Speech-language pathologists’ perspectives on cognitive communication assessment during post-traumatic amnesia

Patient-Centered Approaches to Cognitive Assessment in Acute TBI

PURPOSE OF THE REVIEW

The purpose of this article is to help clinicians understand how underlying pathophysiologies and medical comorbidities associated with acute traumatic brain injury (TBI) can impact assessment of cognition during the initial stages of recovery. Clinicians can use information from this article to develop assessment plans rooted in patient-centered care.

RECENT FINDINGS

The authors conducted a review of the literature related to the assessment of cognition in acute TBI, focusing on pathophysiology, medical comorbidities, and assessment approaches. Results indicated that TBI pathophysiologies associated with white and gray matter changes make many patients vulnerable to cognitive deficits. Acute comorbidities such as psychological and pain status influence cognitive abilities as well. The current approaches to cognitive assessment can be limited in many ways, though by using the patient's neuropathological profile, noted comorbidities, and other patient specific factors, clinicians can potentially improve the effectiveness of assessment.

A Scoping Review of Cognitive Assessment in Adults With Acute Traumatic Brain Injury

PURPOSE

The purpose of this study was to describe and synthesize the current research regarding the prevailing cognitive domains impacted by acute traumatic brain injury (TBI) in adults. Standardized and nonstandardized assessments of cognitive function and comorbidities influencing cognitive function during the initial stages of recovery are presented to help guide clinical assessment.

METHOD

A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, was used to explore four electronic databases. Searches identified peer-reviewed empirical literature addressing aspects of cognitive domains impacted after TBI, cognitive assessment, and comorbidities impacting assessment in adults after acute TBI.

RESULTS

A total of 1,072 records were identified and reduced to 75 studies based on inclusion criteria. The cognitive domains most impacted in acute TBI were memory and executive function. The Glasgow Coma Scale (GCS) was the most frequently used tool to assess cognitive abilities, despite it being a measurement of consciousness, not of cognition. Psychological changes were the most commonly noted comorbidity impacting cognitive assessment.

CONCLUSIONS

Assessment of cognition after acute TBI requires a multifaceted approach that considers the typical profile of cognitive impairment, as well as patient-specific factors influencing cognitive abilities following initial brain injury. The present results support the generally held view that memory and executive function deficits are common cognitive difficulties associated with acute TBI in adults. The GCS remains the most widely used tool to assess function, though numerous tools are available that specifically address cognitive domains. Acute medical comorbidities common within this stage of injury are highlighted, as well as gaps of clinical knowledge that remain.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.18372086.

Expression of propositional attitudes in conversation by adults with traumatic brain injury: A relevance theoretic approach

BACKGROUND

Impairments in social communication are ubiquitous after moderate to severe traumatic brain injury (TBI). Most attempts to quantify these impairments have been descriptive rather than theoretically motivated. We propose that Relevance Theory provides a framework for characterizing social communication limitations after TBI and linking these problems to underlying cognitive impairments.

AIMS

This study asked how adult speakers with and without TBI used specific linguistic forms in social communication. We selected three linguistic markers that convey thoughts and feelings of the speaker and which are intended to influence the same in the listener: propositional attitude verbs, the discourse marker like and the quotative like.

METHODS & PROCEDURES

Ten adults with moderate to severe TBI and 12 healthy adults completed 5-min casual conversations with student researcher partners as part of a larger research study. Conversations were transcribed and analysed for the frequency of the three linguistic markers, corrected for total words in the transcript.

OUTCOMES & RESULTS

Participants in the TBI group used discourse marker like significantly less than participants in the healthy comparison group (0.75% and 2.06% of total words, respectively; p = 0.05, d = -0.43) and showed less variety in functions of like. The use of propositional attitude verbs and quotative like was not affected by TBI.

CONCLUSIONS & IMPLICATIONS

Expression of propositional attitude seems largely preserved after TBI. Relevance Theory may provide a helpful framework (1) to interpret subtle quantitative and qualitative differences that contribute to social conversation problems of adults with TBI; and (2) to elucidate relations among the social communication signs and symptoms and underlying cognitive impairments. What this paper adds What are the potential or actual clinical implications of this work? More awareness and understanding of how social cognition may look in everyday conversations, may help SLPs who treat patients with such difficulties as a result of 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.