Narrative discourse impairments in Persian-speaking persons with traumatic brain injury: a pilot study

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls

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.

Discourse in aging: Narrative and Persuasive

The growth in the elderly population has posed a social, economic and health challenge for the twenty-first century.

OBJECTIVE

Aging is often characterized by changes in cognitive functions which affect the receptive and expressive capabilities of language. Since language plays a significant role in human life, we evaluate the existence of age-related differences in narrative and persuasive discourses.

METHODS

The narrative discourse of 91 adults and persuasive discourse of 92 adults,aged from 19 to 75 years and stratified into four age groups,were examined.

RESULTS

There was a statistically significant difference between coherence in the elderly group and each of the other three age groups for both types of discourse. There was also a significant difference for the cohesion variable between the elderly and the first age group for narrative discourse only.

CONCLUSION

The results of this study demonstrate that discourse is influenced by aging and type (genre) of discourse task. Therefore, it is essential for clinicians to take into account the linguistic needs of elderly and incorporate these into their clinical programs. Also, this finding can help clinicians to distinguish between discourses of normal aging and other neurologic disorders (for example dementia, right hemisphere damage, aphasia).

Narrative discourse in Persian-speaking patients with mild Alzheimer's disease

Despite the significance of discourse impairments, they have not been thoroughly investigated in Persian-speaking patients with Alzheimer's disease (AD).

OBJECTIVE

the aim of this study was to perform a multi-level analysis of narrative discourse in Persian-speaking patients with mild AD and to compare them with healthy elderly.

METHODS

the study included 14 older adults with mild AD and a matched group of 14 healthy elderly. Using a storytelling task based on serial pictures, both macro- and micro-linguistic aspects of narrative discourse were assessed. Cohesion ratio and coherence were investigated as macrolinguistic dimensions of discourse. The studied microlinguistic features included syntactic complexity and verbal errors (mostly involving phonological and semantic paraphasias and mazes). Severity of AD was determined using the Cognitive Dementia Rating (CDR).

RESULTS

there were significant differences between the groups regarding cohesion ratio (0.9 ± 0.34 vs. 1.29 ± 0.45, p = 0.02) and coherence scores (2.43 ± 0.41 vs. 3.02 ± 0.81, p = 0.03). Verbal errors and syntactic complexity did not differ significantly between the groups.

CONCLUSION

Persian-speaking patients with mild AD show macrolinguistic impairments in producing discourses based on picture description. Therefore, intervention protocols should focus on the ability to organize information on a specific subject and also to connect sentences produced using appropriate cohesive ties.