Acute evaluation of conversational discourse skills in traumatic brain injury

Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments

BACKGROUND

There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI).

OBJECTIVES

To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs.

METHODS

A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs.

RESULTS

We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation.

CONCLUSIONS

Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research.

TRIAL REGISTRATION

PROSPERO database (registration number: CRD42020196861). No funding.

Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations

Traumatic brain injury is damage to the brain occurring after birth, often resulting in the deterioration of cognitive, behavioural, and emotional functions. Neuropsychological evaluation can assist clinicians to better assess the patient's clinical condition, reach differential diagnoses, and develop interventional strategies. However, considering the multiple rating scales available, it is not easy to establish which tool is most suitable for the different brain injury conditions. The aim of this review is to investigate and describe the most used neurocognitive assessment tools in patients with traumatic brain injury to provide clinicians with clear indications on their use in clinical practice. Indeed, during the acute phase, after the head trauma, alertness and wakefulness of the patients affected by a disorder of consciousness can be assessed using different scales, such as the Coma Recovery Scale-Revised. In both postacute and chronic phases after traumatic brain injury, general cognitive assessment tools (such as the Mini Mental State Examination) or more specific cognitive tests (e.g., Wisconsin Card Sorting Test and Trail Making Test) could be administered according to the patient's functional status. In this way, clinicians may be aware of the patient's neuropsychological and cognitive level, so they can guarantee a personalized and tailored rehabilitation approach in this frail patient population.

Discourse Performance in Adults With Mild Traumatic Brain Injury, Orthopedic Injuries, and Moderate to Severe Traumatic Brain Injury, and Healthy Controls

INTRODUCTION

Adults with mild traumatic brain injury (mTBI) are at risk for communication disorders, yet studies exploring cognitive-communication performance are currently lacking.

AIMS

This aim of this study was to characterize discourse-level performance by adults with mTBI on a standardized elicitation task and compare it to (a) healthy adults, (b) adults with orthopedic injuries (OIs), and (c) adults with moderate to severe TBI.

METHOD

This study used a cross-sectional design. The participants included mTBI and OI groups recruited prospectively from an emergency medicine department. Moderate to severe TBI and healthy data were acquired from TalkBank. One-way analyses of variance were used to compare mean linguistic scores.

RESULTS

Seventy participants across all groups were recruited. Groups did not differ on demographic variables. The study found significant differences in both content and productivity measures among the groups. Variables did not appear sensitive to differentiate between mTBI and OI groups.

DISCUSSION

Cognitive and language performance of adults with mTBI is a pressing clinical issue. Studies exploring language with carefully selected control groups can influence the development of sensitive measures to identify individuals with cognitive-communication deficits.

Reaction time and cognitive-linguistic performance in adults with mild traumatic brain injury

Objective: The purpose of this study was to characterize cognitive-linguistic performance in adults with mild traumatic brain injury (mTBI) to advance assessment and treatment practices. We hypothesized that individuals with mTBI would demonstrate longer reaction times (RTs) and greater error rates when compared to an orthopedic injury (OI) group on a category-naming task. Method: Participants were age and education-matched adults with mTBI (n = 20; 12 females) and adults with OI (n = 21; 5 females) who were discharged to home after an Emergency Department visit. Our primary task was a category-naming task shown to be sensitive to language deficits after mTBI. The task was adapted and administered under speeded and unspeeded conditions. Results: There was a significant main effect of condition on RT (speeded faster than unspeeded) and accuracy (more errors in the speeded condition). There was a marginally significant effect of group on errors, with more errors in the mTBI group than the OI group. Naming RT and accuracy in both conditions were moderately correlated with injury variables and symptom burden. Conclusions: Our data showed a marginal effect of group on accuracy of performance. Correlations found between naming and neurobehavioural symptoms, including sleep quality, suggest that the latter should be considered in future research.

Early detection of cognitive impairments with the Montreal Cognitive Assessment in patients with uncomplicated and complicated mild traumatic brain injury

OBJECTIVES

The Montreal Cognitive Assessement (MoCA) is a brief and standardized cognitive screening tool that has been used with several clinical populations. The aim of this study was to screen the early cognitive status of patients following mild traumatic brain injury (mTBI) with the MoCA.

METHODS

The MoCA was administered within the first 2 weeks post-injury to 42 patients with uncomplicated mTBI, 92 patients with complicated mTBI and 50 healthy controls.

RESULTS

Patients with complicated mTBI had a significantly lower performance (more impairments) on the total score of the MoCA than both the group with uncomplicated mTBI and the control group. Also, the group with uncomplicated mTBI had a significantly lower performance than controls. Moreover, age, education and TBI severity had a significant effect on the MoCA total score where younger, more educated and patients with less severe (higher GCS score) mTBI performed significantly better.

CONCLUSIONS

The MoCA may be clinically useful to acutely screen cognition following mTBI.

Social communication assessment after TBI: a narrative review of innovations in pragmatic and discourse assessment methods

BACKGROUND

Social communication assessment after traumatic brain injury (TBI) remains a challenging area within speech-language pathology (SLP) clinical practice. Difficulties include the lack of TBI-specific standardized assessment instruments and limited knowledge and uptake of discourse assessment methods clinically. The aim of this paper was to review recent research literature reporting on innovative social communication and discourse assessment measures and methods, to guide evidence-based SLP practice and inform future research.

MAIN CONTRIBUTION

This review describes novel standardized and non-standardized assessment tools for SLP use reported in TBI research literature from the past 15 years. Measures include published assessment batteries and pragmatic rating scales designed for use with adults with TBI, and novel discourse tasks and protocols.

CONCLUSION

This paper delineates social communication assessment measures and discourse analyses described in research literature that may be practical for SLPs to use with adults with TBI. The clinical implications and utility of these measures are discussed. This should assist SLPs in decision-making on social communication assessment for adults with TBI. Further research is needed to investigate translation of research knowledge on discourse assessment methods to SLP practice.

Do executive function and theory of mind predict pragmatic abilities following traumatic brain injury? An analysis of sincere, deceitful and ironic communicative acts

Quality of life and social integration are strongly influenced by the ability to communicate and previous research has shown that pragmatic ability can be specifically impaired in individuals with traumatic brain injury (TBI). In addition, TBI usually results in damage to the frontotemporal lobes with a consequent impairment of cognitive functions, i.e., attention, memory, executive function (EF) and theory of mind (ToM). The role of the underlying cognitive deficits in determining the communicative-pragmatic difficulties of an individual with TBI is not yet completely clear. This study examined the relationship between the ability to understand and produce various kinds of communicative acts, (i.e., sincere, deceitful and ironic) and the above-mentioned cognitive and ToM abilities following TBI. Thirty-five individuals with TBI and thirty-five healthy controls were given tasks assessing their ability to comprehend and produce sincere, deceitful and ironic communicative acts belonging to the linguistic and extralinguistic scales of the Assessment Battery for Communication (ABaCo), together with a series of EF and ToM tasks. The results showed that, when compared to healthy individuals, participants with TBI performed poorly overall in the comprehension and production of all the pragmatic phenomena investigated, (i.e., sincere, deceitful and ironic communicative acts), and they also exhibited impaired performance at the level of all the cognitive functions examined. Individuals with TBI also showed a decreasing trend in performance in dealing with sincere, deceitful and ironic communicative acts, on both the comprehension and production subscales of the linguistic and extralinguistic scales. Furthermore, a hierarchical regression analysis revealed that - in patients with TBI but not in the controls - EF had a significant effect on the comprehension of linguistic and extralinguistic irony only, while the percentage of explained variance increased with the inclusion of theory of mind. Indeed, ToM had a significant role in determining patients' performance in the extralinguistic production of sincere and deceitful communicative acts, linguistic and extralinguistic comprehension of deceit and the linguistic production of irony. However, with regard to the performance of patients with TBI in the various pragmatic tasks investigated, (i.e., sincere, deceitful and ironic communicative acts), EF was able to explain the pattern of patients' scores in the linguistic and extralinguistic comprehension but not in production ability. Furthermore, ToM seemed not to be able to explain the decreasing trend in the performance of patients in managing the various kinds of communicative acts investigated.

Executive functions assessment in patients with language impairment A systematic review

Acquired language impairments may accompany different conditions. Most recent studies have shown that there is an important relationship between language and cognitive functions, such as executive functions (EF). Therefore, we aimed to investigate which main EF components appear to have the greatest impact in the most prevalent acquired communication disorders in adults, and which neuropsychological tests are being used to evaluate them. In addition, we sought to characterize the relationship between the executive functions and language in these conditions. Working memory (WM) was the most frequently chosen cognitive measure, being evaluated by different span tasks. A relationship between WM and narrative and conversational discourse, writing abilities and grammatical comprehension was found. Other currently used cognitive tests included the Trail Making, Wisconsin, Stroop and Verbal Fluency tests. Language and EF have a complex relationship; hence, a complete assessment should reflect the dynamic processing of cognitive brain functions.

Non literal language comprehension in a large sample of first episode psychosis patients in adulthood

To date no data still exist on the comprehension of figurative language in the early phases of psychosis. The aim of this study is to investigate for the first time the comprehension of metaphors and idioms at the onset of the illness. Two-hundred-twenty eight (228) first episode psychosis (FEP) patients (168 NAP, non-affective psychosis; 60 AP, affective psychosis) and 70 healthy controls (HC) were assessed. Groups were contrasted on: a) type of stimulus (metaphors vs idioms) and b) type of response (OPEN = spontaneous explanations vs CLOSED = multiple choice answer). Moreover, a machine learning (ML) approach was adopted to classifying participants. Both NAP and AP had a poorer performance on OPEN metaphors and idioms compared to HC, with worse results on spontaneous interpretation of idioms than metaphors. No differences were observed between NAP and AP in CLOSED tasks. The ML approach points at CLOSED idioms as the best discriminating variable, more relevant than the set of pre-frontal and IQ scores. Deficits in non-figurative language may represent a core feature of psychosis. The possibility to identify linguistic features discriminating FEP may support the early recognition of patients at risk to develop psychosis, guiding provision of personalized and timely interventions.

Normative Study of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) Test in the French-Canadian Population

PURPOSE

The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES; MacDonald, 2005) test was designed for use by speech-language pathologists to assess verbal reasoning, complex comprehension, discourse, and executive skills during performance on a set of challenging and ecologically valid functional tasks. A recent French version of this test was translated from English; however, it had not undergone standardization. The development of normative data that are linguistically and culturally sensitive to the target population is of importance. The present study aimed to establish normative data for the French version of the FAVRES, a commonly used test with native French-speaking patients with traumatic brain injury in Québec, Canada.

METHOD

The normative sample consisted of 181 healthy French-speaking adults from various regions across the province of Québec. Age and years of education were factored into the normative model.

RESULTS

Results indicate that age was significantly associated with performance on time, accuracy, reasoning subskills, and rationale criteria, whereas the level of education was significantly associated with accuracy and rationale.

CONCLUSION

Overall, mean scores on each criterion were relatively lower than in the original English version, which reinforces the importance of using the present normative data when interpreting performance of French speakers who have sustained a traumatic brain injury.