Microlinguistic deficits in the narrative discourse of adults with traumatic brain injury

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls

BACKGROUND

Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID-19 restrictions have reduced in-person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in-person.

AIMS

To examine the feasibility of telehealth administration of narrative and procedural discourse tasks with individuals with TBI and matched controls.

METHODS & PROCEDURES

A total of 20 individuals with TBI and 20 healthy controls, aged 18-55 years, were directly recruited from the UK and indirectly recruited from the US. For participants with TBI, time post-injury was at least 3 months with no diagnosis of aphasia. Control participants were matched for sex and as closely as possible for age. Feasibility of measures was based upon the time to administer both narrative tasks, the report of any technological problems, and participant feed. Discourse samples were transcribed verbatim and analysed using story grammar analysis (for narrative discourse) and identification of propositions (for procedural discourse). Interrater reliability was calculated using percentage agreement for 50% of the data. Non-parametric analyses were used to analyse the performance of the two groups.

OUTCOMES & RESULTS

Narrative and procedural discourse samples were collected via telehealth in approximately 10 min with no reported technical difficulties or complaints from any participants. For narrative discourse performance, there were significant differences for the TBI and control groups for measures of complete episodes (p < 0.001) and missing episodes (p = 0.005). No significant group differences were noted for any of the procedural discourse measures.

CONCLUSIONS & IMPLICATIONS

Results support the feasibility of collecting discourse samples via telehealth. Although the participants' discourse performance distinguished the TBI and control groups on the narrative task, no differences between the groups were noted for the procedural task. The narrative discourse task may have been more difficult than the procedural task, or video cue support reduced the cognitive load of the procedural task. This finding suggests the use of more complex procedural tasks without video cue support may be needed.

WHAT THIS PAPER ADDS

What is already known on this subject Although little research has explored the feasibility of administering discourse assessments for individuals with TBI via telehealth, some studies have found that discourse interventions can be feasibly administered via telehealth. It is also well established that individuals with TBI struggle with the supra-structural and macro-linguistic elements of discourse production. Both procedural and narrative discourse tasks have been found to differentiate individuals with TBI from healthy controls. What this paper adds to existing knowledge Few studies have investigated the feasibility of, and procedures for, administering discourse tasks via telehealth. Additionally, the inclusion of multiple types of discourse tasks to parse cognitive-communication abilities is lacking in the current literature. Findings from this study support that narrative and procedural discourse can be feasibly sampled via telehealth and that international collaboration for research on this topic can facilitate such studies. Individuals with TBI performed more poorly on three measures of narrative discourse. No differences between groups were identified for the procedural task. What are the potential or actual clinical implications of this work? Telehealth assessment for discourse provides flexibility for both the individual with TBI and the speech-language therapist and does not compromise the quality of data collected. The administration of discourse tasks and collection of data was not time-consuming and was well accepted by the study participants. Additionally, international research collaboration not only expands potential participation in research but increases the opportunity to recruit and study more diverse groups.

Measuring pragmatic competence of discourse output among Chinese-speaking individuals with traumatic brain injury

OBJECTIVE

Discourse analysis is one of the clinical methods commonly used to assess the language ability of individuals with traumatic brain injury (TBI). However, the majority of published analytic frameworks are not geared for highlighting the pragmatic aspect of discourse deficits in acquired language disorders, except for those designed for quantifying conversational samples. This study aimed to examine how pragmatic competence is impaired and reflected in spoken monologues in Chinese speakers with TBI.

METHODS

Discourse samples of five tasks (personal narrative, storytelling, procedural, single- and sequential picture description) were elicited from ten TBI survivors and their controls. Each discourse sample was measured using 16 indices (e.g., number of informative words, percentage of local/global coherence errors, repeated words or phrases) that corresponded to the four Gricean maxims. Twenty-five naïve Chinese speakers were also recruited to perform perceptual rating of the quality of all 50 TBI audio files (five discourse samples per TBI participant), in terms of erroneous/inaccurate information, adequacy of amount of information given, as well as degree of organization and clarity.

RESULTS

The maxim of quantity best predicted TBI's pragmatic impairments. Naïve listeners' perception of pragmatics deficits correlated to measures on total and informative words, as well as number and length of terminable units. Clinically, personal narrative and storytelling tasks could better elicit violations in pragmatics.

CONCLUSION

Applying Gricean maxims in monologic oral narratives could capture the hallmark underlying pragmatic problems in TBI. This may help provide an additional approach of clinically assessing social communications in and subsequent management of TBI.

Verbosity with retelling: Narrative discourse production in temporal lobe epilepsy

To examine micro- and macrolinguistic underpinnings of circumstantiality in temporal lobe epilepsy (TLE), we examined the elicited narrative output of 15 individuals with TLE and 14 controls. To replicate and extend Field and colleagues' (2000) work, participants were asked to produce five immediately consecutive elicitations of an eight-frame cartoon "Cowboy Story" (Joanette et al., 1986). Following transcription and coding, detailed multi-level discourse analysis demonstrated a typical pattern of compression in controls. The narratives produced by individuals with TLE were less fluent, cohesive, and coherent across trials: producing fewer novel units and more repetitive and extraneous content. Significant group by trial interactions in sample length, spontaneous duration, and statements, were not explained by seizure burden, age, or lexical retrieval deficits. These findings suggest that they do not benefit from repeated engagement with a narrative in the same manner as controls. Disturbed social cognition and pragmatics in TLE might underpin communication inefficiencies.

Vague retellings of personal narratives in temporal lobe epilepsy

PURPOSE

Aside from deficits identified in single-word level retrieval, individuals with temporal lobe epilepsy (TLE) exhibit clinical oddities, such as circumstantiality in their language production. Circumstantiality refers to the use of language which is pedantic, repetitive, and overly detailed. This becomes particularly evident when elicitation tasks impose minimal structure, or when impersonal narratives are retold over consecutive occasions. Personal reminiscence is highly specific and localised in time, placing unique demands on cognitive-linguistic systems. It is hypothesised that the nature of this elicitation paradigm will produce a unique psycholinguistic phenotype in those with TLE. Among controls there is a compression of output for impersonal narratives, meaning that they use fewer words over less time and are more fluent. The opposite effect is observed when personal narratives are retold.

METHODS

To investigate the micro- and macrolinguistic processes underpinning personal discourse production in TLE, we examined the elicited language output of 15 surgically naïve individuals with TLE and 14 healthy controls. Participants were asked to recall and re-tell an autobiographical memory on four immediately consecutive occasions, representing an alternative unstructured elicitation. Following transcription and coding of output, a detailed multi-level discourse analysis of output volume, fluency, cohesion, and coherence was conducted.

RESULTS

As anticipated, a distinctly different pattern emerged in TLE when compared with controls who did not compress their output volume across repetitions but instead produced greater novelty, and a more coherent and refined account over time. Individuals with TLE consistently told a less distinct story across repetitions, with disturbances in fluency, cohesion, and coherence.

CONCLUSION

This reflects a reduced capacity to produce a coherent mental representation, in all likelihood related to the neurolinguistic demands of recalling and retelling specific personal events.

Sentence types and complexity of spontaneous discourse productions by Cantonese-speakers with traumatic brain injury- a preliminary report

Previous investigations on sentence production in English-speaking individuals with traumatic brain injury (TBI) have yielded mixed conclusions based on their findings. While some studies found comparable sentence complexity between speakers with TBI and control speakers, others reported more syntactic and lexical errors, reduced sentence complexity, and erroneous word order transpositions in the sentence production of speakers with TBI. These contradictory findings could possibly be due to the use of language measures that were less sensitive to subtle syntactic impairments among speakers with TBI. In this preliminary report, the language samples obtained from 11 Cantonese-speaking participants with mild-moderate TBI in Guangzhou, with a mean age of 37.6 and mean years of education of 10 years, and nine control speakers with a similar age range and education background were analyzed using in-depth linguistic-oriented frameworks adopted from pervious works in Cantonese. The results indicated that the TBI group produced more errors, different varieties of sentence types, and lower syntactic complexity in their sentence production compared with the control group. The findings suggested that the more refined and linguistic-oriented measures used in the present study were more sensitive in identifying the subtle syntactic impairments produced by the participants with TBI.

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.

Neuroimaging and Psychometric Assessment of Mild Cognitive Impairment After Traumatic Brain Injury

Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.

Idea Formulation for Spoken Language Production: The Interface of Cognition and Language

BACKGROUND

Language and communication are fundamental to the human experience, and, traditionally, spoken language is studied as an isolated skill. However, before propositional language (i.e., spontaneous, voluntary, novel speech) can be produced, propositional content or 'ideas' must be formulated.

OBJECTIVE

This review highlights the role of broader cognitive processes, particularly 'executive attention', in the formulation of propositional content (i.e., 'ideas') for propositional language production.

CONCLUSIONS

Several key lines of evidence converge to suggest that the formulation of ideas for propositional language production draws on executive attentional processes. Larger-scale clinical research has demonstrated a link between attentional processes and language, while detailed case studies of neurological patients have elucidated specific idea formulation mechanisms relating to the generation, selection and sequencing of ideas for expression. Furthermore, executive attentional processes have been implicated in the generation of ideas for propositional language production. Finally, neuroimaging studies suggest that a widely distributed network of brain regions, including parts of the prefrontal and parietal cortices, supports propositional language production.

IMPLICATIONS

Theoretically driven experimental research studies investigating mechanisms involved in the formulation of ideas are lacking. We suggest that novel experimental approaches are needed to define the contribution of executive attentional processes to idea formulation, from which comprehensive models of spoken language production can be developed. Clinically, propositional language impairments should be considered in the context of broader executive attentional deficits.

Differences in linguistic cohesion within the first year following right and left hemisphere lesions

BACKGROUND

Characterizing productive language deficits following lesions to the right (RH) or left hemispheres (LH) is valuable in identifying appropriate therapeutic goals. While damage to the LH classically is associated with deficits in language, RH lesions also result in changed communication beyond prosody due to cognitive-linguistic effects. Cohesion, reference to introduced content across sentences within discourse, relies on a listener's clear and unambiguous understanding that a reference has occurred. To date, we are not aware of any prior work that has compared patterns of cohesive strategy between RH and LH lesioned individuals with cohesion deficits.

AIMS

The purpose of the present study is to determine whether individuals with communication deficits following RH and LH lesions differ in the inclusion and clarity of cohesive markers.

METHODS & PROCEDURES

Seventy-six RH samples and 145 LH samples were used for comparison of cohesion performance in a Cookie Theft picture description task. Cohesive ties were assessed following the protocol outlined in Liles and Coelho (1998). It was hypothesized that individuals with LH lesions would present a different pattern of cohesion behaviour than RH lesioned individuals when considered both acutely and chronically.

OUTCOMES & RESULTS

Overall, samples from LH and RH groups did not differ in word counts or cohesive marker usage. However, the patterns of markers they chose to employ were different. LH samples used conjunctions and personal pronouns more frequently and used lexical cohesive markers less frequently than RH samples. Acutely, patterns of cohesive marker use between LH and RH samples were more similar. Chronically, LH samples contained more personal pronouns and the differences in lexical cohesive markers remained unchanged. When cohesion was unsuccessful, LH and RH damage were associated with different patterns of error. LH samples tended to omit information needed to clarify the intended referent, resulting in incomplete cohesion errors. RH samples tended to sustain breakdowns in cohesion from sentence to sentence, not resolving incorrectly chosen pronouns or ambiguities left in their samples.

CONCLUSIONS

LH and RH lesions resulted in differing patterns of chosen cohesive markers and errors when cohesion was unsuccessful. This was particularly true in lexical cohesion, which has been far less studied than closed-class cohesive markers like referential pronouns. It was also noted that cohesive behavior did not appear to "recover" for either group, suggesting spontaneous recovery is minimal and present strategies for language therapy may not effectively address this linguistic function.

Patterns of narrative discourse in early recovery following severe Traumatic Brain Injury

Primary Objective: To investigate the nature and patterns of narrative discourse impairment in people with severe Traumatic Brain Injury (TBI) during early recovery.Methods and Procedures: A single image picture description task was administered to 42 participants with severe TBI at 3 and 6-months post-injury. The same task was administered to 37 control participants. Discourse samples were analyzed with measures of productivity, informativeness and story organization. The performance of people with TBI was compared with the control group at both 3 and 6 months, and the performance of the participants with TBI was also compared across the two time points. Individual patterns of performance were also examined.Results: Inferential analyses revealed significant differences between the control group and the group with TBI on informativeness at both time points and  number of complete episodes at 3 months, but no significant differences for productivity measures. There was no significant change for the group with TBI between 3 and 6 months. However, individual improvement over time was observed.Conclusions: People with TBI have discourse difficulties early post TBI that are also present at 6-months post-injury. In order to understand longer-term discourse recovery, it is necessary to examine participant patterns over further time points on this narrative task.

Writing Changes and Perceptions After Traumatic Brain Injury: "Oh, by the way, I can't write"

PURPOSE

Language and cognitive disruptions following traumatic brain injury (TBI) can negatively affect written expression and may result in increased difficulty achieving academic, vocational, social, and personal goals; however, scarce literature exists about TBI's effect on writing abilities. The purpose of this qualitative study was to describe the experiences and perceptions of people with TBI regarding their engagement in writing activities.

METHOD

A transcendental phenomenological design structured the research. Data collection from 11 adults with TBI included gathering demographic and background information, completion of a TBI Symptom Checklist, and engagement in semistructured interviews.

RESULTS

Four major themes and 21 subthemes about postinjury writing recovery and current writing status emerged from the data analysis. Participants reported the extent to which writing difficulties interfered with daily activities and identified support strategies used to address persistent challenges.

CONCLUSION

Understanding the writing experiences and perceptions of people with TBI can guide professionals in designing assessments and interventions to facilitate educational, vocational, social, and personal success following injury.

Discourse-based treatment in mild traumatic brain injury

BACKGROUND

Individuals with traumatic brain injury (TBI) present with numerous discourse deficits associated with impairments to the linguistic system and other cognitive systems. Individuals with TBI may produce discourse that is lacking important information and poorly organized, as well as containing numerous coherence disrupting elements. Yet there are few studies directly addressing discourse deficits in individuals with TBI to guide clinicians.

AIMS

The purpose of the study was to determine if discourse processing treatment improved the discourse production in individual with TBI. Aims of the study included determining if the discourse processing treatment improved completeness and informativeness in TBI discourse samples.

METHODS & PROCEDURES

The study included three participants with mild-to-moderate TBI. The study utilized an A-B with maintenance design that incorporated components of functional practice, structured cues in the form of comprehension questions and story guide, and meta-cognitive and meta-linguistic processes. Discourse samples were obtained for baseline, treatment, and maintenance one-week and one-month post treatment. Stimuli included 12 sequential pictures, as well as a single picture and a recount probe.

OUTCOMES & RESULTS

All participants demonstrated small gains in completeness and informativeness for treated items, and 2 of 3 participants demonstrated a medium therapeutic effect for untreated stimuli. Participants also produced discourse with fewer errors for both treated and untreated stimuli after treatment with no therapeutic effect to a small effect for the generalization stimuli.

CONCLUSIONS

The study demonstrated that the discourse processing treatment is capable of producing small therapeutic effects that persisted one-month post treatment in adults with mild-to-moderate TBI.

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.

Analysis of Story Recall in Military Veterans With and Without Mild Traumatic Brain Injury: Preliminary Results

PURPOSE

The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI).

METHOD

Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale-Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP).

RESULTS

Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group.

CONCLUSIONS

The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.

Discourse Characteristics in Aphasia Beyond the Western Aphasia Battery Cutoff

PURPOSE

This study examined discourse characteristics of individuals with aphasia who scored at or above the 93.8 cutoff on the Aphasia Quotient subtests of the Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007). They were compared with participants without aphasia and those with anomic aphasia.

METHOD

Participants were from the AphasiaBank database and included 28 participants who were not aphasic by WAB-R score (NABW), 92 participants with anomic aphasia, and 177 controls. Cinderella narratives were analyzed using the Computerized Language Analysis programs (MacWhinney, 2000). Outcome measures were words per minute, percent word errors, lexical diversity using the moving average type-token ratio (Covington, 2007b), main concept production, number of utterances, mean length of utterance, and proposition density.

RESULTS

Results showed that the NABW group was significantly different from the controls on all measures except MLU and proposition density. These individuals were compared to participants without aphasia and those with anomic aphasia.

CONCLUSION

Individuals with aphasia who score above the WAB-R Aphasia Quotient cutoff demonstrate discourse impairments that warrant both treatment and special attention in the research literature.

Automated Proposition Density Analysis for Discourse in Aphasia

PURPOSE

This study evaluates how proposition density can differentiate between persons with aphasia (PWA) and individuals in a control group, as well as among subtypes of aphasia, on the basis of procedural discourse and personal narratives collected from large samples of participants.

METHOD

Participants were 195 PWA and 168 individuals in a control group from the AphasiaBank database. PWA represented 6 aphasia types on the basis of the Western Aphasia Battery-Revised (Kertesz, 2006). Narrative samples were stroke stories for PWA and illness or injury stories for individuals in the control group. Procedural samples were from the peanut-butter-and-jelly-sandwich task. Language samples were transcribed using Codes for the Human Analysis of Transcripts (MacWhinney, 2000) and analyzed using Computerized Language Analysis (MacWhinney, 2000), which automatically computes proposition density (PD) using rules developed for automatic PD measurement by the Computerized Propositional Idea Density Rater program (Brown, Snodgrass, & Covington, 2007; Covington, 2007).

RESULTS

Participants in the control group scored significantly higher than PWA on both tasks. PD scores were significantly different among the aphasia types for both tasks. Pairwise comparisons for both discourse tasks revealed that PD scores for the Broca's group were significantly lower than those for all groups except Transcortical Motor. No significant quadratic or linear association between PD and severity was found.

CONCLUSION

Proposition density is differentially sensitive to aphasia type and most clearly differentiates individuals with Broca's aphasia from the other groups.

Language impairments in traumatic brain injury: a window into complex cognitive performance

Often, standard aphasia batteries do not fully characterize higher-order cognitive-linguistic sequelae associated with a traumatic brain injury (TBI). Limited understanding and detection of complex linguistic deficits have thwarted efforts to comprehensively remediate higher-order language deficits that persist even in chronic stages of recovery post-TBI. This chapter reviews key precursor metrics that have motivated efforts to elucidate higher-order language proficiencies after a TBI. The chapter further expounds on a paradigmatic shift away from sole focus on lower level basic skills, towards a more top-down cognitive control approach to measure, retrain, and strengthen complex language abilities in TBI. The intricate relations between complex language abilities and cognitive control functions are also discussed. The concluding section offers promising directions for future research and clinical management based on new discoveries of higher-order language impairments and their modifiability in TBI populations.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information

OBJECTIVE

Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings.

PARTICIPANTS

Fifteen adults with and 15 adults without severe TBI.

DESIGN

Repeated-measures between-groups design.

MAIN MEASURES

Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions.

RESULTS

Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group.

CONCLUSIONS

Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.

Linguistic analysis of discourse in aphasia: A review of the literature

This review examined previous research applications of linguistic discourse analysis to assess the language of adults with aphasia. A comprehensive literature search of seven databases identified 165 studies that applied linguistic measures to samples of discourse collected from people with aphasia. Analysis of methodological applications revealed an increase in published research using linguistic discourse analysis over the past 40 years, particularly to measure the generalisation of therapy outcomes to language in use. Narrative language samples were most frequently subject to analysis though all language genres were observed across included studies. A total of 536 different linguistic measures were applied to examine language behaviours. Growth in the research use of linguistic discourse analysis and suggestions that this growth may be reflected in clinical practice requires further investigation. Future research directions are discussed to investigate clinical use of discourse analysis and examine the differences that exist between research and clinical practice.

Persuasive discourse impairments in traumatic brain injury

Background:

Considering the cognitive and linguistic complexity of discourse production, it is expected that individuals with traumatic brain injury (TBI) should face difficulties in this task. Therefore, clinical examination of discourse has become a useful tool for studying and assessment of communication skills of people suffering from TBI. Among different genres of discourse, persuasive discourse is considered as a more cognitively demanding task. However, little is known about persuasive discourse in individuals suffering from TBI.

Objectives:

The purpose of this study was to evaluate the performance of adults with TBI on a task of spoken persuasive discourse to determine the impaired linguistic measures.

Patients and Methods:

Thirteen TBI nonaphasic Persian speaking individuals, ranged between 19 to 40 years (Mean = 25.64 years; SD = 6.10) and 59 healthy adults matched by age, were asked to perform the persuasive discourse task. The task included asking the participants to express their opinion on a topic, and after the analysis of the produced discourse, the two groups were compared on the basis of their language productivity, sentential complexity, maze ratio and cohesion ratio.

Results:

The TBI group produced discourses with less productivity, sentential complexity, cohesion ratio and more maze ratio compared the control group.

Conclusions:

As it is important to consider acquired communication disorders particularly discourse impairment of brain injured patients along with their other clinical impairments and regarding the fact that persuasive discourse is crucial in academic and social situations, the persuasive discourse task presented in this study could be a useful tool for speech therapists, intending to evaluate communication disorders in patients with TBI.

Delayed Stimulus-Specific Improvements in Discourse Following Anomia Treatment Using an Intentional Gesture

Purpose: In this study, the authors assessed how the addition of intentional left-hand gestures to an intensive treatment for anomia affects 2 types of discourse: picture description and responses to open-ended questions.Method: Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over 3 weeks.Seven subjects also incorporated intentional left-hand gestures into each treatment trial.Results: Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in Western Aphasia Battery—Aphasia Quotient(WAB–AQ; Kertesz, 1982) scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the gesture group produced more words at each assessment, whereas the no gesture group produced fewer words at each assessment. These patterns led to improvements in picture descriptions and minimal declines in question responses in the gesture group. In contrast, the no gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pretreatment levels.Conclusion: The intensive treatment protocol is a successful method for improving picture naming even of untrained items.Further, the authors conclude that the intentional left-hand gesture contributed significantly to the generalization of treatment to discourse.

Verbal and visuospatial executive functions in healthy elderly: The impact of education and frequency of reading and writing

Objective

To assess the predictive role of education and frequency of reading and writing habits (FRWH) on the cognitive flexibility, inhibition and planning abilities of healthy elderly individuals.

Methods

Fifty-seven healthy adults aged between 60 and 75 years with 2 to 23 years of formal education were assessed as to the frequency with which they read and wrote different types of text, as well as their number of years of formal education. Executive functions were evaluated using the Hayling Test and the Modified Wisconsin Card Sorting Test (MWCST).

Results

Weak to moderate positive correlations were found between education, FRWH and the number of categories completed in the MWCST, while negative correlations were identified between these variables and the number of perseverative and non-perseverative errors on the task. Only the FRWH was significantly correlated with the number of failures to maintain set. Speed and accuracy on the Hayling Test were only correlated with participant education. Both education and FRWH significantly predicted performance on the MWCST, and the combination of these two variables had a greater predictive impact on performance on this task than either of the two variables alone. Variability in scores on the Hayling Test was best accounted for by participant education.

Conclusion

In this sample of elderly subjects, cognitive flexibility was sufficiently preserved to allow for adequate performance on verbal tasks, but may have benefitted from the additional stimulation provided by regular reading and writing habits and by formal education in the performance of more complex non-verbal tasks.

Impairment of script comprehension in Lewy body spectrum disorders

A disabling impairment of higher-order language function can be seen in patients with Lewy body spectrum disorders such as Parkinson's disease (PD), Parkinson's disease dementia (PDD), and dementia with Lewy bodies (DLB). We focus on script comprehension in patients with Lewy body spectrum disorders. While scripts unfold sequentially, constituent events are thought to contain an internal organization. Executive dysfunction in patients with Lewy body spectrum disorders may interfere with comprehension of this internal structure. We examined 42 patients (30 non-demented PD and 12 mildly demented PDD/DLB patients) and 12 healthy seniors. We presented 22 scripts (e.g., "going fishing"), each consisting of six events. Pilot data from young controls provided the basis for organizing associated events into clusters and arranging them hierarchically into scripts. We measured accuracy and latency to judge the order of adjacent events in the same cluster versus adjacent events in different clusters. PDD/DLB patients were less accurate in their ordering judgments than PD patients and controls. Healthy seniors and PD patients were significantly faster to judge correctly the order of highly associated within-cluster event pairs relative to less closely associated different-cluster event pairs, while PDD/DLB patients did not consistently distinguish between these event-pair types. This relative insensitivity to the clustered-hierarchical organization of events was related to executive impairment and to frontal atrophy as measured by volumetric MRI. These findings extend prior work on script processing to patients with Lewy body spectrum disorders and highlight the potential impact of frontal/executive dysfunction on the daily lives of affected patients.

The cognitive basis for sentence planning difficulties in discourse after traumatic brain injury

PURPOSE

Analyses of language production of individuals with traumatic brain injury (TBI) place increasing emphasis on microlinguistic (i.e., within-sentence) patterns. It is unknown whether the observed problems involve implementation of well-formed sentence frames or represent a fundamental linguistic disturbance in computing sentence structure. This study investigated the cognitive basis for microlinguistic deficits in individuals with TBI.

METHOD

Fifteen nonaphasic individuals with severe TBI and 6 age- and education-matched non brain-injured adults participated in this study. Monologic discourse samples were analyzed for pausing patterns, mazes, errors, and abandoned utterances. Measures of cognitive abilities were correlated with the sentence measures.

RESULTS

The speakers with TBI produced more pauses between clauses (but not within clauses) as well as more mazes than did the non brain-injured speakers. Significant regression models were built. Raven's Coloured Progressive Matrices (Raven, 1965), a measure associated with working memory, predicted pause behavior, and Likenesses-Differences (Baker & Leland, 1967), a measure of executive function, predicted maze behavior.

CONCLUSIONS

Sentence planning impairments following TBI are associated with deficient organization and monitoring of language representations in working memory. These findings suggest that the deficits are due to problems in the recruitment and control of attention for sentence planning. These findings bear on sentence processing models that emphasize the activation, organization, and maintenance of language representations for accurate sentence production.

In-person versus telehealth assessment of discourse ability in adults with traumatic brain injury

OBJECTIVES

To compare in-person versus telehealth (TH) assessment of discourse ability in adults with chronic traumatic brain injury (TBI).

DESIGN

Repeated-measures design with random order of conditions.

PARTICIPANTS

Twenty adults with moderate-to-severe TBI.

METHOD

Participants completed conversation, picture description, story-generation, and procedural description tasks. Sessions were video-recorded and transcribed.

MEASURES

Measures of productivity and quality of discourse.

RESULTS

Significant differences between conditions were not detected in this sample, and feedback from participants was positive.

CONCLUSIONS

These preliminary results support the use of TH for the assessment of discourse ability in adults with TBI, at least for individuals with sufficient cognitive skills to follow TH procedures.

Intact discourse cohesion and coherence following bilateral ventromedial prefrontal cortex

Discourse cohesion and coherence give communication its continuity providing the grammatical and lexical links that hold an utterance or text together and give it meaning. Researchers often link cohesion and coherence deficits to the frontal lobes by drawing attention to frontal lobe dysfunction in populations where discourse cohesion and coherence deficits are reported and through attribution of these deficits to underlying cognitive impairments putatively associated with the frontal lobes. We examined the distinct contribution of a region of the frontal lobes, the ventromedial prefrontal cortex (vmPFC), to discourse cohesion and coherence across a range of discourse tasks. We found that bilateral vmPFC damage does not impair cohesion and coherence in spoken discourse. This study provides insights into the contribution of the major anatomical subdivisions of the frontal lobes to language use and furthers our understanding of the neural and cognitive underpinnings of discourse cohesion and coherence.

Operative and nonoperative linguistic outcomes in brain injury patients

OBJECTIVE AND BACKGROUND

Linguistic function is one of vulnerable aspects of traumatic brain injury (TBI) which may have destructive effects on patients' communicative activities and daily life, years following trauma. This paper attempts to answer the controversy whether surgery affects increase and decrease of linguistic impairment or not.

MATERIALS AND METHODS

Two hundred forty-one TBI patients aged 18-65 with abnormal CT findings and at least 20 minute post-trauma amnesia (PTA), who were conscious at discharge, participated in this study. Based on operative intervention, the samples were divided into two groups: operative and nonoperative. Cognitive and aphasic deficits were inspected formally and pragmatic disorder was informally appraised at discharge.

RESULTS

The groups had no significant differences in aphasia incidence and language pragmatic impairment, though they were significantly distinctive in aphasia subcategories and cognitive deficit after trauma. Fluent aphasia was more common in both groups alike. In aphasia subcategories, however, transcortical sensory aphasia (TSA) in operative and anomia in nonoperative group were the most prevalent. Several variables appeared strikingly related to higher aphasia in operative groups as follows: moderate to severe injury, 18-35 and over 50 years of age, more than 1 week PTA, intracranial surgery of multiple lesions in left or bilateral hemisphere fronto-temporal cortex plus post-trauma cognitive and pragmatic impairments, and diffuse axonal injuries.

DISCUSSION

Almost certainly, meaningful drop of cognitive function post surgery roots back in significant loss of initial consciousness level. Related factors to postoperative aphasia suggest taking policies through surgery intervention. Discerning the indispensable contributions of neurosurgeons, neurolinguists, and neuroscientists, results inspire more clinical future studies.

Effects of social cognitive demand on Theory of Mind in conversations of adults with traumatic brain injury

BACKGROUND

A requisite skill for successful conversation is the ability to adjust one's language according to contextual factors.

AIMS

This study examined one aspect of language use in context-the use of mental-state terms, i.e. words that communicate thoughts, beliefs or feelings-in conversations between adult males with and without traumatic brain injury (TBI) and familiar partners.

METHODS & PROCEDURES

Participants were five males in the chronic stage of recovery following severe TBI and five male peers matched for age, conversing with friends. Conversational context was manipulated using conversation starters that were designed to induce differing levels of self-disclosure or intimacy, with the expectation that mental-state term use would increase when participants talked about more intimate topics.

OUTCOMES & RESULTS

Participants in both groups used more mental-state terms in more intimate conversations; however, adults with TBI did not increase their mental-state term use to the same extent as matched peers. Adults with TBI also used a significantly different pattern of mental-state term types across intimacy levels as compared with peers.

CONCLUSIONS & IMPLICATIONS

These quantitative and qualitative differences may contribute to social conversation problems of adults with TBI.

Effective factors on linguistic disorder during acute phase following traumatic brain injury in adults

Traumatic brain injury (TBI) has been known to be the leading cause of breakdown and long-term disability in people under 45 years of age. This study highlights the effective factors on post-traumatic (PT) linguistic disorder and relations between linguistic and cognitive function after trauma in adults with acute TBI. A cross-sectional design was employed to study 60 post-TBI hospitalized adults aged 18-65 years. Post-traumatic (PT) linguistic disorder and cognitive deficit after TBI were respectively diagnosed using the Persian Aphasia Test (PAT) and Persian version of Mini-Mental State Examination (MMSE) at discharge. Primary post-resuscitation consciousness level was determined using the Glasgow Coma Scale (GCS). Paracilinical data was obtained by CT scan technique. Multiple logistic regression analysis illustrated that brain injury severity was the first powerful significant predictor of PT linguistic disorder after TBI and frontotemporal lesion was the second. It was also revealed that cognitive function score was significantly correlated with score of each language skill except repetition. Subsequences of TBI are more commonly language dysfunctions that demand cognitive flexibility. Moderate, severe and fronto-temporal lesion can increase the risk of processing deficit in linguistic macrostructure production and comprehension. The dissociation risk of cortical and subcortical pathways related to cognitive-linguistic processing due to intracranial lesions can augment possibility of lexical-semantic processing deficit in acute phase which probably contributes to later cognitive-communication disorder.

The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders

OBJECTIVE

Patients with Lewy body spectrum disorders (LBSD) such as Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies exhibit deficits in both narrative comprehension and narrative expression. The present research examines the hypothesis that these impairments are due to a material-neutral deficit in organizational executive resources rather than to impairments of language per se. We predicted that comprehension and expression of narrative would be similarly affected and that deficits in both expression and comprehension of narrative would be related to the same anatomic distribution of prefrontal disease.

METHOD

We examined 29 LBSD patients and 26 healthy seniors on their comprehension and expression of narrative discourse. For comprehension, we measured accuracy and latency in judging events with high and low associativity from familiar scripts such as "going fishing." The expression task involved maintaining the connectedness of events while narrating a story from a wordless picture book.

RESULTS

LBSD patients were impaired on measures of narrative organization during both comprehension and expression relative to healthy seniors. Measures of organization during narrative expression and comprehension were significantly correlated with each other. These measures both correlated with executive measures but not with neuropsychological measures of lexical semantics or grammar. Voxel-based morphometry revealed overlapping regressions relating frontal atrophy to narrative comprehension, narrative expression, and measures of executive control.

CONCLUSIONS

Difficulty with narrative discourse in LBSD stems in part from a deficit of organization common to comprehension and expression. This deficit is related to prefrontal cortical atrophy in LBSD.

A study of patients' perceptions of diabetes care delivery and diabetes: propositional analysis in people with type 1 and 2 diabetes managed by group or usual care

OBJECTIVE

We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care.

RESEARCH DESIGN AND METHODS

Three open questions were administered to 120 patients (43 with T1DM and 77 with T2DM) who had been randomized at least 2 years before to be followed by group care and 121 (41 T1DM and 80 T2DM) who had always been on usual care. The responses were analyzed by propositional analysis, by identifying the focal nuclei, i.e., the terms around which all sentences are organized, and then other predicates, according to their hierarchical relationship to the nuclear proposition. Specific communicative units were arbitrarily classified into three categories: attitudes, empowerment, and locus of control.

RESULTS

Patients on group care showed more positive attitudes, higher sense of empowerment, and more internal locus of control than those on usual care. In addition, they expressed a wider and more articulated range of concepts associated with the care received and made less use of medical terminology (P < 0.001, all). Higher HbA(1c) was associated with negative attitudes (P = 0.025) and negative empowerment (P = 0.055).

CONCLUSIONS

Group treatment reinforces communication and peer identification and may achieve its clinical results by promoting awareness, self-efficacy, positive attitudes toward diabetes and the setting of care, an internal locus of control, and, ultimately, empowerment in the patients.

Productive vocabulary across discourse types

AIMS: The goals of the study were (a) to examine the effect of discourse type on lexical diversity by testing whether there are significant differences among language samples elicited using four discourse tasks (procedures, eventcasts, story telling, and recounts); and (b) to assess the extent to which age influences lexical diversity when different types of discourse are elicited. METHODS #ENTITYSTARTX00026; PROCEDURES: A total of 86 cognitively healthy adults participated in the study and comprised two groups - young adults (20-29 years old) and older adults (70-89 years old). Participants completed the discourse tasks and their language samples were analysed using dedicated software (voc-D) to obtain estimates of their lexical diversity. OUTCOMES #ENTITYSTARTX00026; RESULTS: A mixed 2 × 4 ANOVA was conducted and followed by an investigation of simple main effects. A lexical diversity hierarchy was established that was similar for both age groups. The study also uncovered age-related differences that were evident when the stimuli were verbally presented but were eliminated when the language samples were elicited using pictorial stimuli. CONCLUSIONS: Results indicated that lexical diversity is one of the microlinguistic indices that are influenced by discourse type and age, a finding that carries important methodological implications. Future investigations are warranted to explore the patterns of lexical diversity in individuals with neurogenic language disorders and assess the clinical utility of measures of lexical diversity.

Lexical diversity for adults with and without aphasia across discourse elicitation tasks

BACKGROUND: Differences in lexical diversity (LD) across different discourse elicitation tasks have been found in neurologically intact adults (NIA) (Fergadiotis, Wright, & Capilouto, 2010) but have not been investigated systematically in people with aphasia (PWA). Measuring lexical diversity in PWA may serve as a useful clinical tool for evaluating the impact of word retrieval difficulties at the discourse level. AIMS: The study aims were (a) to explore the differences between the oral language samples of PWA and NIA in terms of LD as measured by dedicated computer software (voc-D), (b) to determine whether PWA are sensitive to discourse elicitation task in terms of LD, and (c) to identify whether differences between PWA and NIA vary in magnitude as a function of discourse task. METHOD #ENTITYSTARTX00026; PROCEDURES: Oral language samples from 25 PWA and 27 NIA were analysed. Participants completed three commonly used discourse elicitation tasks (single pictures, sequential pictures, story telling) and voc-D was used to obtain estimates of their LD. OUTCOMES #ENTITYSTARTX00026; RESULTS: A mixed 2 × 3 ANOVA revealed a significant group task interaction that was followed by an investigation of simple main effects and tetrad×comparisons. Different patterns of LD were uncovered for each group. For the NIA group results were consistent with previous findings in the literature according to which LD varies as a function of elicitation technique. However, for PWA sequential pictures and story telling elicited comparable estimates of LD. CONCLUSIONS: Results indicated that LD is one of the microlinguistic indices that are influenced by elicitation task and the presence of aphasia. These findings have important implications for modelling lexical diversity and selecting and interpreting results from different discourse elicitation tasks.

Discovering a new identity after brain injury

Acquired brain injury (ABI) is one example of the chronic conditions that people of varying socioeconomic status must bear. Concerns with identity and self are endemic to surviving brain injury. For this study, a brain tumour survivor injured 17 years earlier, took photographs of her life with brain injury and discussed them with other brain injury survivors and the author. Narrative analysis methods were used to analyse her photographs and interview, and generate a visual illness narrative with four photographs and their accompanying interview text. Her visual illness narrative reveals discovery of a post-brain injury identity whose multiplicity of self-definitions includes chef, brain injury survivor, gardener, and self-advocate. Study findings reveal that identity issues of importance to brain injury survivors can include (1) learning the new, post-brain injury self, and (2) building a new identity whose multiple, partial identities include (a) the new brain injured self, (b) an old self (with its residual strengths), and (c) a self who does meaningful activities (e.g. parenting, partnering, art, gardening, volunteering, helping others, or paid work). Study results suggest that using visual research methods can help to put biographical disruption such as brain injury into perspective as a life lived.