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Greenslade KJ, Honan C, Harrington L, Kenealy L, Ramage AE, Bogart E. Wishes, beliefs, and jealousy: use of mental state terms in Cinderella retells after traumatic brain injury. Front Hum Neurosci 2024; 18:1386227. [PMID: 38807634 PMCID: PMC11130410 DOI: 10.3389/fnhum.2024.1386227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Traumatic brain injury (TBI) negatively impacts social communication in part due to social cognitive difficulties, which may include reduced mental state term (MST) use in some discourse genres. As social cognitive difficulties can negatively impact relationships, employment, and meaningful everyday activities, assessing and treating these difficulties post-TBI is crucial. To address knowledge gaps, the present study examined MST use in the narrative retells of adults with and without severe TBI to compare between-group performance, evaluate changes over the first two years post-TBI, and investigate the impact of participant and injury-related variables. Methods The total number of MSTs, ratio of MSTs to total utterances, and diversity of MSTs were identified in the Cinderella narratives of 57 participants with no brain injury and 57 with TBI at 3, 6, 9, 12, and 24-months post-TBI. Results Reduced MST use in participants with TBI was found at 3, 6, 9, and 12-months post-TBI, but these reductions disappeared when story length (total utterances) was accounted for. Further, MST diversity did not differ between groups. Similarly, although the total number of MSTs increased over time post-TBI, no changes were observed in the ratio of MSTs to total utterances or MST diversity over time. Injury severity (post-traumatic amnesia duration), years of education, and verbal reasoning abilities were all related to MST use. Discussion Overall, although individuals used fewer MSTs in complex story retells across the first year following severe TBI, this reduction reflected impoverished story content, rather than the use of a lower ratio of MSTs. Further, key prognostic factors related to MST use included injury severity, educational attainment, and verbal reasoning ability. These findings have important implications for social communication assessment and treatment targeting social cognition post-TBI.
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Affiliation(s)
- Kathryn J. Greenslade
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Cynthia Honan
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Lauren Harrington
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Laura Kenealy
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Amy E. Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
- Interdisciplinary Program in Neuroscience and Behavior, University of New Hampshire, Durham, NH, United States
| | - Elise Bogart
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Tomlin L, Smidt A, Bogart E. Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38558515 DOI: 10.1111/1460-6984.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. AIMS The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. METHODS AND PROCEDURES A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. OUTCOMES AND RESULTS The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. CONCLUSIONS AND IMPLICATIONS The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. WHAT THIS PAPER ADDS What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.
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Affiliation(s)
| | - Andy Smidt
- The University of Sydney, Sydney, Australia
- Southern Cross University, Lismore, Australia
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Muehlschlegel S, Rajajee V, Wartenberg KE, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Hwang DY, Kim KS, Madzar D, Mahanes D, Mainali S, Meixensberger J, Sakowitz OW, Varelas PN, Weimar C, Westermaier T. Guidelines for Neuroprognostication in Critically Ill Adults with Moderate-Severe Traumatic Brain Injury. Neurocrit Care 2024; 40:448-476. [PMID: 38366277 PMCID: PMC10959796 DOI: 10.1007/s12028-023-01902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Moderate-severe traumatic brain injury (msTBI) carries high morbidity and mortality worldwide. Accurate neuroprognostication is essential in guiding clinical decisions, including patient triage and transition to comfort measures. Here we provide recommendations regarding the reliability of major clinical predictors and prediction models commonly used in msTBI neuroprognostication, guiding clinicians in counseling surrogate decision-makers. METHODS Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we conducted a systematic narrative review of the most clinically relevant predictors and prediction models cited in the literature. The review involved framing specific population/intervention/comparator/outcome/timing/setting (PICOTS) questions and employing stringent full-text screening criteria to examine the literature, focusing on four GRADE criteria: quality of evidence, desirability of outcomes, values and preferences, and resource use. Moreover, good practice recommendations addressing the key principles of neuroprognostication were drafted. RESULTS After screening 8125 articles, 41 met our eligibility criteria. Ten clinical variables and nine grading scales were selected. Many articles varied in defining "poor" functional outcomes. For consistency, we treated "poor" as "unfavorable". Although many clinical variables are associated with poor outcome in msTBI, only the presence of bilateral pupillary nonreactivity on admission, conditional on accurate assessment without confounding from medications or injuries, was deemed moderately reliable for counseling surrogates regarding 6-month functional outcomes or in-hospital mortality. In terms of prediction models, the Corticosteroid Randomization After Significant Head Injury (CRASH)-basic, CRASH-CT (CRASH-basic extended by computed tomography features), International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT)-core, IMPACT-extended, and IMPACT-lab models were recommended as moderately reliable in predicting 14-day to 6-month mortality and functional outcomes at 6 months and beyond. When using "moderately reliable" predictors or prediction models, the clinician must acknowledge "substantial" uncertainty in the prognosis. CONCLUSIONS These guidelines provide recommendations to clinicians on the formal reliability of individual predictors and prediction models of poor outcome when counseling surrogates of patients with msTBI and suggest broad principles of neuroprognostication.
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Affiliation(s)
- Susanne Muehlschlegel
- Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Saint Luke's Health System, Kansas City, MO, USA
| | - David Y Hwang
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dea Mahanes
- Departments of Neurology and Neurosurgery, University of Virginia Health, Charlottesville, VA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany
| | | | - Christian Weimar
- Institute of Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper Klinikum Dachau, Dachau, Germany.
- Faculty of Medicine, University of Würzburg, Würzburg, Germany.
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Greenslade KJ, Bogart E, Gyory J, Jaskolka S, Ramage AE. Story Grammar Analyses Capture Discourse Improvement in the First 2 Years Following a Severe Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1004-1020. [PMID: 38354104 PMCID: PMC11001193 DOI: 10.1044/2023_ajslp-23-00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/03/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE Narration within a story grammar framework requires speakers to organize characters and events logically. Despite abundant research characterizing narrative deficits following a traumatic brain injury (TBI), the evolution of narrative story grammar over the first 2 years post-TBI has rarely been explored. This study analyzed story grammar in complex narratives of adults with and without severe TBI to (a) examine between-group differences and (b) investigate longitudinal changes over the first 2 years post-TBI. METHOD Story grammar analyses of Cinderella narratives from 57 participants with TBI and 57 participants with no brain injury yielded measures of productivity (total number of episodes, total number of story grammar elements), elaboration (total number of elaborated-complete episodes, mean number of episodic elements per episode), and completeness (total number of incomplete episodes). Mann-Whitney U tests compared measures across groups; generalized estimating equation (GEE) models identified predictors of change, including recovery time (3, 6, 9, 12, and 24 months post-TBI) and demographic/injury-related characteristics. RESULTS Between-group differences were statistically significant for all productivity and elaboration measures at 3, 6, and 9 months post-TBI; one productivity measure and one elaboration measure at 12 months; and none of the measures at 24 months. GEE models showed significant improvements in all productivity and elaboration measures over the first 24 months post-TBI, with educational attainment and duration of posttraumatic amnesia affecting recovery. Incomplete episodes only showed between-group differences at 12 months and did not capture recovery. CONCLUSION Productivity and elaboration are key story grammar variables that (a) differentiate complex narration in individuals with and without severe TBI and (b) capture narrative improvements over the first 2 years post-TBI. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25148999.
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Affiliation(s)
- Kathryn J. Greenslade
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
| | - Elise Bogart
- Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, New South Wales, Australia
| | - Joanna Gyory
- Health Management and Policy, University of New Hampshire, Durham
| | - Serena Jaskolka
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
| | - Amy E. Ramage
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham
- Interdisciplinary Program in Neuroscience and Behavior, University of New Hampshire, Durham
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Steel J, Coluccio I, Elbourn E, Spencer E. How do speech-language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:591-607. [PMID: 36117377 DOI: 10.1111/1460-6984.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI. AIMS To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations. METHODS & PROCEDURES This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision-making. Participants were recruited through national and international SLP professional bodies, TBI-specific or SLP special-interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses. OUTCOMES & RESULTS There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self-monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings. CONCLUSIONS & IMPLICATIONS Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal-based approach. Factors affecting the use of discourse in practice included client-specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision-making for SLPs working in TBI. WHAT THIS PAPER ADDS What is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal-based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI-specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice.
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Affiliation(s)
- Joanne Steel
- The University of Newcastle, Newcastle, NSW, Australia
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Cruse N, Piotto V, Coelho C, Behn N. Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:519-531. [PMID: 36377239 DOI: 10.1111/1460-6984.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Nicole Cruse
- University of Connecticut, Storrs, CT, USA
- Sacred Heart University, Fairfield, CT, USA
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Hoffman R, Spencer E, Steel J. A qualitative exploration of speech-language pathologists' approaches in treating spoken discourse post-traumatic brain injury. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:608-622. [PMID: 36918757 DOI: 10.1111/1460-6984.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. AIMS To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. METHODS & PROCEDURES Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. OUTCOMES & RESULTS Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment. CONCLUSIONS & IMPLICATIONS This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice. WHAT THIS PAPER ADDS What is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post-TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision-making for discourse interventions post-TBI are limited. What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post-TBI. It details the factors that influence clinical decision-making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context-sensitive discourse intervention post-TBI. It indicates the need for an in-depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience.
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Affiliation(s)
| | | | - Joanne Steel
- University of Newcastle, Callaghan, NSW, Australia
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Elbourn E, Brassel S, Steel J, Togher L. Perceptions of communication recovery following traumatic brain injury: A qualitative investigation across 2 years. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:463-482. [PMID: 36239151 DOI: 10.1111/1460-6984.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exploring the perceptions of individuals with traumatic brain injury (TBI) towards their brain injury recovery across the continuum of care may offer insights to support engagement with rehabilitation services. Illness narratives are a potentially valuable avenue for examining perceptions of recovery that may influence engagement. AIMS The aim of this study is to explore the perspective of individuals with severe TBI towards their communication, brain injury and recovery experiences at 6 months, 1 year and 2 years post-injury. METHODS & PROCEDURES Discourse samples were obtained from 12 participants with severe TBI at 6 months, 1 year and 2 years following injury. A standardised protocol was used to elicit responses relating to perceptions of communication, the brain injury narrative, and perceptions of recovery facilitators. A thematic analysis of the discourse samples was completed. OUTCOMES & RESULTS Three overarching themes were identified: experiences of communication recovery are diverse (Theme 1), varied experiences of recovery and rehabilitation (Theme 2), and continuous and lifelong journey of recovery (Theme 3). Primary communication concerns included presence of anomia, dysarthria, conversational topic difficulties, impacts of fatigue and memory difficulties. Illness narratives revealed the importance of re-establishing a sense of self and the perceived importance of a strong social network post-injury. CONCLUSIONS & IMPLICATIONS The varied nature of communication challenges and recovery after TBI highlights the need for holistic, multidisciplinary support as well as inclusion of family and friends in the recovery process. Social communication intervention is a perceived priority area for individuals with TBI. Illness narratives may also play a valuable role in therapy and help to shape post-injury identity. Managing the impacts of fatigue on communication and encouraging individuals to take ownership over their recovery and treatment may also help to improve patient outcomes. Supporting individuals to construct positive brain injury narratives that reaffirm a sense of self and include perspectives of family and friends may offer a potential future avenue for rehabilitation. Tailored but flexible, team-based service delivery models for individuals with TBI that span from acute to long-term care are warranted. WHAT THIS STUDY ADDS?: What is already known on this subject Communication recovery from traumatic brain injury (TBI) is complex and multifaceted. The perceptions of individuals with TBI toward their communication recovery is largely unknown. To establish rehabilitation services that meet the needs of these individuals, we need to understand how they experience communication recovery. What this paper adds to existing knowledge Social communication interventions were perceived as a priority for intervention by individuals with TBI. Fatigue was identified as perceived barrier to communication recovery. Taking ownership over one's recovery process was revealed as a facilitator of recovery. Illness narratives were found to strengthen post-injury identity over time. What are the potential or actual clinical implications of this work? Speech pathologists should prioritise social communication interventions and fatigue management for communication. Facilitating ownership of the recovery process and offering long-term supports are key aspects of treatment. Supporting positive illness narratives as part of treatment may facilitate post-injury identity construction.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, New South Wales, Australia
| | - Sophie Brassel
- The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Steel
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, New South Wales, Australia
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VanSolkema M, McCann CM, Barker-Collo S, Foster A. The treatment journey of attention-related communication difficulties following traumatic brain injury: Perspectives of international health professionals. Neuropsychol Rehabil 2023; 33:1728-1756. [PMID: 36413175 DOI: 10.1080/09602011.2022.2147552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022]
Abstract
Traumatic brain injuries (TBI) can result in long-lasting changes in cognition, communication, behavior, and physical abilities that require specialized rehabilitation by health professionals. Communication difficulties following TBI are driven by difficulties in all aspects of cognition and linguistic skills. This study focuses specifically on attention-related communication difficulties and how international health professionals are treating this frequently occurring difficulty following TBI. One hundred and sixty-four international health professionals (e.g., speech language therapists, occupational therapists, neuropsychologists, clinical psychologists, and medical doctors) from seven countries completed an online survey. A small portion from New Zealand then participated in a focus group reviewing the topic of attention-related communication difficulties following TBI. This mixed-methods study used reflexive thematic analysis to analyse the qualitative data from both survey and focus groups alongside quantitative survey results. Fourmain themes were identified that relate to how attention-related communication difficulties should be treated and a roadmap for this important area following TBI was outlined. The four themes include: (1) signposts for attention and communication recovery; (2) change agents of attention and communication; (3) core therapy components; and (4) collaborative teams allow for better and more efficient treatment related to the client's goals. Clinical implications are discussed.
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Affiliation(s)
- Maegan VanSolkema
- School of Psychology (Speech Science), University of Auckland, Auckland, New Zealand
- ABI Rehabilitation New Zealand Ltd., Auckland, New Zealand
| | - Clare M McCann
- School of Psychology (Speech Science), University of Auckland, Auckland, New Zealand
| | | | - Allison Foster
- Foster Medical Communications Ltd., Auckland, New Zealand
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Togher L, Elbourn E, Kenny B, Honan C, Power E, Tate R, McDonald S, MacWhinney B. Communication and Psychosocial Outcomes 2-Years After Severe Traumatic Brain Injury: Development of a Prognostic Model. Arch Phys Med Rehabil 2023; 104:1840-1849. [PMID: 37146957 DOI: 10.1016/j.apmr.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/19/2023] [Accepted: 04/09/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To examine predictive factors underlying communication and psychosocial outcomes at 2 years post-injury. Prognosis of communication and psychosocial outcomes after severe traumatic brain injury (TBI) is largely unknown yet is relevant for clinical service provision, resource allocation, and managing patient and family expectations for recovery. DESIGN A prospective longitudinal inception design was employed with assessments at 3 months, 6 months, and 2 years. PARTICIPANTS The cohort included 57 participants with severe TBI (N=57). SETTING Subacute and post-acute rehabilitation. MAIN OUTCOME MEASURES Preinjury/injury measures included age, sex, education years, Glasgow Coma Scale, and PTA. The 3-month and 6-month data points included speech, language, and communication measures across the ICF domains and measures of cognition. The 2-year outcome measures included conversation, perceived communication skills, and psychosocial functioning. Predictors were examined using multiple regression. INTERVENTIONS Not applicable. RESULTS The cognitive and communication measures at 6 months significantly predicted conversation measures at 2 years and psychosocial functioning as reported by others at 2 years. At 6 months, 69% of participants presented with a cognitive-communication disorder (Functional Assessment of Verbal Reasoning and Executive Strategies [FAVRES]). The unique variance accounted for by the FAVRES measure was 7% for conversation measures and 9% for psychosocial functioning. Psychosocial functioning at 2 years was also predicted by pre-injury/injury factors and 3-month communication measures. Pre-injury education level was a unique predictor, accounting for 17% of the variance, and processing speed/memory at 3 months uniquely accounted for 14% of the variance. CONCLUSION Cognitive-communication skills at 6 months are a potent predictor of persisting communication challenges and poor psychosocial outcomes up to 2 years after a severe TBI. Findings emphasize the importance of addressing modifiable cognitive and communication outcomes variables during the first 2 years after severe TBI to maximize functional patient outcomes.
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Affiliation(s)
- Leanne Togher
- Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia
| | - Elise Elbourn
- Faculty of Medicine & Health, Susan Wakil Health Building, The University of Sydney, Sydney, Australia.
| | | | - Cynthia Honan
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Emma Power
- The University of Technology, Sydney, Australia
| | - Robyn Tate
- Faculty of Medicine & Health, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA
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11
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Summaka M, Elias E, Zein H, Naim I, Daoud R, Fares Y, Nasser Z. Computed tomography findings as early predictors of long-term language impairment in patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:686-695. [PMID: 34487454 DOI: 10.1080/23279095.2021.1971982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to assess the relationship between computed tomography (CT) findings, during the acute phase of hospitalization, and long-term language impairment in people with traumatic brain injury (TBI). Another aim was to assess the receptive and expressive abilities of subjects with TBI based on the location of the injury. This is a retrospective observational study including 49 participants with TBI due to war injuries. The Arabic Diagnostic Aphasia Battery (A-DAB-1) was administered to the participants and the Helsinki CT score was computed to quantify brain damage. The results showed that the Helsinki CT score was negatively correlated with the total score of the A-DAB-1 (r = -0.544, p-value < 0.0001). Simple linear regression supported such findings and reflected an inversely proportional relationship between both variables (p-value < 0.0001). When compared with subjects having right hemisphere damage, subjects with left hemisphere and bilateral brain damage performed more poorly on language tasks respectively as follows: A-DAB-1 overall score (92.08-66.08-70.28, p-value = 0.021), Content of descriptive speech (9.57-6.69-7.22, p-value = 0.034), Verbal fluency (6.57-3.54-3.89, p-value = 0.002), Auditory comprehension (9.71-7.54-7.78, p-value = 0.039), Complex auditory commands (9.71-7.65-7.56, p-value = 0.043), Repetition (9.75-7.08-7.61, p-value = 0.036), Naming (9.93-7.15-8.11, p-value = 0.046). Following TBI, CT findings on admission can significantly predict long-term language abilities, with left side lesions inducing poorer outcomes.
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Affiliation(s)
- Marwa Summaka
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Elias Elias
- Department of Complex and minimally invasive spine surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Hiba Zein
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Ibrahim Naim
- Health, Rehabilitation, Iintegration and Research Center (HRIR), Beirut, Lebanon
| | - Rama Daoud
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Youssef Fares
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - Zeina Nasser
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
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12
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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13
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Avramovic P, Rietdijk R, Attard M, Kenny B, Power E, Togher L. Cognitive and Behavioral Digital Health Interventions for People with Traumatic Brain Injury and Their Caregivers: A Systematic Review. J Neurotrauma 2023; 40:159-194. [PMID: 35819294 DOI: 10.1089/neu.2021.0473] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to specialized services; however, there are few synthesized reviews in this field. This review evaluates and synthesizes reports of digital health interventions in TBI rehabilitation and caregiver education. Systematic searches of nine databases (PsycINFO, MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, Web of Science Core Collection, speechBITE, and PsycBITE) were conducted from database inception to February 2022. Studies were included of interventions where the primary treatment focus (> 50%) was on improving communication, social, psychological or cognitive skills of people with TBI and/or communication partners. Data on participants, characteristics of the interventions, outcome measures and findings were collected. Risk of bias was accounted for through methodological quality assessments (PEDro-P and PEDro+, Risk of Bias in N-of-1 Trials) and intervention description. Qualitative data was analyzed using thematic synthesis. Forty-four articles met eligibility criteria: 20 randomized controlled trials, three single-case experimental designs, six non-randomized controlled trials, nine case series studies, and two case studies. Studies comprised 3666 people with TBI and 213 carers. Methodological quality was varied and intervention description was poor. Most interventions were delivered via a single digital modality (e.g., telephone), with few using a combination of modalities. Five interventions used co-design with key stakeholders. Digital health interventions for people with TBI and their caregivers are feasible and all studies reported positive outcomes; however, few included blind assessors. Improved methodological rigor, clearly described intervention characteristics and consistent outcome measurement is recommended. Further research is needed regarding multi-modal digital health interventions.
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Affiliation(s)
- Petra Avramovic
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Michelle Attard
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Belinda Kenny
- School of Health Sciences, University of Western Sydney, Sydney, New South Wales, Australia
| | - Emma Power
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia
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14
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Elbourn E, MacWhinney B, Fromm D, Power E, Steel J, Togher L. TBIBank: An International Shared Database to Enhance Research, Teaching and Automated Language Analysis for Traumatic Brain Injury Populations. Arch Phys Med Rehabil 2023; 104:824-829. [PMID: 36639093 DOI: 10.1016/j.apmr.2022.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Abstract
Traumatic brain injury (TBI) has been established as a priority research area for public health, affecting an estimated 69 million individuals worldwide each year. Large-scale collaborative datasets may help to better understand this heterogenous and chronic health condition. In this paper, we present TBIBank; an innovative digital health resource that aims to establish a shared database for the study of communication disorders after TBI. We provide an overview of the current database, the standard discourse protocol used for the main TBIBank corpus, and the automated language analyses that can enable diagnostic profiling, comparative evaluation of treatment effects and profiling of recovery patterns. We also highlight the e-learning component of the digital health resource as a research translation tool. We conclude with a discussion of the potential research, clinical, and educational applications of TBIBank and future directions for expanding this digital resource.
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Affiliation(s)
- Elise Elbourn
- The University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Davida Fromm
- Carnegie Mellon University, Pittsburgh, PA 15213, United States
| | - Emma Power
- University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Joanne Steel
- The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Leanne Togher
- The University of Sydney, Sydney, NSW 2006, Australia
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15
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Hudnall R, Hassman B, Geelan-Hansen K. Meat tenderizer assault and associated facial trauma: A case report. Trauma Case Rep 2022; 39:100648. [PMID: 35571576 PMCID: PMC9092248 DOI: 10.1016/j.tcr.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Blunt trauma to the face, head and neck is frequently encountered in violent assaults (Brink, 2009 [1]). There can be trauma to the cranium in high energy mechanisms, though interpersonal trauma is less likely to be associated with traumatic brain injury (TBI) (Salentijn et al., 2014 [2]). Case report We describe severe soft tissue facial trauma, ocular trauma, subdural and epidural hematomas as well as calvarial fractures, orbital floor and zygomaticomaxillary complex (ZMC) fracture following assault with a meat tenderizer. Due to the unique mechanism of trauma and the extent of injury including TBI coordination of care involved many teams. The patient was treated, then discharged to a skilled nursing facility with subsequent discharge to home. He has continued neurocognitive improvement but loss of vision in the left eye. Conclusion Violent trauma with a meat tenderizer can lead to significant soft tissue trauma, facial fractures, calvarial fractures and TBI.
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Affiliation(s)
| | | | - Katie Geelan-Hansen
- Corresponding author at: University of Nebraska Medical Center, Department of Otolaryngology-Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, NE 68198-1225, United States of America.
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16
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Mostert CQB, Singh RD, Gerritsen M, Kompanje EJO, Ribbers GM, Peul WC, van Dijck JTJM. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir (Wien) 2022; 164:599-613. [PMID: 35098352 DOI: 10.1007/s00701-021-05086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. METHODS A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. RESULTS Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. CONCLUSION Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. HIGHLIGHTS 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.
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Affiliation(s)
- Cassidy Q B Mostert
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands.
| | - Ranjit D Singh
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Maxime Gerritsen
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
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17
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VanSolkema M, McCann CM, Barker-Collo S, Foster A. Outcomes of attention-related communication deficits following traumatic brain injury: perspectives of international health professionals. Brain Inj 2022; 36:406-414. [PMID: 35192421 DOI: 10.1080/02699052.2022.2034189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE Attention and communication difficulties are common yet often invisible following Traumatic Brain Injury (TBI). The focus of this paper is to use practice-based evidence from health professionals working with individuals following TBI to gain a deep and relevant understanding of the impact that attention and communication can have in the lives of individuals following TBI. RESEARCH DESIGN This dataset comes from a larger mixed-methods study that includes a survey with both open and closed questions and focus group data sources. METHODS AND PROCEDURES Thematic analysis was completed on a single open-ended question from the survey of health professionals. It asked health professionals about the outcomes they believe are directly related to attention difficulties that result in specific communication difficulties. MAIN OUTCOMES AND RESULTS Responses from 73 health professionals who work in neurorehabilitation generated five themes: behavior, connections, self, purpose, and empowerment. The themes were pervasive across all aspects of the recovery journey for individuals post-TBI. CONCLUSIONS The implications for clinical practice and future research indicate a need to focus on attention-related strategies for language deficits; treating communication difficulties related to relationships and friendships; and redefining a sense of self following TBI.
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Affiliation(s)
- Maegan VanSolkema
- School of Psychology,(Speech Science), University of Auckland, Auckland, New Zealand.,ABI Rehabilitation New Zealand Ltd, New Zealand
| | - Clare M McCann
- School of Psychology,(Speech Science), University of Auckland, Auckland, New Zealand
| | | | - Allison Foster
- Foster Medical Communications Ltd, Auckland, New Zealand
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18
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Venkatesan UM, Rabinowitz AR, Wolfert SJ, Hillary FG. Duration of post-traumatic amnesia is uniquely associated with memory functioning in chronic moderate-to-severe traumatic brain injury. NeuroRehabilitation 2021; 49:221-233. [PMID: 34397431 DOI: 10.3233/nre-218022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disrupted memory circuitry may contribute to post-traumatic amnesia (PTA) after traumatic brain injury (TBI). It is unclear whether duration of PTA (doPTA) uniquely impacts memory functioning in the chronic post-injury stage. OBJECTIVE To examine the relationship between doPTA and memory functioning, independent of other cognitive abilities, in chronic moderate-to-severe TBI. METHODS Participants were 82 individuals (median chronicity = 10.5 years) with available doPTA estimates and neuropsychological data. Composite memory, processing speed (PS), and executive functioning (EF) performance scores, as well as data on subjective memory (SM) beliefs, were extracted. DoPTA-memory associations were evaluated via linear modeling of doPTA with memory performance and clinical memory status (impaired/unimpaired), controlling for PS, EF and demographic covariates. Interrelationships between doPTA, objective memory functioning, and SM were assessed. RESULTS DoPTA was significantly related to memory performance, even after covariate adjustment. Impairment in memory, but not PS or EF, was associated with a history of longer doPTA. SM was associated with memory performance, but unrelated to doPTA. CONCLUSIONS Findings suggest a specific association between doPTA-an acute injury phenomenon-and chronic memory deficits after TBI. Prospective studies are needed to understand how underlying mechanisms of PTA shape distinct outcome trajectories, particularly functional abilities related to memory processing.
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Affiliation(s)
- Umesh M Venkatesan
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Amanda R Rabinowitz
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Stephanie J Wolfert
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Frank G Hillary
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Psychology, Pennsylvania State University, University Park, PA, USA
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19
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Solomon NP, Brungart DS, Wince JR, Abramowitz JC, Eitel MM, Cohen J, Lippa SM, Brickell TA, French LM, Lange RT. Syllabic Diadochokinesis in Adults With and Without Traumatic Brain Injury: Severity, Stability, and Speech Considerations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1400-1409. [PMID: 33630660 DOI: 10.1044/2020_ajslp-20-00158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Syllabic diadochokinesis (DDK) is a standard assessment task for motor speech disorders. This study aimed to compare rate and regularity of DDK according to the presence or absence of traumatic brain injury (TBI) and severity of TBI, examine the stability of DDK over time, and explore associations between DDK and extemporaneous speech. Method Military service members and veterans were categorized into three groups: no history of TBI (control), uncomplicated mild TBI (mTBI), and moderate through severe (including penetrating) TBI (msTBI). Participants produced rapid alternating-motion and sequential-motion syllable repetitions during one or two sessions. A semi-automated protocol determined syllabic rate and regularity. Perceptual ratings of selected participants' connected speech samples were compared to DDK results. Results Two hundred sixty-three service members and veterans provided data from one session and 69 from two sessions separated by 1.9 years (SD = 1.0). DDKs were significantly slower overall for mTBI and msTBI groups compared to controls. Regularity of productions did not differ significantly across groups. A significant Group × Task interaction revealed that the msTBI group produced sequential-motion syllable repetitions but not alternating-motion repetitions with greater regularity, whereas the opposite occurred for control and mTBI groups. DDK results did not differ significantly between sessions. Perceptual speech analysis for 30 participants, including 20 with atypical or questionable DDK performance, revealed two participants with mildly abnormal speech. Conclusions Overall, DDK productions are slower than normal in adults with moderate, severe, and penetrating TBI and are stable over time. Regularity of productions did not differentiate groups, although this result differed according to task. There were surprisingly few people identified with disordered speech, making comparisons to DDK data tenuous, and indicating that dysarthria is a rare complication in a population of adults with mostly uncomplicated mTBI who are not selected from referrals to a speech-language pathology clinic.
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Affiliation(s)
- Nancy Pearl Solomon
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Douglas S Brungart
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jessica R Wince
- Walter Reed National Military Medical Center, Bethesda, MD
- Towson University, Baltimore, MD
| | - Jordan C Abramowitz
- Walter Reed National Military Medical Center, Bethesda, MD
- University of Maryland, College Park, MD
| | - Megan M Eitel
- Walter Reed National Military Medical Center, Bethesda, MD
- Henry M. Jackson Foundation, Rockville, MD
- Defense and Veterans Brain Injury Center, Silver Spring, MD
| | - Julie Cohen
- Walter Reed National Military Medical Center, Bethesda, MD
- University of Maryland, College Park, MD
- Henry M. Jackson Foundation, Rockville, MD
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD
- Defense and Veterans Brain Injury Center, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
| | - Tracey A Brickell
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Defense and Veterans Brain Injury Center, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
- General Dynamics Information Technology, Falls Church, VA
| | - Louis M French
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Defense and Veterans Brain Injury Center, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
| | - Rael T Lange
- Walter Reed National Military Medical Center, Bethesda, MD
- Defense and Veterans Brain Injury Center, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
- General Dynamics Information Technology, Falls Church, VA
- University of British Columbia, Vancouver, Canada
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20
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Keegan LC, Suger C, Togher L. Discourse Analysis of Humor After Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:949-961. [PMID: 33556258 DOI: 10.1044/2020_ajslp-20-00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Individuals with cognitive communication difficulties after traumatic brain injury (TBI) often experience difficulties with social communication. Humor is a sociolinguistic skill that requires social, cognitive, emotional, and behavioral skills and, when used effectively, may serve to enhance one's social relationships. There is a paucity of research related to the use of humor in individuals with TBI. This study categorizes humor use in individuals with cognitive communication difficulties after TBI and examines the linguistic construction of these humorous exchanges. Method The humorous exchanges of nine individuals who had cognitive communication difficulties after a moderate-to-severe TBI were examined. Conversations were collected from a community-based communication skills group, categorized using thematic analysis methods, and examined linguistically using the discourse analysis tools of systemic functional linguistics. Results All participants demonstrated the ability to use a variety of categories of humor, and discourse analysis methods revealed humor use as a strength for engaging with others. Examples of such engagement include use of humor to elicit attention, assert authority, share information, acknowledge shared difficulties, and demonstrate affiliation toward their communication partners. Conclusions Discourse analysis of humor can provide speech-language pathologists with important information about the linguistic strengths of individuals with cognitive communication difficulties. This has important implications for clinical service provision.
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Affiliation(s)
- Louise C Keegan
- Department of Rehabilitation Sciences, Moravian College, Bethlehem, PA
| | - Caitlin Suger
- Frye Regional Medical Center, Duke LifePoint Health, Hickory, NC
| | - Leanne Togher
- Department of Speech Pathology, University of Sydney, New South Wales, Australia
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21
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Correlations between Dual-Pathway White Matter Alterations and Language Impairment in Patients with Aphasia: A Systematic Review and Meta-analysis. Neuropsychol Rev 2021; 31:402-418. [PMID: 33656701 DOI: 10.1007/s11065-021-09482-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/25/2021] [Indexed: 02/06/2023]
Abstract
While converging evidence suggests linguistic roles of white matter tracts, detailed associations between white matter alterations of dual pathways and language abilities remain unknown in aphasic patients. We aimed to verify language functions of dual-pathway tracts from specific domains and investigate the influence of moderators. PubMed, Web of Science, Embase, and CENTRAL were searched for studies published between January 1, 1985 and March 17, 2019. A meta-analysis of 46 studies including 1353 aphasic patients was performed by pooling correlation coefficients between linguistic domains and diffusion metrics of dual-pathway tracts. Among these tracts, the fractional anisotropy (FA) value of the left inferior fronto-occipital fasciculus predominated across most linguistic aspects, showing the strongest correlations with global severity, comprehension, naming and reading ability. The left uncinate fasciculus and inferior longitudinal fasciculus also showed significant FA - comprehension correlations. For syntactic processing, FA values of the left superior longitudinal fasciculus and arcuate fasciculus showed significant positive correlations. Meta-regression revealed no influence of etiology on FA - language correlations, while sex had a moderating effect on the FA - comprehension correlation of the arcuate fasciculus, and age influenced the FA - naming correlation in the superior longitudinal fasciculus. In conclusion, multifunctional characteristics of tracts were revealed in aphasic patients, including broad linguistic associations of the inferior fronto-occipital fasciculus, and repetition and syntactic involvement of the arcuate fasciculus. Language associations of the inferior longitudinal fasciculus and uncinate fasciculus were clarified regarding comprehension subdomains. The insignificant moderating effect of the etiology indicates damage of dual pathways is the common neural mechanism, while sex and age influence the correlation with comprehension and naming ability, respectively, in specific tracts.
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Sutiono AB. Cognitive and speech improvement in young severe head injury patients associated with multiple intracranial trauma: A case report and review of the literature in developing countries. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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LeBlanc J, Seresova A, Laberge-Poirier A, Tabet S, Alturki AY, Feyz M, de Guise E. Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:130-144. [PMID: 33368845 DOI: 10.1111/1460-6984.12589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although previous research studies have defined several prognostic factors that affect cognitive-communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive-communication impairment in complicated mild TBI (mTBI) specifically. AIMS To determine which demographic and trauma-related factors are associated with cognitive-communication performance in the early recovery phase of acute care following a complicated mTBI. METHODS & PROCEDURES Demographic and accident-related data as well as the scores on cognitive-communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism. OUTCOMES & RESULTS Females performed better than males on letter-category naming, while those more advanced in age performed worse on most cognitive-communication measures. Patients with higher education achieved better confrontation and letter-category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming. CONCLUSIONS & IMPLICATIONS Cognitive-communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury-related factors affect cognitive-communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper adds What is already known on the subject In early acute recovery studies including all severity of TBI, cognitive-communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury-related variables predict cognitive-communication performance after a complicated mTBI specifically. What this paper adds to existing knowledge We confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive-communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive-communication skills in this group of patients. What are the potential or actual clinical implications of this work? The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive-communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care.
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Affiliation(s)
- Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Center, Montreal, QC, Canada
| | - Alena Seresova
- Traumatic Brain Injury Program, McGill University Health Center, Montreal, QC, Canada
| | | | - Sabrina Tabet
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Abdulrahman Y Alturki
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Adult Neurosurgery Department, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Center, Montreal, QC, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
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Roldán-Palacios M, López-López A. Disfluency as an Indicator of Cognitive-Communication Disorder Through Learning Methods. Brain Inform 2021. [DOI: 10.1007/978-3-030-86993-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Grayson L, Brady MC, Togher L, Ali M. The impact of cognitive-communication difficulties following traumatic brain injury on the family; a qualitative, focus group study. Brain Inj 2020; 35:15-25. [PMID: 33327774 DOI: 10.1080/02699052.2020.1849800] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary Objective: To identify how families experience cognitive-communication difficulties following Traumatic Brain Injury (TBI). Experiences of information, training and support for managing communication changes were also explored. Research Design: Qualitative focus group methodology using thematic analysis. Method: 15 family members of individuals with cognitive-communication difficulties following severe TBI participated in the study; four parents, six spouses, three siblings and two offspring. The majority of participants were female (80%, n = 12), with a mean age of 51 (range 19-71). Four focus groups were held with family members at 0-12 months, 12-36 months and 36+ months post-injury. The data were transcribed verbatim and analyzed using NVIVO 12.Results: Cognitive-communication difficulties were found to impact upon family functioning and psychological wellbeing for several years post-injury. Changes to social cognition, insight and the "filter switch" of the person following TBI were key areas of distress. Participants highlighted the need for information about communication changes to be provided at several time points post-injury. The need for peer support from other families with experience of cognitive-communication difficulties was also identified.Conclusion: Cognitive-communication difficulties impact upon family functioning for many years following injury with families continuing to have support needs for communication well beyond the acute rehabilitation stage.
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Affiliation(s)
- Lynn Grayson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland.,NHS Lanarkshire, Carluke, Scotland
| | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Myzoon Ali
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland
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Greenslade KJ, Stuart JEB, Richardson JD, Dalton SG, Ramage AE. Macrostructural Analyses of Cinderella Narratives in a Large Nonclinical Sample. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1923-1936. [PMID: 32924890 PMCID: PMC8740559 DOI: 10.1044/2020_ajslp-19-00151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
Purpose Macrostructural narrative analyses are important clinical measures, revealing age-related declines and disorder-related impairments in the accuracy, completeness, logical sequencing, and organization of content. The current study aims to provide preliminary data on typical aging and psychometric evidence supporting multilevel Main Concept, Sequencing, and Story Grammar (MSSG) analyses that capture these aspects of narratives. Method Transcripts of Cinderella narratives for 92 healthy control participants stratified across four age brackets from the online database AphasiaBank were coded by Richardson and Dalton (2016) for main concept (MC) analysis. In the current study, MSSG analyses were completed for (a) logical sequencing, independently and in combination with MC accuracy and completeness (MC + sequencing), and (b) story grammar organization (i.e., inclusion of episodic components and complexity of episodes). Interrater agreement (99%-100%) revealed highly reliable scoring. Results Descriptive statistics for the typically aging sample are presented for sequencing, MC + sequencing, total episodic components, and episodic complexity. Scores for participants over 60 years of age were lower (poorer) than scores for those 20-59 years of age, supporting the construct validity of score use for identifying age-related declines in performance. Conclusions This study's novel MSSG analyses of narrative production efficiently assess the logical sequencing and story grammar organization of content in healthy controls. Preliminary reliability and validity evidence support the use of all scores to measure age-related changes in narrative macrostructure. Data from this typically aging sample provide a foundation for future research and clinical assessment aimed at quantifying narrative deficits in adults with communication disorders. Supplemental Material https://doi.org/10.23641/asha.12683495.
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Affiliation(s)
- Kathryn J. Greenslade
- Department of Communication Sciences & Disorders, University of New Hampshire, Durham
| | - Jade E. B. Stuart
- Department of Communication Sciences & Disorders, University of New Hampshire, Durham
| | | | - Sarah Grace Dalton
- Department of Speech Pathology and Audiology, Marquette University, Milwaukee, WI
| | - Amy E. Ramage
- Department of Communication Sciences & Disorders, University of New Hampshire, Durham
- Interdisciplinary Program in Neuroscience and Behavior, University of New Hampshire, Durham
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VanSolkema M, McCann C, Barker-Collo S, Foster A. Attention and Communication Following TBI: Making the Connection through a Meta-Narrative Systematic Review. Neuropsychol Rev 2020; 30:345-361. [PMID: 32712759 DOI: 10.1007/s11065-020-09445-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIM Communication difficulties are one of the hallmark characteristics of adults following traumatic brain injury (TBI), a difficulty that incorporates multiple aspects of cognition and language. One aspect of cognition that impacts communication is attention. This review explores both attention and communication following moderate to severe TBI and aims to connect them through a narrative analysis of the discourse surrounding the terms and how they have evolved over time. This includes exploring and reviewing theories and specific constructs of these two aspects of cognition. METHOD A meta-narrative systematic literature review was completed according to RAMESES methodology. RESULTS A total of 37 articles were included in the review. The disciplines that populated the articles included, but were not limited to, speech language pathology (SLP) 36.5%, psychology 23.8%, and a collaboration of neuropsychology and SLP 7.9%. Of the papers that were included, 10% explored and supported theories of attention related to executive function affecting communication. Specific levels of attention were mapped onto specific communication skills with the corresponding year and authors to create a timeline and narrative of these concepts. CONCLUSIONS The main communication behaviours that are related to attention in the context of post-TBI cognition include discourse, tangential communication, social communication, auditory comprehension, verbal reasoning, topic maintenance, interpretation of social cues and emotions, verbal expression, reading comprehension, verbal response speed, and subvocal rehearsal.
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Affiliation(s)
- Maegan VanSolkema
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand. .,ABI Rehabilitation, NZ, Ltd., Auckland, New Zealand.
| | - Clare McCann
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
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Cunningham KT, Haley KL. Measuring Lexical Diversity for Discourse Analysis in Aphasia: Moving-Average Type-Token Ratio and Word Information Measure. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:710-721. [PMID: 32191154 DOI: 10.1044/2019_jslhr-19-00226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this study was to compare the utility of two automated indices of lexical diversity, the Moving-Average Type-Token Ratio (MATTR) and the Word Information Measure (WIM), in predicting aphasia diagnosis and responding to differences in severity and aphasia subtype. Method Transcripts of a single discourse task were analyzed for 478 speakers, 225 of whom had aphasia per an aphasia battery. We calculated the MATTR and the WIM for each participant. We compared the group means among speakers with aphasia, neurotypical controls, and left-hemisphere stroke survivors with mild aphasia not detected by an aphasia battery. We examined whether each measure distinguished levels of aphasia severity and subtypes of aphasia. We used each measure to classify aphasia versus neurotypical control and compared the areas under the curve. Results The WIM and the MATTR differentiated among people with aphasia, neurotypical controls, and people with mild aphasia. Both measures demonstrated moderately high predictive accuracy in classifying aphasia. The WIM demonstrated greater sensitivity to aphasia severity and subtype compared to the MATTR. Conclusions The WIM and the MATTR are promising measures that quantify lexical diversity in different and complementary ways. The WIM may be more useful for quantifying the effect of treatment or disease progression, whereas the MATTR may be more useful for discriminating discourse produced by people with very mild aphasia from discourse produced by neurotypical controls. Further validation is required.
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Affiliation(s)
- Kevin T Cunningham
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
| | - Katarina L Haley
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, University of North Carolina, Chapel Hill
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Rietdijk R, Power E, Attard M, Heard R, Togher L. Improved Conversation Outcomes After Social Communication Skills Training for People With Traumatic Brain Injury and Their Communication Partners: A Clinical Trial Investigating In-Person and Telehealth Delivery. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:615-632. [PMID: 32078409 DOI: 10.1044/2019_jslhr-19-00076] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of the study was to investigate the effectiveness of social communication skills training (TBIconneCT) for people with traumatic brain injury (TBI) and their communication partners, delivered in-person or via telehealth, on quality of conversations. Method This study is a clinical trial, including an in-person intervention group (n = 17), a telehealth intervention group (n = 19), and a historical control group (n = 15). Participants were adults at least 6 months post moderate-to-severe TBI with social communication skills deficits and their usual communication partners. Participants completed a casual and purposeful conversation task at pre-intervention, postintervention, and a follow-up assessment. A blinded assessor evaluated conversations using the Adapted Measure of Participation in Conversation and the Adapted Measure of Support in Conversation. Treatment effects were examined by comparing groups on change in ratings between pre- and posttraining. Maintenance of effects was examined using change between posttraining and follow-up assessment. The trial protocol was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001024538). Results Trained participants with TBI had significant improvements in participation in casual conversation compared to controls. Trained communication partners also had significant improvements compared to controls on ratings of support in casual conversations. However, treatment effects were not maintained at follow-up for two of eight measures. Comparisons between outcomes of in-person and telehealth groups found negligible to small effect sizes for six of eight measures. Conclusions The findings reinforce previous studies demonstrating the efficacy of communication partner training after TBI. Telehealth delivery produced similar outcomes to in-person delivery.
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Affiliation(s)
- Rachael Rietdijk
- The University of Sydney, Sydney School of Health Sciences, New South Wales, Australia
| | - Emma Power
- The University of Sydney, Sydney School of Health Sciences, New South Wales, Australia
- The University of Technology Sydney, Graduate School of Health, New South Wales, Australia
| | - Michelle Attard
- The University of Sydney, Sydney School of Health Sciences, New South Wales, Australia
| | - Robert Heard
- The University of Sydney, Sydney School of Health Sciences, New South Wales, Australia
| | - Leanne Togher
- The University of Sydney, Sydney School of Health Sciences, New South Wales, Australia
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Power E, Weir S, Richardson J, Fromm D, Forbes M, MacWhinney B, Togher L. Patterns of narrative discourse in early recovery following severe Traumatic Brain Injury. Brain Inj 2019; 34:98-109. [PMID: 31661629 PMCID: PMC8903041 DOI: 10.1080/02699052.2019.1682192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/22/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Emma Power
- University of Technology Sydney, Graduate School of Health, Sydney, Australia
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Stephanie Weir
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Jessica Richardson
- Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Davida Fromm
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Margaret Forbes
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Brian MacWhinney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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