Delineating Communication Impairments Associated With Mild Traumatic Brain Injury

Attentional Orienting and Disfluency-Related Memory Boost Are Intact in Adults With Moderate-Severe Traumatic Brain Injury

PURPOSE

Traumatic brain injury (TBI) is associated with a range of cognitive-communicative deficits that interfere with everyday communication and social interaction. Considerable effort has been directed at characterizing the nature and scope of cognitive-communication disorders in TBI, yet the underlying mechanisms of impairment are largely unspecified. The present research examines sensitivity to a common communicative cue, disfluency, and its impact on memory for spoken language in TBI.

METHOD

Fifty-three participants with moderate-severe TBI and 53 noninjured comparison participants listened to a series of sentences, some of which contained disfluencies. A subsequent memory test probed memory for critical words in the sentences.

RESULTS

Participants with TBI successfully remembered the spoken words (b = 1.57, p < .0001) at a similar level to noninjured comparison participants. Critically, participants with TBI also exhibited better recognition memory for words preceded by disfluency compared to words from fluent sentences (b = 0.57, p = .02).

CONCLUSIONS

These findings advance mechanistic accounts of cognitive-communication disorder by revealing that, when isolated for experimental study, individuals with moderate-severe TBI are sensitive to attentional orienting cues in speech and exhibit enhanced recognition of individual words preceded by disfluency. These results suggest that some aspects of cognitive-communication disorders may not emerge from an inability to perceive and use individual communication cues, but rather from disruptions in managing (i.e., attending, weighting, integrating) multiple cognitive, communicative, and social cues in complex and dynamic interactions. This hypothesis warrants further investigation.

An exploration of higher-level language comprehension deficits and factors influencing them following blast TBI in US veterans

PRIMARY OBJECTIVE

The objective of this study was to investigate the factors that might have a negative influence on auditory processing and higher-level language processing in the US veterans of the recent foreign wars (Iraq and Afghanistan).

RESEARCH DESIGN

Exploratory, cross-sectional, correlational, prospective, cohort-design.

METHODS AND PROCEDURES

The experimental group consisted of 12 US veterans of war (10 males and 2 females) with blast exposure. The control group consisted of six US veterans (5 males and 1 female) without the history of blast exposure. Both groups were matched in mean age. Both groups were tested on Boston Assessment of Traumatic Brain Injury, Consonant Trigrams Test, Symbol Digit Modality Test, Trail Making Test, SCAN-3, CELF-5-Metalinguistics, CASL, and an unpublished test on the processing of sentence prosody.

MAIN OUTCOMES AND RESULTS

Significant group differences in attention, and time-compressed sentence processing were found. For those veterans (in the experimental group) who were not wearing their helmets at the time of blast, additional significant differences were noted with inferencing and auditory figure-ground tasks.

CONCLUSIONS

Findings support the importance of including speech/language pathologists in all stages of recovery for veterans post-blast exposure.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Auditory comprehension performance of college students with and without sport concussion on Computerized-Revised Token Test Subtest VIII

Aim:

Auditory comprehension (AC) and visually assessed cognitive functions were compared in early stage postconcussed (PC) athletes and healthy controls using the Subtest VIII of the Computerized-Revised Token Test (C-RTT) and Immediate Postconcussion Assessment and Cognitive Test (ImPACT).

Results:

As compared with healthy controls (n = 30), PC subjects (n = 30) had significantly lower C-RTT efficiency scores (p = 0.018), and lower ImPACT scores; total symptom score (p = 0.000.), verbal memory (p = 0.000), visual memory (p = 0.000), visual motor speed (p = 0.000) and reaction time (p = 0.004) in this post-test only matched subject design. Impulse Control was not significant (p = 0.613). Multiple regression and ANOVA indicated an association with reaction time only (p = 0.012) for the PC subjects. After controlling for reaction time, a significant difference in AC remained.

Conclusion:

The relationship between AC and other visually assessed cognitive functions was inconsistent suggesting that the C-RTT and ImPACT assessed different functional systems.

Frontal and Temporal Structural Connectivity Is Associated with Social Communication Impairment Following Traumatic Brain Injury

OBJECTIVES

Although it has been well documented that traumatic brain injury (TBI) can result in communication impairment, little work to date has examined the relationship between social communication skills and structural brain integrity in patients with TBI. The aim of the current study was to investigate the association between self- and other-perceived communication problems and white matter integrity in patients with mild to severe TBI.

METHODS

Forty-four individuals (TBI=24) and people with whom they frequently communicate, as well as demographically matched normal healthy comparisons (NC) and their frequent communication partners, were administered, respectively, the La-Trobe Communication Questionnaire Self form (LCQ-SELF) and Other form (LCQ-OTHER). In addition, diffusion tensor imaging data were collected, and fractional anisotropy (FA) measures were extracted for each lobe in both hemispheres.

RESULTS

Within the TBI group, but not within the NC group, participants who were perceived by their close others as having more communication problems had lower FA in the left frontal and temporal lobes (p<.01), but not in other brain regions.

CONCLUSIONS

Frontotemporal white matter microstructural integrity is associated with social communication abilities in adults with TBI. This finding contributes to our understanding of the mechanisms leading to communication impairment following TBI and can inform the development of new neuromodulation therapies as well as diagnostic tools. (JINS, 2016, 22, 705-716).

Development and application of cognitive-pragmatic language ability assessment protocol for traumatic brain injury

The study aim was to introduce a newly-developed multifaceted cognitive-pragmatic language assessment protocol. This study was also designed to assess the reliability and validity of the assessment protocol in the discrimination between mild traumatic brain injury (mTBI) and normal control. Individuals in this study were 25 to 64 years old. Ten mTBIs and twenty-two control group were recruited for the preliminary study. Their mean ages were 45.20 and 41.23, respectively. For the main study, we recruited 39 mTBIs and 100 healthy individuals whose mean ages were 44.67 and 40.84, respectively. The newly-developed protocol was completed through a systematic review based on an item analysis. We administered the CAPTBI based on nine domains, 22 subcategories, and 57 items. All nine domains of the CAPTBI were found to be significant variables by which mTBI individuals can be distinguished from normal individuals (p < .001). We also presented the cut-off points by education level to maximize the validity of differentiating the two groups. This study is the first attempt to evaluate mTBI by means of the cognitive-linguistic protocol with multiple domains. The CAPTBI is an appropriate tool for differentiating the cognitive-pragmatic language abilities between mTBI and control group.

Variations in the presentation of aphasia in patients with closed head injuries

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat

Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI.

Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat.

Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD.

Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

Treatment of Cognitive-Communicative Disorders Following Blast Injury

Purpose: Mild traumatic brain injury (mTBI) following exposure to a blast is the signature injury of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The purposes of this article are to describe the characteristics of the service members who experience blast injuries, the cognitive-communicative deficits they present, and the role of the speech-language pathologist (SLP) in managing these deficits.

Method: Demographic data for the service members who have experienced blast injuries in OIF/OEF are reviewed and reported. The literature on treating cognitive-communicative disorders following mTBI is reviewed and is discussed in the context of managing the deficits reported by service members returning from Iraq and Afghanistan.

Results and conclusions: Information regarding the effects of blast exposure on the human body continues to emerge. Data regarding the most effective treatment for cognitive-communicative deficits following blast injury are needed. For now, SLPs must rely on the best evidence from the civilian mTBI literature, clinical expertise, and the personal values of the individual with TBI to develop effective treatment programs targeting the cognitive-communicative disorders experienced by these individuals.

A failure to stop and attention fluctuations: an evoked oscillations study of the stop-signal paradigm

OBJECTIVE

It is not always clear whether inhibition or attention deficit underlies a failure to stop a prepared motor response. One possible way to approach this question is to resort to measures of evoked oscillations since functional correlates of different frequency oscillations are relatively well understood.

METHODS

The present study examined event-related oscillations during a stop-signal task in non-clinical adults. In 25% of trials of an auditory discrimination tasks subjects had to refrain from a prepared motor response.

RESULTS

In successful stop trials, the Go N2 peaked later and the Stop N2 peaked earlier than in failed stop trials. Relative to successful, failed stop trials were associated with a larger N1-N2 and Go P3, and a smaller Stop P3 in the central and posterior cortical regions. The latter effect was exclusively determined by evoked delta oscillations, whereas all other frequency bands contributed to enhanced responses in failed comparative to successful stop trials.

CONCLUSIONS

The sum of presented evidence seems to show that success or failure to stop mostly depends on how the subject prepares for the Go and Stop stimuli in advance. If attention is more directed towards the Stop signal, the stopping succeeds, otherwise it fails.

SIGNIFICANCE

These data may contribute to understanding the cognitive basis of successful and unsuccessful stopping performance.