The relationship between naming difficulty and FAS performance following traumatic brain injury

Measures of figural fluency: Relationship to neuropsychological variables and traumatic brain injury severity

Figural fluency tests were originally developed as a measure of right frontal lobe integrity and are presently a standard component of neuropsychological evaluation. To better understand the clinical interpretation of figural fluency scores (design output and perseverative errors), the current study investigated two trials from the Ruff Figural Fluency Test (RFFT) and their correlations with other neuropsychological variables in examinees who were being evaluated for cognitive difficulties (N = 84). Design output was significantly correlated (r_s > .4) with psychomotor speed, non-verbal memory, and false positive recognition errors on a verbal memory test, while perseverative errors did not show a significant correlation with these variables or with design output. Design output also showed a significant correlation with phonemic fluency (r_s > .3) as well as correlations (r_s > .25) with semantic fluency and intellectual functioning. In a sample of examinees with mild (n = 33), complicated-mild (n = 11), and moderate-severe (n = 16) traumatic brain injuries (TBI), group differences in design output did not reach significance, whereas perseverative errors were significantly related to the severity of injury. This study suggests that design output and perseverative errors on figural fluency may be separate measures, and their clinical interpretations are discussed.

“So that's the way it is for me — always being left out.” Acquired Pragmatic Language Impairment and Social Functioning following Traumatic Brain Injury

Our ability to interact appropriately in everyday interpersonal situations is fundamental to successful social integration. Impaired pragmatic competence correlates significantly and substantially with indices of social function across several domains for adults with acquired neurological disorders. In particular, evidence supports the negative impact of pragmatic impairments on the development and maintenance of relationships and community integration more generally.

Pragmatic language competence sits in a complex, multifactorial space characterised by interacting associations with cognitive and psychological functions and social and environmental parameters. This complexity is evident in much of the research seeking to unravel the nature and magnitude of interactions between pragmatic language competence and social outcomes in adults with acquired neurological disorders.

Over recent years our understanding of the impact of pragmatic impairments on social outcome has benefited substantially from inclusion of the insider's perspective in our research evidence base. Indeed, a methodological inclusion of constructivist paradigms has enabled the development of a rich understanding of the devastating social impact of impaired pragmatic competence.

The aim of this paper is to review pragmatic language impairment in the context of traumatic brain injury (TBI) and detail its impact on social functioning from the perspectives of people with TBI and their intimate partners/spouses and friends. With these perspectives as background, the paper concludes with consideration of therapeutic developments and a brief look at a novel intervention designed to reduce the negative impact of pragmatic deficits and improve functional language use following TBI.

Comprehension and Generation of Metaphoric Language in Children, Adolescents, and Adults with Dyslexia

Difficulties with figurative language comprehension were documented in adult dyslexia (DYS). In the present research, we investigated the comprehension and generation of metaphors in 37 children, 35 adolescents, and 34 adults with and without DYS. We also tested the contribution of executive function to metaphor processing. A multiple-choice questionnaire with conventional and novel metaphors was used to assess comprehension; a concept-explanation task was used to test conventional and novel metaphor generation (verbal creativity). The findings indicated differences between the dyslexic children and the control group in conventional metaphor comprehension. However, both groups performed similarly in the novel metaphor comprehension test. Furthermore, although children and adolescents with DYS showed similar performance in metaphor generation as their typically developing peers, adults with DYS generated more metaphors than controls. While scores on tests of verbal knowledge and mental flexibility contributed to the prediction of conventional metaphor comprehension, scores on non-verbal tests and mental flexibility contributed to the prediction of novel metaphor generation. Our findings suggest that individuals with DYS are not impaired in novel metaphor comprehension and metaphor generation and that metaphor comprehension and generation utilize different cognitive resources. Copyright © 2016 John Wiley & Sons, Ltd.

Computerized Analysis of Verbal Fluency: Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

In verbal fluency (VF) tests, subjects articulate words in a specified category during a short test period (typically 60 s). Verbal fluency tests are widely used to study language development and to evaluate memory retrieval in neuropsychiatric disorders. Performance is usually measured as the total number of correct words retrieved. Here, we describe the properties of a computerized VF (C-VF) test that tallies correct words and repetitions while providing additional lexical measures of word frequency, syllable count, and typicality. In addition, the C-VF permits (1) the analysis of the rate of responding over time, and (2) the analysis of the semantic relationships between words using a new method, Explicit Semantic Analysis (ESA), as well as the established semantic clustering and switching measures developed by Troyer et al. (1997). In Experiment 1, we gathered normative data from 180 subjects ranging in age from 18 to 82 years in semantic ("animals") and phonemic (letter "F") conditions. The number of words retrieved in 90 s correlated with education and daily hours of computer-use. The rate of word production declined sharply over time during both tests. In semantic conditions, correct-word scores correlated strongly with the number of ESA and Troyer-defined semantic switches as well as with an ESA-defined semantic organization index (SOI). In phonemic conditions, ESA revealed significant semantic influences in the sequence of words retrieved. In Experiment 2, we examined the test-retest reliability of different measures across three weekly tests in 40 young subjects. Different categories were used for each semantic ("animals", "parts of the body", and "foods") and phonemic (letters "F", "A", and "S") condition. After regressing out the influences of education and computer-use, we found that correct-word z-scores in the first session did not differ from those of the subjects in Experiment 1. Word production was uniformly greater in semantic than phonemic conditions. Intraclass correlation coefficients (ICCs) of correct-word z-scores were higher for phonemic (0.91) than semantic (0.77) tests. In semantic conditions, good reliability was also seen for the SOI (ICC = 0.68) and ESA-defined switches in semantic categories (ICC = 0.62). In Experiment 3, we examined the performance of subjects from Experiment 2 when instructed to malinger: 38% showed abnormal (p< 0.05) performance in semantic conditions. Simulated malingerers with abnormal scores could be distinguished with 80% sensitivity and 89% specificity from subjects with abnormal scores in Experiment 1 using lexical, temporal, and semantic measures. In Experiment 4, we tested patients with mild and severe traumatic brain injury (mTBI and sTBI). Patients with mTBI performed within the normal range, while patients with sTBI showed significant impairments in correct-word z-scores and category shifts. The lexical, temporal, and semantic measures of the C-VF provide an automated and comprehensive description of verbal fluency performance.

Acute evaluation of conversational discourse skills in traumatic brain injury

This study looked at performance on the conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) in 195 adults with TBI of all severity hospitalized in a Level 1 Trauma Centre. To explore validity, results were compared to findings on tests of memory, mental flexibility, confrontation naming, semantic and letter category naming, verbal reasoning, and to scores on the Montreal Cognitive Assessment. The relationship to outcome as measured with the Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOS-E), length of stay, and discharge destinations was also determined. Patients with severe TBI performed significantly worse than mild and moderate groups (χ(2)(KW2df) = 24.435, p = .0001). The total D-MEC score correlated significantly with all cognitive and language measures (p < .05). It also had a significant moderate correlation with the DRS total score (r = -.6090, p < .0001) and the GOS-E score (r = .539, p < .0001), indicating that better performance on conversational discourse was associated with a lower disability rating and better global outcome. Finally, the total D-MEC score was significantly different between the discharge destination groups (F(3,90) = 20.19, p < .0001). Thus, early identification of conversational discourse impairment in acute care post-TBI was possible with the D-MEC and could allow for early intervention in speech-language pathology.

Component analysis of verbal fluency performance in younger participants with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To investigate phonemic and semantic verbal fluency performance in a group of young adult participants with and without traumatic brain injury.

RESEARCH DESIGN

Group comparison.

METHODS AND PROCEDURES

Twenty-five participants with moderate-to-severe TBI and 25 participants with no brain damage (NBD) were given phonemic and semantic verbal fluency tasks. Responses were analysed quantitatively and qualitatively.

MAIN OUTCOMES AND RESULTS

Young participants with moderate-to-severe TBI generated significantly fewer total correct words and sub-categories for both fluency conditions when compared to controls. The total number of correct words generated on the phonemic condition and for the semantic category of animals was positively correlated with the number of category switches produced during the task.

CONCLUSIONS

While young participants with moderate-to-severe TBI produced fewer total correct words on both verbal fluency conditions in comparison to controls, these differences were greater on the phonemic condition. Participants with moderate-to-severe TBI switched less frequently on both fluency tasks and produced smaller cluster sizes only on the phonemic task in comparison to controls. These results are in contrast with previous investigations that have observed greater age-related declines on semantic tasks when compared to phonemic tasks.

Effects of video modelling on emerging speech in an adult with traumatic brain injury: preliminary findings

PRIMARY OBJECTIVE

Research has shown that traumatic brain injury (TBI) can affect a person's ability to perform previously learned skills. Dysexecutive syndrome and inattention, for example, alongside a number of other cognitive and behavioural impairments such as memory loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study examined the efficacy of video modelling in emerging speech in an adult male with TBI caused by an assault.

RESEARCH DESIGN

In an effort to identify functional relations between this novice intervention and the target behaviour, experimental control was achieved by using within-system research methodology, overcoming difficulties of forming groups for such an highly non-homogeneous population.

METHODS AND PROCEDURES

Across a number of conditions, the participant watched a videotape in which another adult modelled a selection of 19 spoken words. When this modelled behaviour was performed in vivo, then generalization across 76 other words in the absence of a videotape took place.

MAIN OUTCOMES AND RESULTS

It was revealed that video modelling can promote the performance of previously learned behaviours related to speech, but more significantly it can facilitate the generalization of this verbal behaviour across untrained words.

CONCLUSIONS

Video modelling could well be added within the rehabilitation programmes for this population.

Does the presence of posttraumatic anosmia mean that you will be disinhibited?

Dispute has surrounded the issue of whether the relationship between anosmia and executive dysfunction in traumatic brain injury (TBI) may be artefactual due to poor ascertainment. Three groups matched for age, gender, education, Full Scale IQ, and the Wechsler Working Memory Index and showing adequate symptom validity were compared: 30 anosmic TBIs (TBI-A) matched for posttraumatic amnesia (PTA) and working memory functioning with 36 nonanosmic TBIs (TBI-NA) and 51 controls. The groups performed the FAS test, the Animal Fluency test, the Stroop Neurological Screening Test (SNST), the Wisconsin Card Sorting Test-64 (WCST-64) and the Trail Making Test (TMT-B) as well as tests of emotional functioning and return to work outcome. After adjusting for the covariates (i.e., gender; Wechsler Test of Adult Reading, WTAR; and years of education), a significant effect was found for items successfully completed on the SNST, the FAS task, the Animal Fluency task, and the WCST-64 categories completed. After adjusting for the covariates, a significant difference was found for number of errors on the SNST and for the number and type of errors on TMT-B. The two groups did not differ in terms of their affective functioning (i.e., Beck Depression Inventory or Beck Anxiety Inventory), or in terms of their outcome with regard to return to work. The findings support the notion that the TBI-A group demonstrated considerably weaker performance on executive tasks than did the nonanosmic TBIs. These patients were not, however, more prone to an error-prone pattern of performance, and, if anything, their executive deficit was more likely attributable to a reduced productivity of response.

Hemispheric and executive influences on low-level language processing after traumatic brain injury

OBJECTIVE

The purpose of this study was to examine whether minor high-level language deficits found after traumatic brain injury (TBI) might be due to low-level language processing issues or executive control influences. A possible mechanism was also investigated.

METHOD

Nineteen age- and education-matched healthy controls (16 M, 3 F) and 19 persons who had experienced a complicated mild, moderate or severe TBI between 1-3 years prior (16 M, 3 F; mean GCS = 9.44) participated in two computerized behavioural experiments utilizing two paradigms standard in the psycholinguistic literature (priming with lexical decision and verb generation), which included trials of greater and lesser executive demand.

RESULTS

Response time and accuracy differences were found in both experiments, indicating deficits in single-word processing for the patient group. Disproportionate difficulty was found for trials which included an executive component. Right visual field (left hemisphere) preferences were found to be stronger in the TBI group than in controls.

CONCLUSIONS

Results suggest that persons with TBI may have difficulties in processing single words alone, especially under conditions of increased executive demand, and that atypical patterns of hemispheric recruitment may be associated with these difficulties.

Searching for the right word: performance on four word-retrieval tasks across childhood

Word retrieval was assessed in 207 normally developing Hebrew-speaking children aged 8-17 through four tasks: picture naming, phonemic fluency, semantic fluency, and homophone meaning generation (HMGT). Scores on all tests correlated positively and significantly with participant age. Yet, age effects and the correlation between age and test scores were weakest for the naming test and strongest for the HMGT. We discuss the nature of the word search involved in each task and suggest that the more executive demands required by a test the steeper the slope of performance increase on this test.

Relation of executive functioning to pragmatic outcome following severe traumatic brain injury

PURPOSE

This study was designed to explore the behavioral nature of pragmatic impairment following severe traumatic brain injury (TBI) and to evaluate the contribution of executive skills to the experience of pragmatic difficulties after TBI.

METHOD

Participants were grouped into 43 TBI dyads (TBI adults and close relatives) and 43 control dyads. All TBI participants had sustained severe injury (mean posttraumatic amnesia duration = 45.19 days, SD = 39.15) due to a moving vehicle-related trauma. A minimum of 2 years had elapsed since injury (M = 5.36 years, SD = 3.61). The La Trobe Communication Questionnaire (LCQ; Douglas, O'Flaherty, & Snow, 2000) was administered to all participants. Measures of executive function included the following: the FAS verbal fluency task (Spreen & Benton, 1969), the Speed and Capacity of Language Processing test (Baddeley, Emslie, & Nimmo-Smith, 1992), and the Rey Auditory Verbal Learning Task (Rey, 1964).

RESULTS

Perceptions of TBI participants and their relatives were significantly correlated (r = .63, p < .001) and significantly different from those of controls, F(1, 84) = 37.2, p < .001. Pragmatic difficulties represented violations in 3 domains of Grice's (1975) Cooperative Principle (Quantity, Relation, and Manner), and executive function measures predicted 37% (32% adjusted) of the variability in LCQ scores.

CONCLUSIONS

The study demonstrates evidence of a significant association between executive impairment and the pragmatic communication difficulties experienced by individuals with TBI.

The relationship between working memory, processing speed, verbal comprehension and FAS performance following traumatic brain injury

PRIMARY OBJECTIVE

To investigate the relationship of working memory, processing speed and verbal comprehension with FAS performance in individuals who had sustained a traumatic brain injury (TBI).

METHODS AND PROCEDURE

Sixty-three patients with a TBI were grouped according to the presence of impaired verbal fluency performance and then compared on a number of cognitive and demographic variables.

RESULTS

Following a TBI, working memory and processing speed had the greatest influence on verbal fluency performance. For those individuals who have not sustained a TBI, education, verbal intelligence, working memory and speed of information processing were related to FAS performance.

CONCLUSIONS

The findings of the study indicate that FAS performance was related to verbal intelligence, working memory ability, attention and speed of information processing. The results further suggest that different variables are related to FAS performance following a TBI as compared with control group performances.