Understanding Cognitive Communication Needs in Pediatric Traumatic Brain Injury: Issues Identified at the 2020 International Cognitive-Communication Disorders Conference

Purpose In early 2020, the second International Cognitive-Communication Disorders Conference was held to provide an opportunity for researchers and clinician-scientists to discuss the most recent advances and pressing issues in the care of individuals with cognitive-communication disorders (CCDs). Presentations and discussions resulted in the identification of four areas in need of attention: (a) terminology, (b) training, (c) interdisciplinary teams, and (d) pediatrics. We will explore the four themes identified at ICCDC, specifically expanding on how terminology, training, and teams intersect in pediatric traumatic brain injury care. Additionally, we will provide two case studies to highlight the integration of these themes and suggest ways to advance clinical service provision across medical and educational settings for persons with CCDs through the lens of pediatrics. Conclusion While speech-language pathology has come a long way since the original discussion of CCD over 30 years ago, clinicians and researchers have ongoing opportunities to help advance the ways in which speech-language pathologists offer support to persons, specifically children, with CCDs and to continue to advance the profession.

Detection of text-based social cues in adults with traumatic brain injury

OBJECTIVES

Written text contains verbal immediacy cues-word form or grammatical cues that indicate positive attitude or liking towards an object, action, or person. We asked if adults with moderate-severe traumatic brain injury (TBI) would respond to these cues, given evidence of TBI-related social communication impairments.

METHODS

Sixty-nine adults with TBI and 74 healthy comparison (HC) peers read pairs of sentences containing different types of immediacy cues (e.g., speaker A said "these Canadians" vs. B said "those Canadians.") and identified which speaker (A or B) had a more positive attitude towards the underlined entity (Task 1); and pairs of sentences comprised of a context sentence (e.g., Fred is asked, "Did you visit Joan and Sue?") and a statement sentence (Fred says, "I visited Sue and Joan.") and were asked to indicate how much Fred liked or disliked the underlined words (Task 2).

RESULTS

HC group scores were significantly higher on Task 1, indicating more sensitivity to cues. On Task 2, TBI and HC group ratings differed across cue types and immediacy types, and the TBI group appeared to have less sensitivity to these cues.

CONCLUSIONS

Findings suggest that TBI-related impairments may reduce sensitivity to subtle social cues in text.

Impaired theory of mind in adults with traumatic brain injury: A replication and extension of findings

OBJECTIVE

To replicate a previous study of Theory of Mind (ToM) task performance in adults with traumatic brain injury (TBI) under different working memory (WM) demands, and determine if there are sex-based differences in effects of WM load on ToM task performance.

METHOD

58 adults with moderate-severe TBI (24 females) and 66 uninjured adults (34 females) matched group-wise for age, sex, and education viewed a series of video vignettes from the Video Social Inference Task (VSIT) (Turkstra, 2008) and answered ToM questions. Vignette presentation format required updating and maintenance of information, and WM load was manipulated by varying presence of distracters.

RESULTS

There were main effects of group and WM load, no significant effect of sex, and a marginal interaction of group by WM load, with larger between-group differences in conditions with higher WM load. VSIT scores for the condition with the highest WM load were significantly correlated with scores on the first trial of the California Verbal Learning Test.

CONCLUSIONS

We replicated findings of lower scores in adults with TBI on a video-based ToM task, and provided additional evidence of the effect of WM load on social cognition task performance. There were no significant accuracy differences between men and women, inconsistent with prior evidence - including our own data using the same test. There is strong evidence of a female advantage on other social cognition tasks, and the parameters of this advantage remain to be discovered.

Cognitive-communication disorders in children with traumatic brain injury

Children with moderate to severe traumatic brain injury (TBI) are at risk of developing cognitive-communication disorders that have devastating effects on their school life, family life, and social life. These problems can be difficult for families to describe and may be overlooked by community-based providers who are unfamiliar with TBI sequelae. To support the identification and management of cognitive-communication disorders, we review the common signs and symptoms of these disorders in children with TBI and discuss principles of assessment and intervention.

Spoken Persuasive Discourse Abilities of Adolescents With Acquired Brain Injury

Purpose

The aim of this study was to examine the performance of adolescents with acquired brain injury (ABI) during a spoken persuasive discourse task. Persuasive discourse is frequently used in social and academic settings and is of importance in the study of adolescent language.

Method

Participants included 8 adolescents with ABI and 8 peers without ABI who were matched for age, gender, and education. A spoken persuasive discourse task requiring participants to express their opinion on a topic was administered, and the 2 groups were compared on measures of language productivity, syntactic complexity, and language content. In addition, the relationship between working memory and discourse production was explored.

Results

There were no statistically significant group differences on measures of language productivity or syntactic complexity, with the exception of the use of mazes, which was more prevalent in the discourse of the group with ABI. However, there were significant differences in language content, with age-matched peers producing more than twice as many supporting reasons and far fewer tangentially related utterances than the adolescents with ABI.

Conclusions

Persuasive discourse production was affected following ABI. Given the importance of persuasive discourse in social and academic situations, further investigations into factors that influence discourse production in adolescents with ABI are warranted.

Inference comprehension of adolescents with traumatic brain injury: A working memory hypothesis

This study investigated inference comprehension performance in adolescents who had suffered a traumatic brain injury (TBI). Using stimuli adapted from Lehman-Blake and Tompkins, participants listened to short paragraphs that varied according to the working memory demands of the task and answered comprehension questions that required inferences to be generated. Six adolescents, aged 12-16 years, who had suffered a TBI prior to the age of 10 years, were assessed and their performance was compared to six individually age-matched peers with typical development. Analysis revealed that individuals with TBI did not differ from non-injured peers in their understanding of inferences when the storage demands of the task were minimized. However, when storage demands were high, adolescents with TBI performed poorly compared to their age-matched peers. Results are discussed relative to a working-memory hypothesis of impairment following TBI.

Memory assessment on an interdisciplinary rehabilitation team: a theoretically based framework

PURPOSE

To describe a cognitive neuroscience model of memory that can be used to guide assessment and promote consistent terminology among members of the rehabilitation team, and to relate the model to frequently used assessment measures.

METHOD

Description of a model of memory, description of how frequently used memory measures relate to the model, and presentation of case studies to exemplify the application of the model to the clinical assessment of memory.

CONCLUSIONS

Use of a theoretical framework is important for choosing assessment instruments, interpreting the results of test performance, and communicating with patients, their family members, and other members of the interdisciplinary team. Understanding where in the memory process a breakdown occurs can guide treatment recommendations and feedback to patients and family members.

The revision decision: is change always good? A comparison of CELF-R and CELF-3 test scores in children with language impairment, focal brain damage, and typical development

PURPOSE

The Clinical Evaluation of Language Fundamentals (CELF) is a widely used, comprehensive test battery that assesses language in school-age children and adolescents. The CELF-R (E. Semel, E. H. Wiig, & W. Secord, 1987) was updated to the CELF-3 (E. Semel, E. H. Wiig, & W. A. Secord, 1995) in 1995. The goal of the present study was to compare scores and evaluate the diagnostic utility of the CELF-R and CELF-3 in 2 clinical populations and a typically developing control group.

METHOD

The present study compared CELF-R and CELF-3 test scores of 107 children with language impairment (LI), 54 children with early focal brain damage (FL), and 90 controls.

RESULTS

All 3 groups demonstrated significantly better performance on the CELF-3 than on the CELF-R. LI children scored in the moderately-to-severely impaired range on the CELF-R, but in the mildly-to-moderately impaired range on the CELF-3. FL children went from being mildly-to-moderately impaired on the CELF-R to within normal limits on the CELF-3. Controls went from the average range on the CELF-R to the high average range on the CELF-3.

CONCLUSION

This study is important for professionals who administer language tests and/or use language testing results to recommend appropriate school placements, additional services, and/or interventions. Although psychometric tests are frequently revised, it is not always the case that a revised version has improved diagnostic utility.