Can within-category naming identify subtle cognitive deficits in the mild traumatic brain-injured patient?

Perceptions About Writing by Adults With Moderate or Severe Traumatic Brain Injury

PURPOSE

Writing challenges can cause ongoing distress and limit resumption of pre-injury activities following traumatic brain injury (TBI); however, little TBI research or clinical practice addresses written communication. Understanding the writing perceptions and experiences of adults engaged in intensive, inpatient rehabilitation following hospital discharge for TBI is an initial step in addressing this situation.

METHOD

Transcendental phenomenology served to structure this qualitative research. Six adults between 2 and 6 months post-TBI participated in a common experience of writing about a personal memorable event. Standardized test scores and symptom ratings provided descriptive information about participants. Additionally, participants completed the Neurobehavioral Symptom Inventory and NASA Task Load Index and engaged in semistructured interviews to describe writing perceptions and experiences.

RESULTS

Data analysis revealed themes and subthemes about writing perceptions, challenges, and support strategies. Participants varied in their perceptions of post-injury writing changes. Test results revealed areas of challenge for all participants, but only half reported awareness of writing changes. Those aware of changes differed from other participants regarding word retrieval, memory, and concentration as well as overall effort expended, frustration, and performance quality. Although all participants relied on writing supports, only one had adjusted multiple writing strategies following injury.

CONCLUSIONS

Some adults with TBI are aware of writing changes while receiving posthospital, inpatient rehabilitation services, but others deny such changes. This differs from reports concerning later recovery stages, perhaps because few functional writing opportunities arise during rehabilitation. Application of compensatory strategies specific to post-injury writing challenges is unlikely while awareness remains limited.

Discourse Performance in Adults With Mild Traumatic Brain Injury, Orthopedic Injuries, and Moderate to Severe Traumatic Brain Injury, and Healthy Controls

INTRODUCTION

Adults with mild traumatic brain injury (mTBI) are at risk for communication disorders, yet studies exploring cognitive-communication performance are currently lacking.

AIMS

This aim of this study was to characterize discourse-level performance by adults with mTBI on a standardized elicitation task and compare it to (a) healthy adults, (b) adults with orthopedic injuries (OIs), and (c) adults with moderate to severe TBI.

METHOD

This study used a cross-sectional design. The participants included mTBI and OI groups recruited prospectively from an emergency medicine department. Moderate to severe TBI and healthy data were acquired from TalkBank. One-way analyses of variance were used to compare mean linguistic scores.

RESULTS

Seventy participants across all groups were recruited. Groups did not differ on demographic variables. The study found significant differences in both content and productivity measures among the groups. Variables did not appear sensitive to differentiate between mTBI and OI groups.

DISCUSSION

Cognitive and language performance of adults with mTBI is a pressing clinical issue. Studies exploring language with carefully selected control groups can influence the development of sensitive measures to identify individuals with cognitive-communication deficits.

Passive Elaborative Cueing of Retrieval ProcessesFollowing Traumatic Brain Injury

Purpose: Semantic elaboration is a process in which target information is analyzed in relation to content associated in meaning. The goal of the present study was to examine the use of phrasal cues intended to engage elaborative processes theorized to bolster cognitive performance.Methods: Twenty-two individuals with a history of traumatic brain injury (TBI) and twenty-six neurotypical (NT) individuals were studied. Short phrases intended to elicit elaborative encoding were presented prior to the introduction of a prospective memory task and word-stem completions. Phrases embodied one of three conditions: repeated, semantic, or unrelated information. The stem-completion task was presented between each prospective memory task with fixations serving as cues signaling task completion or functioning as distractors. Event-related potentials (ERPs) were captured during the presentation of word-stems. Following the completion of all word-stems, participants were presented with an old/new recognition task.Results: Linear mixed-effects model analyses revealed a significant effect of condition with respect to word retrieval and recognition memory. Captured ERPs revealed neural signatures resembling a P200.Conclusion: Semantic content increased stimulus saliency, facilitated lexical retrieval, and enhanced retention with the latter process revealing use of semantic cues as a more adept rehearsal strategy than repetition.

Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism

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.

Cognitive-communication skills and acute outcome following mild traumatic brain injury

PURPOSE

Little is known about cognitive-communication skills post mild traumatic brain injury (mTBI). We aimed to determine how performance on cognitive-communication measures in the acute recovery period relates to early outcome following complicated mTBI.

METHOD

Results of language and communication skill measures, demographic and accident-related data, length of stay (LOS), Glasgow Outcome Scale-Extended (GOSE) scores and discharge destinations were retrospectively gathered for 128 admitted patients with complicated mTBI.

RESULTS

More than half of the individuals required rehabilitation services post discharge from hospital with over a third needing in-patient rehabilitation. Patients with poorer skills in auditory comprehension, verbal reasoning, confrontation naming, verbal fluency and conversational discourse were more likely to require in-patient rehabilitation. Subjects with worse skills in naming, conversational discourse and letter-category verbal fluency had a greater chance of being referred to out-patient rehabilitation services. Thus patients with both auditory comprehension and oral expression deficits were more likely to require in-patient services whereas those who had oral expression deficits but no significant difficulty in auditory comprehension were more often referred to out-patient services. Also, worse conversational discourse skills and semantic-category naming ability were related to lower GOSE scores and the chance of a longer LOS was greater when letter-category naming was poorer.

CONCLUSION

The likelihood of individuals requiring rehabilitation services post mTBI was related to performance on several oral expression and auditory comprehension measures. It is therefore important to evaluate cognitive-communication skills early to determine rehabilitation needs.

Reaction time and cognitive-linguistic performance in adults with mild traumatic brain injury

Objective: The purpose of this study was to characterize cognitive-linguistic performance in adults with mild traumatic brain injury (mTBI) to advance assessment and treatment practices. We hypothesized that individuals with mTBI would demonstrate longer reaction times (RTs) and greater error rates when compared to an orthopedic injury (OI) group on a category-naming task. Method: Participants were age and education-matched adults with mTBI (n = 20; 12 females) and adults with OI (n = 21; 5 females) who were discharged to home after an Emergency Department visit. Our primary task was a category-naming task shown to be sensitive to language deficits after mTBI. The task was adapted and administered under speeded and unspeeded conditions. Results: There was a significant main effect of condition on RT (speeded faster than unspeeded) and accuracy (more errors in the speeded condition). There was a marginally significant effect of group on errors, with more errors in the mTBI group than the OI group. Naming RT and accuracy in both conditions were moderately correlated with injury variables and symptom burden. Conclusions: Our data showed a marginal effect of group on accuracy of performance. Correlations found between naming and neurobehavioural symptoms, including sleep quality, suggest that the latter should be considered in future research.

Implicit causality bias in adults with traumatic brain injury

INTRODUCTION

Individuals with moderate or severe traumatic brain injury often experience impairments in pragmatic language functions. Pragmatic language has been studied primarily in connected language genres such as narratives. It may be, however, that individuals with traumatic brain injury also miss microscopic cues, such as social cues embedded in single word meanings or sentence structure. The current study examined one type of sentence-level pragmatic language cue: implicit causality bias. Implicit causality bias is the attribution of an interpersonal transitive verb action to either the subject noun phrase or object noun phrase of a sentence, and is an inherent property of English-language verbs.

METHOD

In this study, 19 adults with traumatic brain injury and 18 typical adults were asked to provide sensible and spontaneous completions to 96 sentence fragments. Each fragment contained one interpersonal transitive verb and two noun phrases to which the cause of the verb could be attributed.

RESULTS

Adults with traumatic brain injury showed significantly less implicit causality bias than typical adults, and also made more errors in assigning the causality of a clause.

CONCLUSIONS

These results challenge assumptions regarding intact implicit processing in adults with traumatic brain injury, and reveal mechanisms by which communication could fail in everyday social interactions.

Recognition Accuracy and Reaction Time of Vocal Expressions of Emotion by African-American and Euro-American College Women

This study examined the relationship of racial group membership and vocal expressions of emotion. Recognition accuracy and reaction time were examined using the Diagnostic Assessment of Nonverbal Accuracy 2 Receptive Paralanguage subtests with 18 young Euro-American and African-American women. Participants listened to Euro-American children and adults speaking a neutral sentence, and identified the emotion as happy, sad, angry, or fearful. Analysis identified a significant effect for race on reaction time. Euro-American participants had faster mean RT than the African-American women for the recognition of vocal expression of emotion portrayed by Euro-Americans. However, no significant differences were found in mean accurate identification between the two groups. The finding of a significant difference in recognition RT but not in accuracy between the stimuli spoken by an adult and a child was unexpected. Both racial groups had faster mean RT in response to vocal expression of emotion by children.

The effects of mild traumatic brain injury on confrontation naming in adults

PRIMARY OBJECTIVE

To compare confrontation-naming in adults with MTBI to a group of normal adults under increased processing load conditions.

RESEARCH DESIGN

A randomized block, repeated measures design was used to examine confrontation-naming response latency and accuracy using a computerized experimental program.

METHODS AND PROCEDURES

Twenty-four adults having sustained a MTBI (aged 18-53) and 24 age-matched controls named pictures from three levels of vocabulary as quickly and accurately as possible. All MTBI participants were assessed with the Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) for later comparison.

MAIN OUTCOMES AND RESULTS

The results revealed a main effect of group ( p < or = 0.001) for the latency data and a group by vocabulary level interaction ( p = 0.043) for the accuracy data. No significant correlations were found between response latency and accuracy with performance on the SCATBI. Reaction time measures may reveal inefficiencies not tapped by traditional measures.

The Influence of an Auditory Distraction on Rapid Naming After a Mild Traumatic Brain Injury: A Longitudinal Study

OBJECTIVE

The purpose of this investigation was to examine speeded performance over time and the impact of a common auditory distraction on performance after a mild traumatic brain injury (MTBI).

METHODS

Fourteen adults (ages 18-53) treated for a MTBI and 14 age and education-matched controls were asked to perform two speeded naming tasks. Both tasks were presented with or without the presence a common auditory distraction. The MTBI group was tested within 5 days, 30 days, 60 days, and 6 months postinjury. Latency (ms) and accuracy of response were recorded.

RESULTS

Initially, the MTBI group demonstrated significantly longer response latencies and lower accuracy levels for both tasks. Similar results were found at 30 days postinjury. At 60 days postinjury, no significant difference was found for task 1 accuracy. Significant differences remained for task 1 latency, task 2 latency, and task 2 accuracy. At 6 months postinjury, no significant differences were found. The presence of an auditory distraction differentially affected the MTBI group for task 2 accuracy upon initial testing and at 30 days postinjury only.

CONCLUSIONS

The MTBI group performed both tasks significantly slower and less accurately than the control group upon initial testing and at 30 days postinjury. The presence of pop music further influenced accuracy of complex processing. At 60 days postinjury, accuracy of simple processing returned to preinjury levels and the auditory distraction no longer differentially influenced the MTBI group. All performance differences were resolved at 6 months postinjury.

Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis

There continues to be debate about the long-term neuropsychological impact of mild traumatic brain injury (MTBI). A meta-analysis of the relevant literature was conducted to determine the impact of MTBI across nine cognitive domains. The analysis was based on 39 studies involving 1463 cases of MTBI and 1191 control cases. The overall effect of MTBI on neuropsychological functioning was moderate (d = .54). However, findings were moderated by cognitive domain, time since injury, patient characteristics, and sampling methods. Acute effects (less than 3 months postinjury) of MTBI were greatest for delayed memory and fluency (d = 1.03 and .89, respectively). In unselected or prospective samples, the overall analysis revealed no residual neuropsychological impairment by 3 months postinjury (d = .04). In contrast, clinic-based samples and samples including participants in litigation were associated with greater cognitive sequelae of MTBI (d = .74 and .78, respectively at 3 months or greater). Indeed, litigation was associated with stable or worsening of cognitive functioning over time. The implications and limitations of these findings are discussed.