Stretching the Truth: Identifying, Defining, and Measuring Confabulation for Speech-Language Pathologists Working With the Traumatic Brain Injury Population

PURPOSE: Confabulation is a complex phenomenon that presents unique challenges for speech-language pathologists (SLPs) providing cognitive-communication rehabilitation for individuals with traumatic brain injury (TBI). However, confabulation is conceptually poorly defined, and no clear descriptions or guidelines exist for the assessment or management of confabulation for SLPs. This tutorial provides a condensed background regarding underlying theories, differing etiologies, and previously used assessments and interventions in order to provide current recommendations for SLPs working with individuals with TBI who confabulate. METHOD: We conducted a literature review examining the history and clinical background of confabulation, methods of assessment, and intervention. This was used to identify gaps in knowledge, key theories, and traditionally used assessment and intervention strategies. RESULTS: Various definitions of confabulation exist and differ by clinical diagnosis. Limited information is available within current best practice guidelines for cognitive-communication disorders. Current literature suggests use of metacognitive strategies, dynamic assessment, and tools such as patient interviews, journaling, and video feedback to address executive function deficits. However, the lack of specific clinical guidelines for confabulation often leads clinicians to rely on informal or ad hoc strategies that may not fully address the complexity of the behavior. Although some SLPs report confidence in identifying confabulation, this may not reflect a consistent or evidence-based approach in clinical practice. CONCLUSION: By increasing clinical awareness and providing direction for evidence-informed practice, SLPs can work with the multidisciplinary team to better identify and address confabulation, supporting clients' functional communication, social reintegration, and quality of life following TBI.