66, all ps < .001). Reading impairments were more prevalent in moderate-to-severe TBI (32%) compared to mild TBI (13%). CONCLUSIONS: This preliminary analysis suggests reading comprehension may be an underassessed barrier to employment following TBI. The strong association with verbal comprehension indicates that language assessments routinely administered by speech-language pathologists may serve as screening tools for reading-related employment risk. Findings support incorporating reading assessment into cognitive-communication evaluations when vocational outcomes are rehabilitation priorities, although larger prospective studies are needed to establish causality and generalizability as well as to evaluate rehabilitative approaches.