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Patterns of impairment of narrative language in mild Traumatic Brain Injury
Abstract
Mild traumatic brain injury (mTBI) represents a condition whose cognitive and behavioral sequelae are often underestimated, even when it exerts a profound impact on the patients' every-day life. The present study aimed to analyze the features of narrative discourse impairment in a group of adults with mTBI. 10 mTBI non-aphasic speakers (GCS > 13) and 13 neurologically intact participants were recruited for the experiment. Their cognitive, linguistic and narrative skills were thoroughly assessed. The group of mTBIs exhibited normal phonological, lexical and grammatical skills. However, their narratives were characterized by the presence of frequent interruptions of ongoing utterances, derailments and extraneous utterances that at times made their discourse vague and ambiguous. They produced more errors of global coherence [F (1; 21) = 24.242; p = .000; ηp2 = 0. 536] and fewer Lexical Information Units [F (1; 21) = 7.068; p = .015; ηp2 = .252]. The errors of global coherence correlated negatively with non-perseverative errors on the WCST (r = −.755; p < .012). The macrolinguistic problems made their narrative samples less informative than those produced by the group of control participants. These disturbances may reflect a deficit at the interface between cognitive and linguistic processing rather than a specific linguistic disturbance. These findings suggest that also persons with mild forms of TBI may experience linguistic disturbances that may hamper the quality of their every-day life.
... The detailed relationship between memory and discourse remains elusive. Studies conducted in populations with neuro-communicative disorders have found the following: in traumatic brain injury, working memory (WM) was found to be correlated with syntactic complexities (Youse and Coelho, 2005) while vSTM was linked to informativeness and global coherence (Galetto et al., 2013); in aphasia, WM was associated with global coherence in story retell (Cahana-Amitay and Jenkins, 2018), but no such an association was observed in personal narratives (Rogalski et al., 2010). Limited research conducted in mild cognitive impairment (MCI) or dementia suggested that episodic memory is correlated positively with global coherence in autobiographical narratives in MCI (Seixas-Lima et al., 2020), and WM negatively correlated with the use of nominal references and pronouns in narratives and picture descriptions, respectively (Almor et al., 1999;March et al., 2009). ...
... Our aim is to examine if discourse can be utilized clinically to inform methods of diagnosing dementia. Specifically, based on the High Level Language Hypothesis (Galetto et al., 2013), macrolinguistic deficits could be attributed to impaired conceptual organization of a narrative; it was therefore hypothesized that (1) there would be a positive association between episodic memory and global coherence of personal narrative. In addition, organizing a discourse requires a person to temporarily move forward or backward between mental sets, a crucial component in vSTM; it was therefore hypothesized that (2) vSTM would be correlated with informativeness of discourse production and empty speech. ...
... Our finding that global coherence is correlated with vSTM measures is in line with previous studies (Brandão et al., 2009;Kim et al., 2019). The relationship between informativeness in picture description (as reflected by the main concept performance) and vSTM confirmed previous reports in AD and traumatic brain injury (Brandão et al., 2009;Galetto et al., 2013). It can be interpreted based on reports investigating neural correlates of vSTM and language production. ...
Introduction
Memory and discourse production are closely related in healthy populations. A few studies in people with amnestic mild cognitive impairment and people with dementia (PWD) suggested similar links, although empirical evidence is insufficient to inform emerging intervention design and natural language processing research. Fine-grained discourse assessment is needed to understand their complex relationship in PWD.
Methods
Spoken samples from 104 PWD were elicited using personal narrative and sequential picture description and assessed using Main Concept Analysis and other content-based analytic methods. Discourse and memory performance data were analyzed in bivariate correlation and linear multiple regression models to determine the relationship between discourse production and episodic autobiographical memory and verbal short-term memory (vSTM).
Results
Global coherence was a significant predictor of episodic autobiographical memory, explaining over half of the variance. Both episodic autobiographical memory and vSTM were positively correlated with global coherence and informativeness, and negatively with empty speech indices.
Discussion
Coherence in personal narrative may be supported by episodic autobiographical memory and vice versa, suggesting potential mechanism of interventions targeting personhood through conversation. Indices of global coherence, informativeness, and empty speech can be used as markers of memory functions in PWD.
... It is necessary to understand EF impairments in these clinical populations since EF deficits contribute to poorer communication outcomes (Diedrichs et al., 2022;Galetto et al., 2013;Kuzmina & Weekes, 2017;Mohapatra, 2019). Assessing EFs using a combination of verbal and nonverbal measures is also important because in certain clinical populations, such as people with aphasia, verbal and nonverbal EFs have unique relationships with language. ...
... power of .8, and a medium effect size (f = 0.25), indicates that the minimum number of participants needed for this study was 28 (16 per group). We based our effect size calculation from work done by Galetto et al. (2013; WCST perseverative errors from Table 4). ...
... In addition to establishing that the VCST measures similar constructs as the BCST, our results also provide important insights into EF deficits in mTBI. We observed that the mTBI group had poorer shifting than the control group on both tasks, which corresponds to previous works (Barlow et al., 2018;Galetto et al., 2013). Shifting is associated with nonperseverative errors (Sullivan et al., 1993), which can be separated into efficiency errors (errors made while the participant is attempting to find the new sorting rule) and distraction errors (errors made after the participant correctly identifies the sorting rule; Nyhus & Barceló, 2009). ...
Purpose:
The Wisconsin Card Sorting Test (WCST) is commonly used to measure nonverbal executive functions (EFs) in a variety of clinical populations. However, in some clinical populations (e.g., people with aphasia), deficits may be present in more linguistic (or verbal) domains and less pronounced in nonverbal domains. Thus, when determining possible deficits in these individuals, it is critical to assess both verbal and nonverbal cognitive abilities. The purpose of this study was to create a verbal card sorting task (VCST) to complement the WCST.
Method:
We created the VCST by modifying a computerized version of the WCST, the Berg Card Sorting Task (BCST). We then compared 35 individuals with mild traumatic brain injury (mTBI) and 33 matched controls' performance on each task. We tested the VCST in individuals with mTBI first because they demonstrate impaired EFs but unimpaired language. We therefore expected the mTBI group to perform similarly on the VCST and BCST, suggesting that the two tasks measure EFs similarly.
Results:
In line with our hypothesis, the mTBI group had unimpaired inhibition and sustained attention but impaired shifting on each task. Component loadings for both tasks were also similar, and participants' inhibition and shifting scores positively correlated across the two tasks.
Conclusions:
Together, these findings suggest that the VCST is a potentially useful tool for measuring verbal EF deficits. Our results also provide important insights into the EF impairments experienced by individuals with mTBI.
Supplemental material:
https://doi.org/10.23641/asha.23230475.
... Specifically, studies have documented difficulty with clear expression of ideas, poor text organization, incomplete content, abrupt topic shifts, and poor overall coherence (Body & Perkins, 2004;Lindsey et al., 2018;Jorgensen & Togher, 2009;King et al., 2006;Snow et al., 1997;Tucker & Hanlon, 1998). This is in line with other TBI-related studies that have reported particular difficulty with discourse organization, inclusion of salient content, productivity, and topic maintenance following TBI (Coelho, 2002;Coelho et al., 2013;Galetto et al. 2013;Norman et al., 2013). Such cognitive communication impairments have been shown to impact TBI outcomes as diverse as job attainment and the development and maintenance of social relationships (Brooks et al., 1987;Cornis-Pop et al., 2012;Galski et al., 1998;Norman et al., 2013). ...
... The discourse outcome measures selected for this study include global coherence and story completeness, which have been found to be sensitive to discourse deficits following TBI (Galetto et al., 2013;. In addition, measures found to be sensitive to PTSD from analyses of trauma narratives include word count, negative emotion, cognitive process, and nonfluencies based on their associations with PTSD symptomology and narratives (Jaeger et al., 2014;O'Kearney & Perrott, 2006;Papini et al., 2015). ...
... Lower global coherence scores in the mTBI group as compared to the NBI group and the lack of differences regarding discourse content mirrors previous research. For example, Galetto et al. (2013) found that individuals with mTBI had adequate lexical and grammatical skills but produced more errors of global coherence, making their discourse samples less informative than those of the control group. Reduced global coherence is likely the result of cognitive dysfunction and may account for some of the difficulty many of these individuals experience with topic maintenance during conversation. ...
Purpose
Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD.
Method
Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness.
Results
Results revealed a significant difference between the mTBI ( Mdn = 3.33) and NBI ( Mdn = 3.50) groups, χ ² (3) = 6.044, p = .017, ε ² = .03, for global coherence. Word count differed significantly between the mTBI + PTSD ( Mdn = 135) and NBI ( Mdn = 195) groups, χ ² (3) = 7.968, p = .006, ε ² = .06. No other group differences were observed.
Discussion
Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.
... According to the DSM-5, the cognitive domain of language includes subdomains corresponding to both expressive language (naming, word-finding, fluency, grammar and syntax) and receptive language (Sachdev et al., 2014). Language domain deficits have been noted during both acute and chronic mTBI, up to ∼3.3 years post-injury (King et al., 2006;Rapoport et al., 2006;Galetto et al., 2013) no distinction between complicated and uncomplicated mTBI being drawn. According to one meta-analysis, mTBI participants exhibited better language performance ∼3 months-post-injury compared to the acute stage, which illustrates how language can improve over time (Belanger et al., 2005). ...
... According to one meta-analysis, mTBI participants exhibited better language performance ∼3 months-post-injury compared to the acute stage, which illustrates how language can improve over time (Belanger et al., 2005). Interestingly, language deficits observed after mTBI (e.g., global incoherence, inaccuracy of information, disruption of utterances) could be consequences of other high-order cognitive impairments-such as slower processing speed, inefficient attentional processing, EF disruption and poor memory encoding-rather than manifestations of true language deficits (Barwood and Murdoch, 2013;Galetto et al., 2013). However, caution should be exerted when drawing any conclusions pertaining to this topic due to the relative paucity of adequately powered studies investigating language after mTBI. ...
... Grammar and syntax may not be affected considerably in the spontaneous speech of TBI patients, as recent studies have found no impairments of such abilities in either mTBI (∼3.3 years postinjury) or moderate TBI (∼1.9 years post-injury), whereas severe TBI patients had somewhat worse performance (∼5.5 years post-injury) (Galetto et al., 2013;Marini et al., 2014Marini et al., , 2017, no distinction being drawn between complicated and uncomplicated mTBI. Although TBI-related syntactic deficits have been noted, such deficits may be the consequence of a primary semantic deficit or, alternatively, could be characteristic of specific samples (e.g., of patients with both TBI and aphasia) (Coelho et al., 2005). ...
Traumatic brain injury (TBI) can be serious partly due to the challenges of assessing and treating its neurocognitive and affective sequelae. The effects of a single TBI may persist for years and can limit patients’ activities due to somatic complaints (headaches, vertigo, sleep disturbances, nausea, light or sound sensitivity), affective sequelae (post-traumatic depressive symptoms, anxiety, irritability, emotional instability) and mild cognitive impairment (MCI, including social cognition disturbances, attention deficits, information processing speed decreases, memory degradation and executive dysfunction). Despite a growing amount of research, study comparison and knowledge synthesis in this field are problematic due to TBI heterogeneity and factors like injury mechanism, age at or time since injury. The relative lack of standardization in neuropsychological assessment strategies for quantifying sequelae adds to these challenges, and the proper administration of neuropsychological testing relative to the relationship between TBI, MCI and neuroimaging has not been reviewed satisfactorily. Social cognition impairments after TBI (e.g., disturbed emotion recognition, theory of mind impairment, altered self-awareness) and their neuroimaging correlates have not been explored thoroughly. This review consolidates recent findings on the cognitive and affective consequences of TBI in relation to neuropsychological testing strategies, to neurobiological and neuroimaging correlates, and to patient age at and assessment time after injury. All cognitive domains recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are reviewed, including social cognition, complex attention, learning and memory, executive function, language and perceptual-motor function. Affect and effort are additionally discussed owing to their relationships to cognition and to their potentially confounding effects. Our findings highlight non-negligible cognitive and affective impairments following TBI, their gravity often increasing with injury severity. Future research should study (A) language, executive and perceptual-motor function (whose evolution post-TBI remains under-explored), (B) the effects of age at and time since injury, and (C) cognitive impairment severity as a function of injury severity. Such efforts should aim to develop and standardize batteries for cognitive subdomains—rather than only domains—with high ecological validity. Additionally, they should utilize multivariate techniques like factor analysis and related methods to clarify which cognitive subdomains or components are indeed measured by standardized tests.
... A. King, Hough, Walker, Rastatter, & Holbert, 2006;Shaffer, Bijur, Chadwick, & Rutter, 1980;Stockbridge, Doran, King, & Newman, 2018;Wrightson, McGinn, & Gronwall, 1995) and verbal fluency for both semantic categories (Ewing-Cobbs, Levin, Eisenberg, & Fletcher, 1987;McCauley et al., 2014) and phonemes (Stockbridge & Newman, 2018). Deficits also have been observed in repeating sentences aloud, writing sentences in response to dictation (Ewing-Cobbs & Barnes, 2002;Ewing-Cobbs et al., 1987), providing transitions between topics, using clear referents (Biddle, McCabe, & Bliss, 1996;Chapman et al., 1992;Ewing-Cobbs, Brookshire, Scott, & Fletcher, 1998), story grammar (i.e., the pattern of introduction, rising and falling action or conflict, and resolution, present in typical descriptions of events), and cohesion (Galetto, Andreetta, Zettin, & Marini, 2013;Marini et al., 2011;Stockbridge & Newman, 2018;Tucker & Hanlon, 1998). Recent and emerging evidence from concussion alone (as compared to mTBI more broadly) has, understandably, provided a more nuanced and inconsistent account of these effects, particularly with regard to deficits in more complex linguistic performance (e.g., Harvey, 2016;Kovach, 2015). ...
... Adding to this overall profile, slowed information processing is a classic observation following mTBI (Babikian & Asarnow, 2009;Tromp & Mulder, 1991) that has garnered increased attention in recent years (Fueger, 2017;Gagnon, Swaine, Friedman, & Forget, 2004) due to observable effects long after the mildest injuries. Mild deficits in problem solving, executive function, and delayed recall have been observed in adults with mTBI as long as 2 years after injury (Galetto et al., 2013). More sensitive measures related to how an individual processes information, rather than task accuracy, may capture a richer array of cognitive changes from mTBIs. ...
... Further work is needed in order to replicate these findings under longitudinal clinical management. Prior studies have found deficits in the provision of essential story information, use of transitions, and cohesion when reporting on pediatric clinical samples that include both mild and more severe injuries (Biddle et al., 1996;Brookshire, Chapman, Song, & Levin, 2000;Chapman et al., 1992;Ewing-Cobbs et al., 1998) or adults with mild brain injury (Galetto et al., 2013;Marini et al., 2011;Tucker & Hanlon, 1998). Particularly relevant to the present work, Galetto et al. (2013) found increased errors in semantically related remote utterances, including tangential utterances, conceptually incongruent information, repetitions and fillers (global coherence; η p 2 = .536), ...
Purpose
The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties.
Method
Participants aged 12–40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions.
Results
Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation.
Conclusions
These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.
... Individuals with closed head injury TBI commonly have difficulty with macrostructural and some microstructural aspects of discourse even in the absence of overt aphasia [3,[17][18][19]. These discourse disruptions can occur in individuals with TBI of any severity, including mild (also called "concussion") [10,18,[20][21][22][23]. Persistent impairments in discourse have been associated with a loss of independence, social isolation, lack of community reintegration, decline in vocational position, depression, and lower quality of life [5,24]. ...
... Macrostructural features include coherence (the relevance of utterances to the theme of the discourse), informativeness (also called completeness), organization (story structure or story grammar), content accuracy (also called critical content), topic management; efficiency (combining critical content and speed), and quality [1,4,12,17,19,21,[30][31][32][33]. Lê and colleagues [4] used a combination of completeness and story grammar to derive a story quality indicator, "story goodness;" they argued plausibly that this should be considered an important metric, as it is what is typically measured in functionally relevant settings: academic settings for children and adolescents, and vocational settings for adults; see also [34]. ...
... There remain, however, very few published investigations examining discourse in genres other than fictional. Whitworth and colleagues [16] characterized the discourse of 30 healthy adults from three age bands (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), 60+ years old) in four genres: recount (personal narrative), procedural, exposition (opinion), and narrative (retelling a fictional narrative) and found coherence to be consistent between the age groups, but informativeness to be slightly lower with older participants. The Whitworth et al. study notwithstanding, research on socially relevant (functional) genres of discourse is sparse. ...
... Both groups were found to exhibit impairments in micro-linguistic measures, but the TBI group was also impaired in global and local coherence. The vast majority of studies on the TBI populations affirmed the deficits in coherence, with greater difficulty with global than local coherence (Galetto, Andreetta, Zettin, & Marini, 2013;Hough & Barrow, 2003). However, it remains inconclusive as to whether the impaired coherence was attributed to the underlying cognitive dysfunctions, language impairment or impacts of elicitation tasks. ...
... To the best of our knowledge, this study is the first among the few reports in the literature that examined global and local coherence of spoken discourse among two different clinical groups of Chinese speakers with CVA and TBI. While most previous studies individually examined a specific narrative type, such as storytelling (Coelho & Flewellyn, 2003;Lindsey et al., 2018) or picture descriptions (Galetto et al., 2013), the present investigation have considered a range of elicitation tasks with reference to AphasiaBank protocol. Our findings revealing the lack of a genre effect on global and local coherence in both clinical groups was novel. ...
... Discourse coherence as a function of language integrity in TBI and CVA Our results regarding both impaired global and local coherence in TBI were largely consistent with previous findings in the English literature (Galetto et al., 2013;Glosser & Deser, 1991;Hough & Barrow, 2003), albeit the lack of statistically significant differences on coherence between the CVA and TBI groups. We argue that these findings further supported the view that speakers with TBI exhibited a great compromise in maintaining and coordinating the overall organisation of the discourse and the relation between adjacent utterances. ...
Purpose: Coherence can reflect subtle language deficits in individuals with traumatic brain injury (TBI) and cerebrovascular accident (CVA). This study aimed at investigating whether global and local coherence in Cantonese-speaking adults with CVA and TBI differ from non-brain-injured (NBI) speakers. Factors contributing to the coherence ratings and impacts of elicitation tasks on coherence were examined.
Method: Two clinical groups with fluent aphasia (7 CVA and 11 TBI) and 18 controls matched in age and education, who were Cantonese speakers living in China participated. Language samples of single and sequential picture description and storytelling were elicited, and subsequently analysed on global and local coherence, content sequence, and informativeness.
Result: TBI speakers had impaired global and local coherence, while CVA speakers had poor global coherence. Sequence of main events produced by the three groups correlated significantly with global coherence. Attention and visuospatial skills were also significantly related to global coherence in both clinical groups. Finally, impaired language integrity was associated with problems of local coherence.
Conclusion: The results were consistent with previous studies. Linguistic deficits of coherence in discourse in the two clinical groups and possible impacts of elicitation tasks on the cognitive demands and coherence ratings were discussed.
... Individuals with TBI without aphasia still present with impairments to both micro-(within utterance) and macrolinguistic (between utterances) processes in discourse Ellis & Peach, 2009;Galetto, Andreetta, Zettin, & Marini, 2013;Hinchliffe, Murdoch, & Chenery, 1998;Peach, 2013). For microlinguistic impairments, the research has been mixed. ...
... Individuals with TBI present with macrolinguistic impairments to discourse (Coelho, 1995;Marini et al., 2011). Individuals with TBI have difficulty in managing and organizing the semantic content during discourse production (Brookshire, Chapman, Song, & Levin, 2000;Galetto et al., 2013;Glosser & Deser, 1990;Le et al., 2011;Marini et al., 2011). This includes omissions of critical information and relevant details (Biddle et al., 1996;Marini et al., 2011) which leads to stories that are often incoherent and difficult to understand. ...
... This includes omissions of critical information and relevant details (Biddle et al., 1996;Marini et al., 2011) which leads to stories that are often incoherent and difficult to understand. Galetto et al. (2013) and Marini et al. (2011) conducted a multilevel error analysis on the narrative discourse samples of individuals with TBI. They discovered that individuals with TBI produced more global coherence errors, such as tangential utterances, which were not relevant to overall topic, as well as conceptually incongruent utterances, which did not conceptually match the stimuli. ...
Background:
Individuals with traumatic brain injury (TBI) present with numerous discourse deficits associated with impairments to the linguistic system and other cognitive systems. Individuals with TBI may produce discourse that is lacking important information and poorly organized, as well as containing numerous coherence disrupting elements. Yet there are few studies directly addressing discourse deficits in individuals with TBI to guide clinicians.
Aims:
The purpose of the study was to determine if discourse processing treatment improved the discourse production in individual with TBI. Aims of the study included determining if the discourse processing treatment improved completeness and informativeness in TBI discourse samples.
Methods & procedures:
The study included three participants with mild-to-moderate TBI. The study utilized an A-B with maintenance design that incorporated components of functional practice, structured cues in the form of comprehension questions and story guide, and meta-cognitive and meta-linguistic processes. Discourse samples were obtained for baseline, treatment, and maintenance one-week and one-month post treatment. Stimuli included 12 sequential pictures, as well as a single picture and a recount probe.
Outcomes & results:
All participants demonstrated small gains in completeness and informativeness for treated items, and 2 of 3 participants demonstrated a medium therapeutic effect for untreated stimuli. Participants also produced discourse with fewer errors for both treated and untreated stimuli after treatment with no therapeutic effect to a small effect for the generalization stimuli.
Conclusions:
The study demonstrated that the discourse processing treatment is capable of producing small therapeutic effects that persisted one-month post treatment in adults with mild-to-moderate TBI.
... For Marini et al. (2017), the association between speech rate and memory occurred only in speakers with moderate as opposed to severe ABI. Memory positively correlated with informativeness (Galetto et al. 2013), which was also associated with executive function (Marini et al. 2014). Reduced intelligibility related to neuro-behavioural and executive dysfunction, poor verbal fluency, working memory, and attention (Rousseaux et al. 2010), as did the production of phonological and semantic errors (LeBlanc et al. 2014, Rousseaux et al. 2010. ...
... Executive function (Le et al. 2014, Marini et al. 2014, attention (Marini et al. 2017), memory (Galetto et al. 2013), and working memory (Chapman et al. 2006 were linked to reductions in local and global coherence. Coelho et al. (2012) found significant associations between working memory and local and global coherence in speakers with L-DLPFC lesions, whereas no correlations were evident in speakers with damage to the right DLPFC. ...
... This review documented ABI-related deficits in productivity, lexical diversity, syntactic complexity, maze production, and the presence of phonological and semantic paraphasias across monologic and conversational discourse. Speakers with ABI also demonstrated comparable performance on micro-linguistic measures to speakers without injury (e.g., Galetto et al. 2013, Moran et al. 2012, which supports the view that deficits at this level are infrequent in this population. This has been attributed to the reduced susceptibility of the cortical regions sub-serving these behaviours to damage (Ulatowska et al. 1981). ...
Background
Cognitive impairment, particularly of executive functioning, has been implicated in deficits in spoken discourse production following acquired brain injury (ABI). However, due to variation in the methodologies and heterogeneity of findings across studies, the nature and extent of this association is not well understood.
Aims
This review aims to synthesize the literature investigating associations between cognitive deficits and discourse impairment after ABI. It is reported in accordance with guidelines of The Preferred Reporting Items of Systematic Reviews and Meta‐Analyses.
Data sources
Searches were conducted of a variety of databases including Medline, PsycINFO, EMBASE, CINAHL, ProQuest, Cochrane and ERIC. Additional studies were identified via reference harvesting.
Eligibility criteria
Studies were included if they reported data on participants with ABI, assessed spoken discourse production and cognitive function, and performed statistical analyses to determine the association between discourse and cognitive variables. This review excluded non‐English sources and those not published in peer‐reviewed journals. Meta‐analyses were not conducted due to variability across tools and terminology used to describe participant injury‐ and non‐injury‐related characteristics and outcomes.
Results
Twenty‐five observational studies were included in the review. Findings revealed significant associations between multiple cognitive functions and discourse across micro‐linguistic to super‐structural measures. Methodological and terminological inconsistencies were identified across studies, which limited systematic comparison of the results.
Conclusions
This review revealed present, yet heterogeneous, relationships between cognitive and discourse deficits in speakers with ABI. Associations were interpreted in light of a well‐established model of discourse processing. Greater comparison across studies would have been facilitated by a standard nomenclature in relation to cognitive constructs and standardized discourse assessment. Future research should explore the influence of injury‐ and participant‐related factors on discourse–cognitive relationships. The lack of information on conversational discourse and paediatric ABI limits the generalizability of this review to daily interaction following ABI. While applicable across the lifespan, in‐depth investigation of discourse following ABI in childhood and adolescence is a priority due to complex changes in language and cognition, and the potential for impairments profoundly impact social, emotional and academic progression into adulthood. Given the centrality of remediating cognitive‐communication difficulties in ABI, the interrelationships between discourse and cognition should retain a critical focus of research. This will inform clinical management and future research with this population. Findings have implications for our theoretical understanding of discourse and the nature of its breakdown in ABI.
... . These deficits can be particularly challenging when a person engages in advanced educational or vocational activities (Galetto et al., 2013;Whelan et al., 2007;Wong et al., 2010). Given that written expression is a sophisticated and high-level form of language production and is a common component of postsecondary academics, this is an area in which effects of mTBI may be particularly detrimental (Wheeler, Nickerson, Long, & Silver, 2014). ...
... Disorders QuarterlyDinnes and Hux research-article2017 1 University of Nebraska-Lincoln, USA mTBI ineffective in revealing significant differences. Instead, case-by-case comparison with normative data is essential when evaluating communication skills (Galetto et al., 2013;Whelan et al., 2007;Wong et al., 2010). In accordance with this notion, researchers have identified discourse analysis as an effective means of investigating communication deficits associated with TBIs across the severity continuum (Coelho, 2002;Galetto et al., 2013;Hartley & Jensen, 1991;Marini et al., 2011;Tucker & Hanlon, 1998;Whelan & Murdoch, 2006;Whelan et al., 2007;Wong et al., 2010). ...
... Instead, case-by-case comparison with normative data is essential when evaluating communication skills (Galetto et al., 2013;Whelan et al., 2007;Wong et al., 2010). In accordance with this notion, researchers have identified discourse analysis as an effective means of investigating communication deficits associated with TBIs across the severity continuum (Coelho, 2002;Galetto et al., 2013;Hartley & Jensen, 1991;Marini et al., 2011;Tucker & Hanlon, 1998;Whelan & Murdoch, 2006;Whelan et al., 2007;Wong et al., 2010). Discourse analysis can be particularly helpful regarding aspects of macrolinguistics involved in the linking of message components and the provision of adequate quantities of salient and relevant information (Galetto et al., 2013;Hux, Wallace, Evans, & Snell, 2008). ...
Written expression is a high-level language process susceptible to impairment given mild traumatic brain injury (mTBI); however, minimal research exists about assessing or treating this aspect of language performance. This study’s purpose was to determine the effect of a multicomponent intervention on the written expression of an undergraduate student with mTBI resulting in generalized expressive language impairment. Pretreatment, intervention, and posttreatment sessions extended over 11 weeks. Intervention addressed semantic associations, semantic mapping, proofreading, organization, foundational skills, and goal setting. Data reflected performance on intervention components, writing probes, and pre–posttreatment completion of a standardized writing measure. Calculation and plotting of correct writing sequence percentages revealed substantial improvement. Linear regression analysis confirmed the trend line slope for intervention probes differed significantly from baseline probes. Comparison of pre–posttreatment test results also confirmed substantial improvement. Multicomponent instruction similar to that recommended for other students with writing challenges may be effective for people with mTBI.
... This has led to conflicting results. For example, even if some evidence suggests that executive difficulties might hinder the ability to organize the micro-and macrolinguistic aspects of a narrative discourse (e.g., monitoring ongoing information while inhibiting irrelevant information as shown in Galetto, Andreetta, Zettin, &Marini, 2013 andGaletto, 2014), other studies failed to find any such relation and have led some authors to postulate a linguistic account of the linguistic difficulties reported in these individuals. For example, Ellis and Peach (2009) hypothesized that the syntactic and semantic impairments observed in persons with TBI may reflect a deficit in online sentence planning. ...
... This has led to conflicting results. For example, even if some evidence suggests that executive difficulties might hinder the ability to organize the micro-and macrolinguistic aspects of a narrative discourse (e.g., monitoring ongoing information while inhibiting irrelevant information as shown in Galetto, Andreetta, Zettin, &Marini, 2013 andGaletto, 2014), other studies failed to find any such relation and have led some authors to postulate a linguistic account of the linguistic difficulties reported in these individuals. For example, Ellis and Peach (2009) hypothesized that the syntactic and semantic impairments observed in persons with TBI may reflect a deficit in online sentence planning. ...
... Their picture descriptions were characterized by mild microlinguistic difficulties (i.e., reduced speech rates) and severe macrolinguistic impairments (i.e., few informative words and several violations of cohesion and global coherence). Interestingly, a factor analysis showed that the reduced speech rate and the high number of cohesive errors were explained by the same factor, whereas the low level of informativeness was explained by the same factor that accounted for the production of errors of global coherence (see also Marini et al., [2014] and Galetto et al., [2013] for similar analyses performed on the narratives produced by persons with moderate and even mild TBI). Unfortunately, such a comprehensive analysis has not been applied yet to the direct comparison of the narratives produced by individuals with TBI of different gravities. ...
Persons with traumatic brain injury (TBI) often experience macrolinguistic (i.e., pragmatic
and discourse) difficulties. However, it is still not clear whether these difficulties are
related to their cognitive impairments and little research has investigated communication
abilities across the severity spectrum of TBI. This study compared the cognitive profile and
narrative performance of persons with mild-to-moderate TBI, individuals with severe TBI
and healthy control participants by adopting a multilevel procedure for discourse analysis.
The results showed both severity-dependent and severity-independent effects on the
participants’ cognitive and narrative skills. A series of correlational analyses and two
Principal Component Analyses confirmed the articulated nature of their narrative impairments
and the complex interplay between cognitive and discourse difficulties in both
groups of patients. The results from this study suggest that trauma severity influences the
gravity of some of the symptoms observed in persons with TBI. At the same time, however,
they highlight the cognitive nature of their narrative difficulties.
... Reports of changes in communication related to disrupted working memory, attention, and executive functioning are common among patients with protracted recovery from mTBI (see Cornis-Pop et al., 2012, for a review) whether from self-report (Kennedy et al., 2021), records review (LeBlanc et al., 2020;Norman et al., 2013Norman et al., , 2020, or behavioral measures (Frencham et al., 2005;Galetto et al., 2013;King et al., 2009;LeBlanc et al., 2021;Norman et al., 2019), but the exact nature and prevalence is unknown. In one study of the incidence of cognitive complaints following concussion, 42%-57% of young adults and adolescents reported these problems (Eisenberg et al., 2014). ...
... Going over the same ground in conversation, switching topics too quickly, and hesitating or pausing while speaking may indicate poor organization of discourse or, when framed with the conversational partner in mind, difficulty with switching between perspectives of the speaker and the listener. Such executive deficits have been observed to impact discourse performance (LeBlanc et al., 2021;Tucker & Hanlon, 1998), with frequent interruptions, reformulations, and poor overall coherence in speakers with mTBI (Galetto et al., 2013). Switching costs, in which accuracy declines and performance slows as people with mTBI attempt to move rapidly between tasks, have also been observed and may underlie such communication failures (Howell et al., 2013;Mayr et al., 2014). ...
Purpose
Speech-language pathologists are increasingly being recognized as key members of concussion management teams. This study investigates whether self-report of communication problems postconcussion may be useful in identifying clients who could benefit from speech-language pathology services.
Method
Participants included 41 adolescents and adults from an outpatient specialty concussion clinic. All completed the La Trobe Communication Questionnaire (LCQ) at admission, and 23 repeated this measure at discharge. Participants were prospectively enrolled, with chart reviews providing demographic, injury, and medical factors. The analysis considered (a) communication complaints and resolution over time, including comparison to two previously published LCQ studies of typical adults and adults with and without traumatic brain injury (TBI); (b) the relationship between communication complaints, participant factors, and common concussion assessments; and (c) factors related to speech-language pathology service referral for rehabilitation.
Results
At first visit, 12 of 41 participants (29%) reported communication problems, although 19 (46%) reported difficulty with greater than half of LCQ items. At a group level, compared to published reference data of both people with chronic mixed severity TBI and controls, participants in this study reported more problems at first visit with communication overall, as well as greater difficulty with the LCQ Initiation/Conversation Flow subscale. Partner Sensitivity subscale scores at first visit were also greater than published control data. LCQ subscale scores of Initiation/Conversation Flow and Partner Sensitivity decreased from first visit to last visit, demonstrating resolution over time. Only concussion symptom scales and not demographic, injury, or cognitive screenings were related to LCQ scores. The same two LCQ subscales, Initiation/Conversation Flow and Partner Sensitivity, predicted referral for speech-language pathology services, along with symptom scales and being injured due to motor vehicle crash.
Discussion
A subset of people recovering from concussion report experiencing communication problems. Reporting of particular communication problems was related to referral for speech-language pathology rehabilitation services and may be useful in directing care after concussion.
... Reports of changes in communication related to disrupted working memory, attention, and executive functioning are common among patients with protracted recovery from mTBI (see Cornis-Pop et al., 2012, for a review) whether from self-report (Kennedy et al., 2021), records review (LeBlanc et al., 2020;Norman et al., 2013Norman et al., , 2020, or behavioral measures (Frencham et al., 2005;Galetto et al., 2013;King et al., 2009;LeBlanc et al., 2021;Norman et al., 2019), but the exact nature and prevalence is unknown. In one study of the incidence of cognitive complaints following concussion, 42%-57% of young adults and adolescents reported these problems (Eisenberg et al., 2014). ...
... Going over the same ground in conversation, switching topics too quickly, and hesitating or pausing while speaking may indicate poor organization of discourse or, when framed with the conversational partner in mind, difficulty with switching between perspectives of the speaker and the listener. Such executive deficits have been observed to impact discourse performance (LeBlanc et al., 2021;Tucker & Hanlon, 1998), with frequent interruptions, reformulations, and poor overall coherence in speakers with mTBI (Galetto et al., 2013). Switching costs, in which accuracy declines and performance slows as people with mTBI attempt to move rapidly between tasks, have also been observed and may underlie such communication failures (Howell et al., 2013;Mayr et al., 2014). ...
Research Objectives
To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services.
Design
Pre-post design.
Setting
Outpatient specialty clinic.
Participants
Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge.
Interventions
Survey completion at first visit and discharge.
Main Outcome Measures
LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records.
Results
Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample.
Conclusions
A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways.
Author(s) Disclosures
We have no conflict of interest to disclose.
... Speed of information processing likely plays a critical role in everyday cognitive-linguistic functions such as word-finding, especially when responding under time pressure. This hypothesis is consistent with results of studies demonstrating that individuals with mTBI have slower speech rate, more effortful naming, and fewer ideas and longer latency times on language tasks when compared to healthy adults (23,46,47). Given the evidence that speed of processing is affected by mTBI, and the potential for slowed speed to affect performance, a promising approach to capturing mTBI effects is to measure RT on cognitive-linguistic tasks. ...
... Researchers have characterized the effect of speed on language in mTBI by administering experimental spoken tasks under timed conditions (48,49), or by including timed variables in narrative tasks (e.g. number of words per minute (1,18,47); ...
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.
... Non-standardized assessments can also elucidate the potential cognitive-communication impairments that may result from concussion. For example, concussed adults describe picture narratives less accurately [34], slower [35], and with more global coherence errors (e.g., tangential utterances, incongruent utterances, repetitions) [36]. These alterations reside at the intersection between cognition and language, providing empirical support for the "high-level language hypothesis": language deficits following TBI may be the result of cognitive, not linguistic alterations [37]. ...
... There are several possible explanations for this paucity of research. First, perhaps language deficits are specifically associated with non-sports-related concussion [29][30][31][32][33][34][35][36], but not SRC. Alternatively, the current lack of research may result from how language assessment batteries were developed. ...
Sports-related Concussions (SRC) and their potential long-term effects are a growing concern among athletes and their families. Research utilizing functional brain imaging/recording techniques (e.g., fMRI, ERP) seeks to explain how neurocognitive brain activity changes in the days and years following SRC. Although language deficits are documented following non-sports related concussion there remains a striking lack of research on how SRCs may influence the language system and their supporting neural mechanisms. Neuroimaging findings, however, demonstrate that SRCs alter structural and functional pathways within the frontotemporal language network. Brain regions included in this network generate language-related event-related brain potentials (ERPs), including the N400 and P600. ERPs have been used to demonstrate long-term neurocognitive alterations associated with concussion and may also provide objective and robust markers of SRC-induced changes to the language system.
... The final four studies included statistical comparisons of individuals with brain injury and controls for percentage of global coherence errors produced during picture description discourse elicitation tasks , Galetto et al. 2013. Marini et al. (2011) included a single picture and two cartoons counterbalanced by order of presentation. ...
... Consequently, the lack of theoretical neurolinguistic or neurobiological explanatory models of global coherence limit the study of global coherence in ageing and neurologically diseased/disordered populations during discourse production. Ultimately, in the absence of a strong theoretical framework to organize the current body of literature, it is unclear if disruptions in global coherence observed in neurologically based disorders are related to independent linguistic deficits, independent cognitive deficits or a combination of the two (Galetto et al. 2013). Future investigations are warranted to determine aspects of linguistic knowledge that contribute to maintenance of global coherence. ...
Background:
Global coherence is a metric of expressive language performance that represents the speaker's ability to initiate, plan and maintain a topic of discussion. Studies indicate that disruptions of global coherence can occur during the ageing process and following neurological disease or injury. However, little is known about the specific impact that the ageing process, disease or injury has on global coherence during discourse production.
Aims:
To review the literature on global coherence in adult populations and assess the impact that age, disease or injury has on global coherence during expressive language tasks.
Methods & procedures:
We completed an in-depth search of Medline and PyschInfo (1990-2014) to identify studies of global coherence in adult populations. We identified studies that included a comparison group and utilized a measure of global coherence during expressive language production among adults.
Outcomes & results:
Twenty studies comprised of 692 study participants who met inclusion criteria were identified for the review of the literature. Studies included participants without neurological impairments and individuals with aphasia, traumatic brain injury, dementia, generalized memory impairment and other neurological conditions. Study results indicated global coherence is an expressive language skill that is influenced by the ageing process and neurological disease or injury.
Conclusions & implications:
Although evidence indicated that global coherence is negatively influenced by ageing and neurological disease/injury, the heterogeneity of study populations, measurement tools and study designs were limiting factors in determining the exact nature by which these factors impact the skill of global coherence.
... Interestingly, errors of cohesion also affected some microlinguistic skills. Similar results have more recently been found on persons with moderate [19] and mild TBI [20] . ...
... The different studies mentioned so far highlight the presence of macrolinguistic difficulties in persons with TBI of different gravities. That said, studies of discourse abilities in individuals with TBI have primarily included English [5,18,21,22] and Italian [6,20,23,24] speakers. Various studies considered different sets of measures, and sometimes for the same measure different or incompatible results have been reported. ...
Objective: Studies have shown the presence of narrative discourse difficulties in persons with Traumatic Brain Injury, even those who do not suffer from aphasia. Yet, there still exist inconsistencies among results of different studies, in particular in microlinguistic level. Moreover, limited languages are studied in this regard. So this study aimed at examining these skills in Persian-speaking individuals with TBI.
The purpose of this pilot study was to analyse the microlinguistic and macrolinguistic skills of Persian-speaking individuals with TBI to determine impaired linguistic measures in different levels of narrative discourse.
Participants and Methods: Fourteen non-aphasic Persian-speaking persons with TBI (9 with severe TBI and 5 with moderate TBI), aged 19-40 years (mean=25.84, SD=5.69) and 61 age-matched healthy adults, completed a narrative task. Measures of language productivity, clause density, verbal-error ratio, and cohesion ratio were calculated. Also, test-retest and inter-rater reliability coefficients were analysed.
Results: The TBI group was impaired on some microlinguistic and all macrolinguistic measures compared to their control peers.
Conclusions: The results of this study suggest that multi-level narrative discourse analysis of Persian-speaking individuals with TBI may be useful for speech/language pathologists wishing to evaluate communication disorders in persons with TBI.
... Therefore, it is good for us now to think about how to approach this textual Anacon. Galetto et al. (2013) and Caspari & Parkinson (2000) suggest that three approaches can be used, namely textual characterization, text type, and translated texts ("translated texts"). ...
This study aims to explore macrolinguistics based on the realm of text with lexical and grammatical means. Also to analyze contrastive texts with textual characteristics, text typology, and translated texts. Some of the other things discussed are ways to analyze discourse, interactions in conversations, and know the components of conversation. Language studies continue to develop from time to time. One of the studies that cannot be separated from language is linguistic studies. The study of linguistics in a language not only covers linguistics from an internal point of view but can also be related to linguistics in general. Macro linguistics in this case is not associated with other disciplines outside of linguistics, but a linguistic study that examines speech based on situations.
... Traumatic brain injury (TBI) can negatively impact many day-to-day functions for individuals, such as the ability to participate in discourse (Coelho, 2007;Galetto et al., 2013;Marini et al., 2011;Stubbs et al., 2018). Impaired discourse is associated with poorer psychosocial adjustment in the first year post-injury (Elbourn et al., 2019). ...
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.
... GC has been associated with working memory (WM) in individuals with aphasia (Cahana-Amitay & Jenkins, 2018) and traumatic brain injury (Coelho et al., 2012). Also in traumatic brain injury, connections between GC and executive function (Le et al., 2014) and delayed recall (Galetto et al., 2013) have been reported. In older adults without brain injury, GC has been linked to executive function (i.e., inhibition) and episodic memory (Wright et al., 2014). ...
Purpose
This study compared global coherence (GC) in individuals with Parkinson's disease (PD) to a healthy older adult (HOA) group during single (sitting) and dual (stationary cycling) tasks. Additionally, it explored the relationship between GC and cognition in PD.
Method
Thirty-seven individuals with PD and 19 HOAs participated in the prospective, cross-sectional study. Participants completed discourse monologues elicited using published prompts while seated and while pedaling a stationary bicycle. Four rating levels of GC were analyzed (GC1 = no relationship to the topic, GC2 = remote relationship, GC3 = conditional relationship, and GC4 = complete relationship) using a published protocol with good interrater reliability and test–retest stability. Participants completed a battery of cognitive tasks, from which four latent factors were extracted: processing speed, working memory, inhibition, and updating.
Results
Linear mixed modeling identified significant effects of GC level and GC level interactions with group, processing speed, and inhibition. The Group × GC Level interaction reflected that the PD group had a higher proportion of GC2 and GC1 utterances and fewer GC4 utterances than the HOA group. No differences between single and dual task conditions were found. Faster speed of processing predicted more GC4 utterances, whereas slower speed of processing predicted more G1 utterances. Better inhibition predicted fewer GC2 utterances. Group also predicted GC4 and GC2 proportions.
Conclusions
Individuals with PD experienced greater difficulties with GC than HOAs. Processing speed and inhibition contributed significantly to GC across groups. Analysis of GC should be considered an informative addition to assessment of communicative effectiveness in PD.
Supplemental Material
https://doi.org/10.23641/asha.20416056
... The multi-level procedure for structural and functional analysis of narrative discourse outlined in the preceding paragraph has proven useful in the assessment of language deficits not only in persons with aphasia (Marini et al., 2007a;Andreetta et al., 2012;Carlomagno et al., 2013;Marangolo et al., submitted 2013aMarangolo et al., submitted , 2014Marangolo et al., 2013b) but also in other neurogenic populations including individuals with right hemisphere damage (Marini et al., 2005a;Marini, 2012), traumatic brain injury (Carlomagno et al., 2011;Marini et al., 2011b;Galetto et al., 2013), schizophrenia (Marini et al., 2008a;Perlini et al., 2012), children with specific language impairment (Marini et al., 2008b) or with Williams' syndrome , and people suffering from Duchenne muscular dystrophy (e.g. Marini et al., 2007b). ...
Di recente numerosi studi hanno dimostrato che i tradizionali test per la valutazione dei disturbi linguistici in pazienti con afasia non sono completamente sufficienti a determinarne le reali competenze comunicative e linguistiche. Di conseguenza, tanto nella ricerca quanto nella pratica clinica si stanno affermando nuovi approcci per valutare queste abilità. Tra questi, l'analisi del loro eloquio spontaneo riveste un'importanza cruciale per il suo alto valore ecologico e la possibilità di esaminare contemporaneamente aspetti strutturali e funzionali del linguaggio. Il presente articolo descrive nel dettaglio una delle tecniche di analisi dell'eloquio narrativo che negli ultimi anni si sta affermando sia nella ricerca che nella pratica clinica. Si tratta di una metodologia per la Valutazione Multilivello dell'Eloquio Narrativo prodotto da pazienti con disturbi del linguaggio (cfr. Marini e coll., 2011). Questa metodologia si basa sull'analisi dei livelli di produttività linguistica, di elaborazione lessicale e grammaticale, di organizzazione narrativa e dei livelli di informatività raggiunti dal paziente. Questa metodologia è stata applicata con successo a numerosi tipi di disturbi, tanto in età adulta (ad es. afasie fluenti e non fluenti, traumi cranici, schizofrenia, demenza di Alzheimer) quanto in età evolutiva (ad es. Disturbi Specifici del Linguaggio, Sindromi di Down e di Williams, Disturbi dello Spettro Autistico).
... Discourse impairments involve impaired organization of content in terms of cohesion and coherence (Coelho, 2007;Coelho, Grela, Corso, Gamble & Feinn, 2005;Marini, Zettin, Bencich, Bosco & Galetto, 2017) and/or reduced communicative efficiency (Galetto, Andreetta, Zettin & Marini, 2013). Pragmatic difficulties in TBI become evident in the context-inappropriate reception and use of language, such as in the interpretation of indirect speech acts (e. g., lies, irony, sarcasm; Arcara et al., 2020;Zimmermann, Gindri, de Oliveira & Fonseca, 2011). ...
Communication disorders following traumatic brain injury have been attributed to social-cognitive dysfunctions. However, this relationship is not always clearly demonstrated in empirical research. This systematic review seeks to clarify the relationship by considering different subcomponents of social cognition and communication. The results show that, for the social-cognitive subcomponents of emotion recognition and empathy, evidence is available mainly for a relationship to global communication abilities. However, we did find a systematic relationship between Theory of Mind and individual aspects of pragmatics (i. e., the processing of irony/sarcasm, insincerity, indirect speech acts). To strengthen the evidence for the role of social-cognitive subcomponents concerning communication, future research could implement a core outcome set based on the present findings.
... deficit but instead occurs, at least in part, because of deficits in other cognitive processes. 3,4 Discourse production is a demanding task that involves the integration of multiple cognitive and linguistic processes. Thus, any disruption in cognitive processing can potentially lead to discourse-level impairments. ...
Persons with traumatic brain injury (TBI) often present with discourse-level deficits that affect functional communication. These deficits are not thought to be primarily linguistic in nature but instead are thought to arise from the interaction of linguistic and cognitive processes. Discourse processing treatment (DPT) is a discourse-based treatment protocol which targets discourse deficits frequently seen in TBI. Attention Process Training-2 (APT-2) is a published treatment protocol which targets four levels of attention. The purpose of this article is to investigate the effectiveness of DPT and APT-2 in improving discourse production and cognition in adults with TBI. Our results suggest that DPT results in greater improvement in discourse informativeness and coherence, but the combination of DPT and APT-2 resulted in greater generalization to untrained stimuli. Both DPT and APT-2 appear to have some potential to improve cognition, but there was intersubject variability with regard to which treatment is more effective.
... Each storytelling was tape-recorded and transcribed verbatim by two authors. The transcripts underwent a multilevel procedure for the analysis of narrative language (Marini, Andreetta, et al., 2011) that has been used with several cohorts of patients with TBI (e.g., Ferretti et al., 2017;Galetto, Andreetta, Zettin, & Marini, 2013;Marini, Andreetta, et al., 2011;Marini et al., 2017), and with individuals with no brain injury (e.g., Marini, Boewe et al., 2005). For the purposes of this study, we focused on two measures that can be derived by such analysis: a measure of productivity, i.e., the number of words produced by participants during each storytelling; a measure of functional communicativeness, i.e., the % of Lexical Information Units (%LIUs) in each storytelling. ...
Objective
Pragmatic impairment and narrative difficulties commonly affect individuals after traumatic brain injury (TBI). Rehabilitative programs may improve such impaired capacities and promote social recovery. Cognitive Pragmatic treatment (CPT) is a rehabilitative group program that encompasses different communicative skills, including sessions dedicated to the ability to structure a discourse with an adequate amount of information and relevant contents. This study aims to determine the efficacy of the CPT program in improving informative skills during narrative production. We also investigated the impact of CPT on some of the patients' cognitive abilities that might affect their communicative skills (e.g., inhibitory control and cognitive flexibility).
Methods
Ten individuals with chronic TBI took part in and completed the CPT program. The participants' narrative abilities were assessed before and after the CPT program, using a picture description task. Moreover, equivalent forms of the Assessment Battery for Communication (ABaCo), and a series of neuropsychological tasks, were administered to the participants to evaluate their pragmatic skills and cognitive profile.
Results
The CPT program induced a significant improvement in pragmatic and informative skills, while no significant improvement was observed in neuropsychological tasks. Importantly, the improvement in pragmatic abilities persisted three months post-training.
Conclusions
The study highlighted the efficacy of the CPT program in improving patients' informativeness, confirming previous reports of its effectiveness in the rehabilitation of communicative-pragmatic skills.
... Researchers report that microstructural aspects of narrative production are generally commensurate with those produced by non-brain-injured peers, but global measures, including content information unit (CIU), efficiency measures, and story grammar analyses, are more sensitive to mTBI-related deficits Marini, Zettin, & Galetto, 2014;Matsuoka et al., 2012). Recently, Galetto, Andreetta, Zettin, and Marini (2013) compared 10 adults with mTBI to non-braininjured peers across a variety of cognitive, linguistic, and narrative assessments. They found no grammatical, lexical, or phonological differences between the groups, but the mTBI group scored significantly poorer than controls in story grammar measures. ...
Purpose:
The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI).
Method:
Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale-Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP).
Results:
Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group.
Conclusions:
The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.
... Therefore , in the critical condition (i.e., narration to a child) the participants were required (but not explicitly asked) to appraise the emotional valence of the stimulus, to down-regulate their consequent emotional reaction according to the interlocutor, and to generate a down-regulated description of the portrayed events. The picture description task employed in this study has been shown to have high ecological validity in the assessment of narrative skills in both healthy individuals (Marini et al., 2005) and brain damaged patients (Galetto et al., 2013). However, since no previous study has used this task to elicit emotional regulation, we preliminarily tested if the emotional content of the narratives could be modulated by the social context of storytelling. ...
In everyday life we need to continuously regulate our emotional responses according to their social context. Strategies of emotion regulation allow individuals to control time, intensity, nature and expression of emotional responses to environmental stimuli. The left inferior frontal gyrus (LIFG) is involved in the cognitive control of the selection of semantic content. We hypothesized that it might also be involved in the regulation of emotional feelings and expressions. We applied continuous theta burst stimulation (cTBS) over LIFG or a control site before a newly-developed ecological regulation task that required participants to produce storytelling of pictures with negative or neutral valence to either a peer (unregulated condition) or a child (regulated condition). Linguistic, expressive, and physiological responses were analyzed in order to assess the effects of LIFG-cTBS on emotion regulation. Results showed that the emotion regulation context modulated the emotional content of narrative productions, but not the physiologic orienting response or the early expressive behavior to negative stimuli. Furthermore, LIFG-cTBS disrupted the text-level structuring of negative picture storytelling and the early cardiac and muscular response to negative pictures; however, it did not affect the contextual emotional regulation of storytelling. These results may suggest that LIFG is involved in the initial detection of the affective arousal of emotional stimuli.
... This study sets the stage for future investigations of the neural underpinnings of discourse processing in adults with and without traumatic brain injury (TBI) to investigate cognitive-communication impairments that are common in the brain-injured population. In persons with brain injury, impairments in discourse have been noted to occur despite intact linguistic abilities at the word and sentence levels and are thought to reflect a disruption of the interplay between language skills and cognitive processes, most notably disrupted executive functions and impaired function of the PFC (Coelho, 2005;Galetto, Andreetta, Zettin, & Marini, 2013;Marini, Zettin, & Galetto, 2014;Ylvisaker, Feeney, & Capo, 2007;Ylvisaker et al., 2001). ...
Discourse is a commonly occurring and cognitively demanding form of naturalistic communication (e.g., conversation, event narration, personal and fictional narratives, text reading/generation). Because of the prevalence of these communication acts in daily routines (e.g., educational, vocational, and social), disrupted discourse is an important target for treatment of persons with cognitivecommunication (CC) disorders (American Speech-Language Hearing Association, 2005). However, there is a paucity of information with regard to the underlying cognitive architecture and processing demands associated with the various forms of discourse in non-brain-injured adults. This is, in part, due to a number of methodological constraints of functional neuroimaging technologies such as functional magnetic resonance imaging that severely limit ecologically typical communication acts such as listening and speaking during scanning. To circumvent these issues, this pilot investigation used functional near infrared spectroscopy (fNIRS) to monitor hemodynamic activity in the prefrontal cortex (PFC) during natural discourse-processing tasks in 13 neurologically healthy adult participants. Task demands were manipulated across a variety of discourse types to elucidate the associated neural and cognitive resources. Results indicate that the comprehension of well-organized discourse text is minimally demanding on the PFC. However, discourse production places a significant burden on the PFC and these processing demands generally reflect the relative complexity of the discourse task. These findings are discussed in terms of potential clinically relevant implications with regard to the elicitation, assessment, and remediation of CC impairments in clinical populations.
... The examination of narrative discourse has become an important clinical tool to describe the effects of traumatic brain injury (TBI) on spoken language (Cannizzaro and Coelho, 2012;Galetto et al., 2013;Marini et al., 2014;Peach, 2013). It has also provided data that have contributed in important ways to understanding how language is organized in both normal and braindamaged speakers (e.g., Adornetti et al., 2014;Cosentino et al., 2013;Glosser and Deser, 1991;Glosser, 1993). ...
... Le ricerche condotte a partire da questo periodo hanno confermato l'esistenza nei pazienti TBI di una dissociazione tra le capacità microelaborative relative all'organizzazione dei singoli enunciati e quelle macroelaborative responsabili dell'organizzazione delle relazioni tra le frasi nel flusso del discorso: i pazienti con TBI non presentano grosse difficoltà nell'organizzare fonologicamente, lessicalmente e sintatticamente le singole frasi, ma hanno deficit marcati nel legare in modo coerente le frasi nel flusso del discorso e della conversazione (cfr. Coelho 2002;Galetto et al. 2013;Glosser, Deser, 1990;Le et al. 2011;Marini et al. 2011). ...
... Le ricerche condotte a partire da questo periodo hanno confermato l'esistenza nei pazienti TBI di una dissociazione tra le capacità microelaborative relative all'organizzazione dei singoli enunciati e quelle macroelaborative responsabili dell'organizzazione delle relazioni tra le frasi nel flusso del discorso: i pazienti con TBI non presentano grosse difficoltà nell'organizzare fonologicamente, lessicalmente e sintatticamente le singole frasi, ma hanno deficit marcati nel legare in modo coerente le frasi nel flusso del discorso e della conversazione (cfr. Coelho 2002;Galetto et al. 2013;Glosser, Deser, 1990;Le et al. 2011;Marini et al. 2011). ...
Il presente volume offre un’introduzione su un tema di crescente interesse nell’ambito delle scienze cognitive del linguaggio: l’analisi del discorso e della conversazione. Tale analisi è condotta all’interno dell’ambito teorico della pragmatica cognitiva, vale a dire in riferimento alle strutture mentali e ai processi coinvolti nell’uso del linguaggio nei contesti comunicativi. Attraverso argomenti teorici ed evidenze empiriche provenienti dalle neuroscienze, i saggi raccolti nel libro mostrano l’importanza che lo studio del discorso e della conversazione riveste per l’elaborazione di un teoria naturalisticamente fondata della comunicazione umana. Con saggi di: Ines Adornetti, Alessandra Chiera, Erica Cosentino, Francesco Ferretti, Rachel Giora, Marzia Mazzer, Teun A. Van Dijk.
... McDonald et al. 1999), specifically in discourse processing. In fact, several studies have shown the existence in these subjects of a dissociation between the abilities underlying local coherence (cohesion) and those that underlie global coherence (e.g., Biddle et al. 1996;Coelho et al. 2012;Galetto et al. 2013;Glosser 1993;Glosser and Deser 1990;Strauss Hough and Barrow 2003;Marini et al. 2011). TBI subjects generally do not present serious difficulties in processing of individual sentences (lexical and syntactic level, i.e., the microlinguistic dimension). ...
In this paper we propose a pragmatic approach to the evolution of language based on analysis of a particular element of human communication: discourse coherence. We show that coherence is essential for effective communication. Through analysis of a collection of neuropsychological and neurolinguistic studies, we maintain that the proper functioning of executive processes responsible for planning and executing actions plays a key role in the construction of coherent discourses. Studies that tested the discursive and conversational abilities of bonobos have showed that apes are unable to construct a flow of discourse governed by coherence, and therefore, apes' conversational interactions are quite different from those of humans. We then propose that the emergence of coherence in communication occurred after the split between great apes' and humans' lines of descendants and that this emergence might have been the result of a specific gradual development in the course of hominin evolution of the executive functions.
... TBI subjects generally do not present serious difficulties processing individual sentences (they have no problems processing lexical items and grammatical aspects) and local coherence, but they have deficits in the organization of global discourse (e.g., Coelho, 2002;Coelho et. al., 2012;Davis & Coehlo 2004;Galetto et al., 2013;Strauss Hough & Barrow, 2003;Marini et al., 2011;McDonald 2008). Consider, for example, the following transcript of a discourse of a TBI patient (C), with a therapist (T) (Perkins 2007, p. 86): ...
In this article we propose that executive functions play a key role in the origin of language. Our proposal is based on the methodological assumption that some of the cognitive systems involved in language functioning are also involved in its phylogenetic origin. In this regard, we demonstrate that a key property of language functioning is discourse coherence. Such property is not dependent on grammatical elements but rather is processed by cognitive systems that are not specific for language, namely the executive functions systems of action planning, control and organization. Data from cognitive archaeology on the making of stone tools show that the processes requested to produce Prehistoric tools imply action organization operations similar to those involved in the processing of coherence. Based on these considerations, we propose that executive functions represent the link between stone tool making and language origins and suggest that they allowed our ancestors to develop forms of proto-discourse governed by coherence.
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.
Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.
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.
Purpose
The study purpose was to capture the clinical practice patterns of speech-language pathologists (SLPs) treating mild traumatic brain injury (mTBI; concussion). Study aims were to (a) characterize expert SLP practice patterns for the management of mTBI and (b) use qualitative content analysis to explore areas of quantitative variability within participants’ responses.
Method
Using a modified Delphi approach, SLPs completed an online survey, with Round 1 responses shaping questions for Round 2. Round 2 results were analyzed using a concurrent partially mixed-methods approach with quantitative and qualitative items. Quantitative consensus agreement levels were set prestudy at 75% agreement or higher. Topic-level items that did not reach consensus were analyzed using qualitative content analysis.
Participants
SLPs engaging in a specialty mTBI-SLP networking group were invited to participate. Round 1 had nine participants (United States: 4, Canada: 5). Round 2 had 18 participants (United States: 12, Canada: 6), with a mean of 15.7 years of experience in mTBI (range: 3–33) and a mean of 7.6 clients with mTBI seen weekly (range: 1–25).
Results
Nearly all topic-level practice items met quantitative consensus (42/45). Consensus areas included using conceptual frameworks, interprofessional teaming, assessment and intervention practices, goal setting, and outcomes. Functional, collaborative, and client-centered care anchored clinical practice. Areas lacking consensus included SLP roles in mTBI mental and somatic health symptoms, specific measurement tools, and intervention dosages. Qualitative themes that emerged included limited interprofessional awareness for the role of SLPs in mTBI and challenges in measurement selection.
Conclusions
Study aims were met with clear consensus on clinical patterns implemented by SLPs specializing in mTBI. Results will inform both current clinical practices and future practice guidelines. High-level guidance and advocacy are needed to clarify SLP practice concerns and advance interprofessional education. Future work should address identified gaps, including targeted assessment tools and consensus on intervention methods.
Research suggests that coherence processing of narratives produced by speakers with traumatic brain injury is dissociated from processing of inter-sentential cohesion and intra-sentential production. The goal of this study was to investigate the relationships between microlinguistic abilities and macrolinguistic operations in narratives produced by individuals with TBI. Narratives with variable story grammar were analysed for co-occurring instances of correct and erroneous cohesive ties, sentence pausing, and mazing to determine the relationships among global coherence, inter-sentential cohesion, and intra-sentential production. Story grammar was predicted by both increased inter-sentential cohesion and increased pausing within sentences. Logistic regression classified the completeness of the story episodes with 94% accuracy based on inter-sentential cohesion and sentence pausing. The results support a resource model of discourse processing where executive disturbances that impair the way individuals with TBI recruit and control cognitive resources result in deficits in multiple levels of discourse processing during narrative construction.
Purpose: Narrative discourse (e.g., telling anecdotes or relating personal events) comprises a key part of social interaction and is commonly affected after traumatic brain injury (TBI). Research over the past decades has enabled improved characterization of discourse impairment after TBI, but a critical lack of research into discourse intervention approaches remains.
Method: This systematic review examined empirical research on narrative discourse intervention after TBI. Searches were conducted on Embase, CINAHL, PsycINFO, and PubMed for original research on spoken narrative discourse treatment, where at least 50% of the study participants were adults with TBI.
Results: Of 519 screened papers, 6 studies met criteria; 3 single case studies and 3 case series studies. Interventions incorporated metacognitive and metalinguistic theoretic principles, with a focus on understanding the structure and elements of narratives. Active components of treatments are discussed and compared in relation to existing narrative discourse treatment programs for other neurological communication disorders.
Conclusions: While all studies reported gains on some measures for treated narratives following intervention, there were mixed results for effect generalization and/or maintenance. INCOG guidelines recommend that interventions after TBI should be contextualized and involve personally relevant materials, and this was not evident in the reviewed intervention approaches. Directions are suggested for clinical practice and future research in treating narratives.
This review aimed at providing a brief and comprehensive summary of recent research regarding the use of the Wisconsin Card-Sorting Test (WCST) to assess executive function in patients with traumatic brain injury (TBI). A bibliographical search, performed in PubMed, Web of Science, Scopus, Cochrane Library, and PsycInfo, targeted publications from 2010 to 2020, in English or Spanish. Information regarding the studies' designs, sample features and use of the WCST scores was recorded. An initial search eliciting 387 citations was reduced to 47 relevant papers. The highest proportion of publications came from the United States of America (34.0%) and included adult patients (95.7%). Observational designs were the most frequent (85.1%), the highest proportion being cross-sectional or case series studies. The average time after the occurrence of the TBI ranged from 4 to 62 years in single case studies, and from 6 weeks up to 23.5 years in the studies with more than one patient. Four studies compared groups of patients with TBI according to the severity (mild, moderate and/or severe), and in two cases, the studies compared TBI patients with healthy controls. Randomized control trials were seven in total. The noncomputerized WCST version including 128 cards was the most frequently used (78.7%). Characterization of the clinical profile of participants was the most frequent purpose (34.0%). The WCST is a common measure of executive function in patients with TBI. Although shorter and/or computerized versions are available, the original WCST with 128 cards is still used most often. The WCST is a useful tool for research and clinical purposes, yet a common practice is to report only one or a few of the possible scores, which prevents further valid comparisons across studies. Results might be useful to professionals in the clinical and research fields to guide them in assessment planning and proper interpretation of the WCST scores.
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
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.
Background: Social communication assessment after traumatic brain injury (TBI) remains a challenging area within speech-language pathology (SLP) clinical practice. Difficulties include the lack of TBI-specific standardized assessment instruments and limited knowledge and uptake of discourse assessment methods clinically. The aim of this paper was to review recent research literature reporting on innovative social communication and discourse assessment measures and methods, to guide evidence-based SLP practice and inform future research.
Main Contribution: This review describes novel standardized and non-standardized assessment tools for SLP use reported in TBI research literature from the past 15 years. Measures include published assessment batteries and pragmatic rating scales designed for use with adults with TBI, and novel discourse tasks and protocols.
Conclusion: This paper delineates social communication assessment measures and discourse analyses described in research literature that may be practical for SLPs to use with adults with TBI. The clinical implications and utility of these measures are discussed. This should assist SLPs in decision-making on social communication assessment for adults with TBI. Further research is needed to investigate translation of research knowledge on discourse assessment methods to SLP practice.
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.
In this paper, we examine a particular property of language functioning: coherence. Through theoretical arguments and empirical data, we show that in order to explain the processing of coherence it is necessary to switch from the models of language grounded on grammar and sentence (microanalysis), such as Chomsky’s Universal Grammar, to the models of language grounded on pragmatics and discourse (macroanalysis). Specifically, we argue that coherence is a property that emerges at the level of discourse and that its processing is independent from devices tied to the processing of the constituents structure of the sentence. By taking into account the studies on the discursive capacities of subjects with traumatic brain injuries, we show that discourse coherence relies on the executive functions of action planning and monitoring.
Higher level traumatically brain-injured (TBI) adults often present a challenge in assessment as well as in the measurement of recovery. Traditional clinical measures of language abilities have not been adequate to identify and describe precisely what is deviant about their communication. Assessment has generally consisted of aphasia tests and measures of general cognitive abilities. Although such measures may be sensitive to deficits in lower level TBI patients or those in the early stages of recovery, their usefulness with higher functioning patients is questionable due to the often subtle nature of their residual communication problems. An overview of discourse analyses is presented and recent applications of these procedures with TBI patients reviewed.
Recent investigations have documented a variety of discourse deficits following traumatic brain injuries (TBI). However, there is a paucity of information relating to the treatment of such deficits. The present study investigated the treatment of discourse production deficits, specifically story grammar ability, in an individual with TBI. Treatment emphasized meta-linguistic comprehension of story grammar structure and the identification and generation of episode components within stories. Over the course of treatment, a marked increase in the number of complete episodes generated by the individual with TBI was noted in story grammar probes. Follow-up probes at 1 and 3 months post-treatment, however, indicated limited carryover and poor generalization of the treatment effects. Findings are interpreted in terms of the individual' s chronic cognitive deficits, disruptions in managerial knowledge, and the limitations of treating discourse acontextually.
This study investigated the relationship between working memory (WM) and narrative discourse production in individuals with closed head injury (CHI). It was hypothesized that those individuals with higher performance on tests of WM would demonstrate better performance on measures of discourse production.
Correlation coefficients were calculated among five discourse measures from two story narratives and scores from three sub-tests of the Wechsler Memory Scale (WMS). Methods and procedures: Fifty-five individuals with moderate-to-severe CHI were studied. Participants included 16 females and 39 males ranging in age from 16-69. Narrative discourse samples were elicited from all participants under two conditions: story retelling and story generation.
The results revealed a number of modest, significant correlations (r=0.29-0.39, p<0.05) between sub-tests of the WMS and measures of discourse production.
Results supported the hypothesis. Story elicitation task differences, limitations of using simple memory span tests as indices of WM and clinical implications of the relationship between WM and discourse production are discussed.
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.
Bac.kground: Story grammar is a super-structural measure of discourse performance that has shown to be sensitive to the deficits seen following traumatic brain injury (TBI). Narrative organisation and identification of logical relationships between events and characters are key components of story grammar. Reports of significant correlations for measures of story grammar and scores from various tests of executive functioning for individuals with TBI are thought to reflect executive control of cognitive and linguistic organisational processes. Aims: The purpose of the present study was to re-examine the relationship between story grammar and executive functions (EF) in a large group of participants with severe TBI secondary to diverse penetrating head wounds. It was hypothesised that participants with TBI would have significantly lower story grammar scores than a comparison group without TBI, and that story grammar performance of the group with TBI would be significantly correlated with their EF scores. Methods & Procedures: A total of 167 participants with TBI and a comparison group of 46 adults without TBI were asked to retell a 16-frame story. Transcripts of each story retelling were broken into T-units and were analysed for story grammar. Outcomes & Results: Results of MANOVA showed significant effect of group on the discourse measures. Univariate tests showed significant differences between the group with TBI and the comparison group for each of the story grammar measures. Story grammar measures were significantly correlated with executive function (EF) scores. Conclusions: Results indicated that the participants with TBI demonstrated significantly poorer performance on measures of story grammar abilities, lending support to earlier reports of story grammar impairments resulting from closed head injury (CHI). The present study also found significant correlations for measures of story grammar and the Sorting Test. Cognitive skills such as mental flexibility, required for successful performance on this card sorting task are likely the same as those required for episode generation. These findings have clinical implications for the management of cognitive-communication disorders in individuals with TBI. First, story grammar warrants inclusion in analyses of discourse. Second, discourse deficits following brain injury do not resolve spontaneously and persist as social barriers.
Individuals with traumatic brain injury (TBI) frequently encounter cognitive communication disorders. Deficits can be subtle but can seriously influence an individual's ability to achieve life goals. Feedback from rehabilitation facilities indicated that high level cognitive communication disorders are not consistently identified in the acute setting. This study aimed to compare the cognitive communication results from two screening assessments, the Cognistat and the Cognitive Linguistic Quick Test (CLQT), in participants with a mild traumatic brain injury and to relate these findings to a range of prognostic indicators.
Eighty-three adults post-TBI (16-81 years; 79.5% males) were recruited at an acute trauma centre. The language components of the two tests were analysed.
The CLQT identified more participants with an impairment in language than the Cognistat, 19.3% compared to 1.2% (p < 0.001). No clinical variables relating to the participants' brain injury were found to be associated with language impairment.
This study found that the CLQT identified more individuals with high level cognitive communication deficits than the Cognistat in the acute setting.
The purpose of this article was to evaluate a new measure of story narrative performance: story completeness. It was hypothesized that by combining organizational (story grammar) and completeness measures, story "goodness" could be quantified.
Discourse samples from 46 typically developing adults were compared with those from 24 adults with acquired brain injuries. Story retellings were elicited and analyzed for episode structure (story grammar). Each story was also evaluated for the presence of 5 key components, yielding the story completeness score. Story goodness was quantified by combining the story grammar and completeness measures using a 2-coordinate grid system. A multivariate analysis of variance was performed as well as correlational analyses between the story grammar and story completeness scores.
There were significant group differences on both story grammar and story completeness. Moderate correlations were noted between the 2 measures, suggesting that the indices were not entirely measuring the same abilities. Plotting the 2 sets of scores into quadrants discriminated the comparison group and the group with brain injury into 4 distinct categories of story "goodness."
The combination of measures provided a more accurate depiction of discourse performance than either measure alone. Results suggest the measure is sensitive, is reliable, and has potential utility for investigating discourse deficits in clinical populations.
Traumatic brain injury (TBI) is a common occurrence with multiple possible neuropsychiatric sequelae, including problems with cognition, emotion, and behavior. While many individuals experience significant improvement over the first months following mild TBI, a nontrivial minority will develop persistent, functionally impairing post-TBI symptoms. Depression and cognitive impairment are among the most common such symptoms, and they may respond to a combination of rehabilitative and pharmacologic treatments. This article discusses the clinical approach to treating an individual with depression and cognitive complaints following mild TBI. Recommendations regarding the diagnosis, evaluation, and treatment of these problems are offered.
Movement disorders attack the part of the brain that controls our movements, they are a complex group of disorders, spanning all aspects of neurological illnesses. Such disorders are widespread, often destroying the independence of those affected. Movement Disorders in Clinical Practice provides a concise, practical overview of the diagnosis, treatment and management of patients with these debilitating conditions, including a brief evaluation of ongoing clinical trials. Edited by two key international movement disorder experts, chapters cover: Parkinson's disease Parkinsonian syndromes Dystonia Tremor Restless legs syndrome An overview of other movement disorders
The purpose of this study was to examine discourse production in adults with traumatic brain injury (TBI) using a picture description and a story retelling task. Our questions were: (1) do individuals with TBI perform differently from educationally compatible controls, and (2) what is the relationship between severity of initial injury and performance on these tasks? Ninety-four individuals with mild, moderate, or severe TBI and 38 control subjects participated. All subjects with TBI had been referred to speech pathology for treatment, but none had yet returned to his or her former employment. The samples were analyzed on a variety of measures that reflect quantity and efficiency of production. Results suggested some task differences that may be associated with varying cognitive demands. For the picture description task, subjects with TBI spoke more slowly, communicated content at a slower rate, and produced longer mazes than did control subjects. On the other hand, stories produced by individuals with TBI were shorter and contained less content than those produced by controls. There was little relationship between the severity of the initial injury and performance on a variety of measures of spoken discourse. Implications are discussed for the diagnostic, prognostic, and treatment challenges in this population.
Objective:
To provide an overview of a series of projects that used a structured self-report screening tool in diverse settings and samples to screen for lifetime history of traumatic brain injury (TBI).
Setting:
Diverse community settings.
Participants:
Homeless persons (n = 111), individuals with HIV seeking vocational rehabilitation (n = 173), youth in the juvenile justice system (n = 271), public schoolchildren (n = 174), substance users (n = 845), intercollegiate athletes (n = 90), and other community-based samples (n = 396).
Design:
Cross-sectional.
Main measure:
Brain Injury Screening Questionnaire.
Results:
Screening using the Brain Injury Screening Questionnaire finds that 27% to 54% of those in high-risk populations report a history of TBI with chronic symptoms. Associations between TBI and social, academic, or other problems are evident in several studies. In non-high-risk community samples, 9% to 12% of individuals report TBI with chronic symptoms.
Conclusion:
Systematic TBI screening can be implemented efficiently and inexpensively in a variety of settings. Lifetime TBI history data gathered using a structured self-report instrument can augment existing estimates of the prevalence of TBI, both as an acute event and as a chronic condition. Identification of individuals with TBI can facilitate primary prevention efforts, such as reducing risk for reinjury in high-risk groups, and provide access to appropriate interventions that can reduce the personal and societal costs of TBI (tertiary prevention).
A group with closed head injury was compared to neurologically intact controls regarding the referential cohesion and logical coherence of narrative production. A sample of six stories was obtained with tasks of cartoon-elicited story-telling and auditory-oral retelling. We found deficits in the clinical group with respect to referential cohesion, logical coherence, and accuracy of narration. The occurrence of deficits depended on the condition of narrative production and, to some extent, on the particular story used. The primary implications of this study pertain to the attention given by researchers to the feature of discourse production being studied and processing demands of the task.
The Reitan-Indiana Aphasia Screening Test (form for young children), which requires only 10–15 minutes for administration, was evaluated as a screening procedure for identifying children with neuropsychological deficits who may benefit from a comprehensive neuropsychological evaluation. Comparisons of groups of normal and braindamaged 6-, 7-, and 8-year-old children indicated that this brief test not only is quite accurate in identifying impaired children, but also correlates well with WISC-R Full Scale IQ when assessed across the range of performances shown by normal and braindamaged children.
In this editorial, the importance of context in communication after traumatic brain injury (TBI) is discussed. Context is defined in a number of ways including the socio-cultural background of the individual, the specific social context of any given communicative setting and the cognitive context of the individual including their prior knowledge and coexisting cognitive deficits. Each of these is covered elsewhere in this special issue of Aphasiology and mentioned perfunctorily here. In addition, however, it is argued that social perception, the ability to read social contextual cues, while critical to language competence is an area that has received relatively little attention in the research literature. However there is evidence that TBI individuals have problems understanding paralinguistic information (e.g. tone of voice), non-verbal cues (e.g. facial expression) and contextual information (e.g. relationship between speakers). The potential role of cognitive disturbances in producing such deficits is briefly considered.
Background: This study examined the utility of story “goodness”, a measure of organisation and completeness, in quantifying narrative discourse deficits following traumatic brain injury (TBI). In an initial study, the story goodness measure demonstrated sensitivity and reliability in distinguishing individuals who had TBI from those who were non-brain-injured.
Aims: The purpose of the current study was to validate previous findings of the story goodness index, specifically in discriminating performance between groups and identifying performance subgroups, in a larger sample of participants with TBI.
Methods & Procedures: A total of 46 non-brain-injured adults and 171 adults with TBI participated. Story retellings were analysed for story grammar and story completeness. The two discourse scores were then plotted as coordinates, which allowed for quantification of story goodness. Statistical analyses included a multivariate analysis of variance and calculation of Pearson correlation coefficients for the discourse measures.
Outcomes & Results: Results indicated that participants’ scores clustered differentially across quadrants between groups and discriminated groups into four distinct categories of story “goodness”.
Conclusions: Findings paralleled those found in the initial study, suggesting that story goodness is a sensitive measure for examining the discourse of individuals with TBI. The story goodness has potential clinical utility and may have implications for investigation of discourse impairments in other clinical populations and treatment of discourse deficits.
Individuals with damage to the prefrontal cortex, and the dorsolateral prefrontal cortex (DLPFC) in particular, often demonstrate difficulties with the formulation of complex language not attributable to aphasia. The present study employed a discourse analysis procedure to characterize the language of individuals with left (L) or right (R) DLPFC lesions. All participants were 30-35 years post-onset of injury and presented with persistent discourse impairments. The discourse performance of the R DLPFC group was not significantly different from either the L DLPFC group or the non-injured comparison group. Individuals from the L DLPFC group demonstrated specific difficulties with narrative coherence and inclusion of critical story components. Both measures were significantly different from the comparison group. The discourse ability of the DLPFC groups was significantly correlated with measures of working memory. Findings support the use of discourse analysis for examining language impairments in individuals with PFC lesions.
The production of informative messages is an effortful endeavor that relies on the interaction between microlinguistic (i.e., lexical and grammatical) and macrolinguistic (i.e., pragmatic and discourse) levels of processing. Although the neural correlates of microlinguistic processing have been extensively studied, investigation of the ability to organize the macrolinguistic aspects of message production is scanty. In this article, we show that repetitive TMS of the dorsal portion of the anterior left, but not right, inferior frontal gyrus reduces the levels of lexical informativeness and global coherence of narratives produced by healthy individuals. Interestingly, levels of productivity and microlinguistic processing were unaffected by the stimulation. These results suggest that the dorsal aspect of the anterior left inferior frontal gyrus is an epicenter of a wider neural network subserving the selection of contextually appropriate semantic representations.
Despite the long-standing interest in structural aspects of aphasic production, no method has emerged for the systematic analysis of aphasic speech. This paper attempts to address that need by outlining a procedure for the quantitative assessment of narrative speech which yields measures for both morphological and structural characteristics of aphasic production. In addition to complete instructions for carrying out this analysis, data for three groups of subjects are presented: agrammatic aphasics, aphasics who are similarly nonfluent but not clinically judged as agrammatic, and normal controls. While the agrammatics were distinguishable from the nonagrammatic patients on most measures, both nonfluent groups showed comparable reductions in the structural complexity of their propositional utterances. Other findings include indications from individual patient data that aspects of grammatical morphology may dissociate in agrammatism.
Currently, computational linguists and cognitive scientists working in
the area of discourse and dialogue argue that their subjective judgments
are reliable using several different statistics, none of which are
easily interpretable or comparable to each other. Meanwhile, researchers
in content analysis have already experienced the same difficulties and
come up with a solution in the kappa statistic. We discuss what is wrong
with reliability measures as they are currently used for discourse and
dialogue work in computational linguistics and cognitive science, and
argue that we would be better off as a field adopting techniques from
content analysis.
Background: Several studies have shown that traditional standardised aphasia tests may not be sensitive enough to adequately assess linguistic deficits and recovery patterns in persons with aphasia. As a result, both functional and structural methods for the analysis of connected language samples from people with aphasia have been devised (see Armstrong, 20001.
Armstrong , E. 2000. Aphasic discourse analysis: The story so far. Aphasiology, 14(9): 875–892. [Taylor & Francis Online], [Web of Science ®], [CSA]View all references; Prins & Bastiaanse, 200449.
Prins , R. and
Bastiaanse , R. 2004. Analysing the spontaneous speech of aphasic patients. Aphasiology, 18(12): 1075–1091. [Taylor & Francis Online], [Web of Science ®]View all references). Aims: The present article focuses on our attempt to provide a comprehensive, multi-level procedure for both structural and functional analysis of narrative discourse produced by speakers with brain damage. Accordingly, we will describe a method for analysis of connected language samples elicited on single picture and cartoon story description tasks. This method has proven sensitive in the assessment of language deficits in many neurogenic populations. Methods & Procedures: A comprehensive description of the language production system, a thorough discussion of the different approaches to discourse analysis in persons with aphasia, and the procedure for the analysis of narrative discourse are detailed. The characteristics of the eliciting stimuli, the procedures for their administration and the transcription of the language samples are carefully explained. The analysis focuses on four main aspects of linguistic processing: productivity, lexical and grammatical processing, narrative organisation, and informativeness. To further illustrate the analytic procedure, two case reports and an appendix with the analysis of a narrative sample are provided. Outcomes & Results: We will provide direct evidence of the usefulness of the multi-level procedure for discourse analysis for assessing changes in discourse performance of two persons with fluent aphasia, with different aetiologies, that were not captured by traditional standardised aphasia tests. Conclusions: The method of analysis presented in this paper has strong grounds in linguistic and psychological theories of linguistic structure and functioning. It also has the advantage of being both quantitative and functional as it captures selective aspects of linguistic processing, and can provide relevant information about the person's communicative and informative skills.
The functional evaluation of discourse informativeness is widely used in both clinical practice and research, and impoverished and confused discourse has been described in individuals with traumatic brain injury (TBI). These symptoms have been related to language processing deficits at the macrolinguistic level. However, the functional counterpart of these deficits, i.e. poor informativeness in standardized analysis of elicited speech samples, has been less explored.
In this pilot study, samples of narrative discourse from 10 non-aphasic TBI adults and 28 healthy adults were examined to study the relationship between standardized measures of informativeness (i.e. Correct Information Unit analysis) and language processing errors at the macrolinguistic level and to compare performance of the two groups.
The participants with TBI did not produce relevant within-sentence errors and information content of their narratives was not different from that of the healthy participants. However, their production of errors of cohesion, local coherence and global coherence was significantly greater. These macrolinguistic errors corresponded to reduced levels of information efficiency (% CIUs score).
Functional measures of speech informativeness such as the CIU scores may be useful for the clinical assessment of discourse processing deficits in TBI individuals without aphasic symptoms.
Persons with traumatic brain injury (TBI) often show impaired linguistic and/or narrative abilities. The present study aimed to document the features of narrative discourse impairment in a group of adults with TBI. 14 severe TBI non-aphasic speakers (GCS<8) in the phase of neurological stability and 14 neurologically intact participants were recruited for the experiment. Their cognitive, linguistic and narrative skills were thoroughly assessed. The group of non-aphasic individuals with TBI had normal lexical and grammatical skills. However, they produced narratives with increased errors of cohesion and coherence due to the frequent interruption of ongoing utterances, derailments and extraneous utterances that made their discourse vague and ambiguous. They produced a normal amount of thematic units (i.e. concepts) in their narratives. However, this information was not correctly organized at micro- and macrolinguistic levels of processing. A Principal Component Analysis showed that a single factor accounted for the production of global coherence errors, and the reduction of both propositional density at the utterance level and proportion of words that conveyed information. It is hypothesized that the linguistic deficits observed in the participants with TBI may reflect a deficit at the interface between cognitive and linguistic processing rather than a specific linguistic disturbance.
Cortical and subcortical gray matter volumes were correlated with a set of linguistic scores in a group of schizophrenia patients. Lexical informativeness was positively associated with the volume of the left frontal cortical and accumbal areas, while left hippocampal atrophy and right ventricle enlargement predicted increased production of semantic paraphasias. Global coherence impairment was predicted by left accumbal volume reduction and left ventricle enlargement. These data confirm that the brain structure of specific cortical and subcortal areas, as determined by magnetic resonance imaging, is related to the compromised semantic retrieval and language control in schizophrenia.
Preparing words in speech production is normally a fast and accurate process. We generate them two or three per second in fluent conversation; and overtly naming a clear picture of an object can easily be initiated within 600 msec after picture onset. The underlying process, however, is exceedingly complex. The theory reviewed in this target article analyzes this process as staged and feedforward. After a first stage of conceptual preparation, word generation proceeds through lexical selection, morphological and phonological encoding, phonetic encoding, and articulation itself. In addition, the speaker exerts some degree of output control, by monitoring of self-produced internal and overt speech. The core of the theory, ranging from lexical selection to the initiation of phonetic encoding, is captured in a computational model, called WEAVER++. Both the theory and the computational model have been developed in interaction with reaction time experiments, particularly in picture naming or related word production paradigms, with the aim of accounting for the real-time processing in normal word production. A comprehensive review of theory, model, and experiments is presented. The model can handle some of the main observations in the domain of speech errors (the major empirical domain for most other theories of lexical access), and the theory opens new ways of approaching the cerebral organization of speech production by way of high-temporal-resolution imaging.
We investigated the relationship of executive functioning and self-awareness to participation in daily life of people after mild traumatic brain injury (mTBI) referred to occupational therapy in the postacute phase.
Thirteen participants who sustained mTBI (average time since injury = 4.7 months, mean age = 43.4 years) were evaluated with the Behavioral Assessment of the Dysexecutive Syndrome, the Dysexecutive Questionnaire, the Self-Awareness of Deficits Interview, and the Participation Index (PI) of the Mayo-Portland Adaptability Inventory.
Analysis revealed high frequencies of deficits in executive functions such as planning and shifting. However, self-awareness of the executive deficits was intact. A significant percentage (62%-85%) of participants experienced restrictions in everyday life activities, and PI scores were significantly correlated with measures of executive functioning.
After mTBI, people may be at significant risk for persistent executive deficits and restrictions in participation that warrant occupational therapy intervention.
Language disturbance is one of the main diagnostic features in schizophrenia and abnormalities of brain language areas have been consistently found in schizophrenic patients. The main aim of this study was to describe the impairment of micro and macrolinguistic abilities in a group of twenty-nine schizophrenic patients during the phase of illness stability compared to forty-eight healthy participants matched for age, gender and educational level. Microlinguistic abilities refer to lexical and morpho-syntactic skills, whereas macrolinguistic abilities relate to pragmatic and discourse level processing. Secondary aims were to detect the effect of macrolinguistic on microlinguistic ability, and the neuropsychological impairment associated with the linguistic deficit. The linguistic assessment was performed on story-telling. Three narratives were elicited with the help of a single-picture stimulus and two cartoon stories with six pictures each. A modified version of the Mental Deterioration Battery was used to assess selective cognitive performances. A series of t-tests indicated that all the macrolinguistic variables were significantly impaired in schizophrenic patients in at least one of the three story-tellings. Furthermore, the limited impairment found in microlinguistic abilities was influenced by macrolinguistic performance. Multivariate stepwise regression analyses suggested that reduced attention performances and deficit in executive functions were predictors of linguistic impairment. Language production in schizophrenia is impaired mainly at the macrolinguistic level of processing. It is disordered and filled with irrelevant pieces of information and derailments. Such erratic discourse may be linked to the inability to use pragmatic rules and to cognitive deficits involving factors such as attention, action planning, ordering and sequencing.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Aspects of productivity, content, and cohesion in the narrative and procedural discourse of 11 closed head-injured (CHI) adults and 21 normal adults were examined. Two narrative tasks, one involving retelling a story heard and the other formulating a story based on a comic strip, and one procedural task of telling how to buy groceries were administered to each subject. CHI subjects consistently produced fewer words, spoke slower, used more mazes (dysfluencies), produced fewer target content units, and used fewer cohesive ties per utterance, as compared to the normal subjects. Other significant differences in discourse occurred between the two groups, but these varied from task to task. Normal subjects varied characteristics of their discourse performance according to the discourse task. Significant differences across tasks occurred on seven of the 13 discourse measures. The CHI subjects, however, showed more limited variation in that their performance varied on only three of the 13 measures. Correlations among discourse, language, and memory measures were examined and discussed. The results of this study indicate that analysis of CHI narrative and procedural discourse has important clinical and theoretical implications.
Dissociations between impairments in microlinguistic and macrolinguistic abilities were examined in brain-damaged patients to assess whether these abilities are psychologically and neurologically distinct. The discourse productions of three groups of patients with equally severe fluent language disorders, but varying neuropathology and varying profiles of associated nonlinguistic cognitive impairments, were analyzed. Patients with fluent aphasia secondary to a single left-hemisphere CVA showed the greatest impairment on syntactic and lexical error measures taken to reflect microlinguistic abilities, but normal performance on measures of macrolinguistic organization (i.e., thematic coherence). Patients with probable Alzheimer's Disease were impaired on thematic coherence measures, but not on measures reflecting microlinguistic syntactic and phonological processes. Closed head injury patients whose primary clinical symptom was a fluent language disorder were impaired on both microlinguistic and macrolinguistic measures, which appears to parallel their deficits both in language-specific and in nonspecific, higher-order, diffusely organized cognitive processes.
The Shewan Spontaneous Language Analysis (SSLA) system is designed to describe and quantify aphasic subjects' connected language using a picture description task. The 12 SSLA variables measure the three components of the linguistic system and additional general parameters of verbal output. Intrajudge, interjudge, and test-retest reliability are within acceptable psychometric standards. The SSLA correlates significantly with clinical judgments of the severity of connected language impairment. The system differentiates aphasic from normal performance, using both clinical and statistical methods. SSLA performance data for a group of aphasic subjects and a group of normal controls will be presented.
A scrambled Story Test was given to four subgroups of aphasic patients and to one group each of right-hemisphere-damaged patients and of normal controls. Subjects were asked to construct narratives from an unordered set of pictures and from unordered sets of corresponding sentences. Two verbal versions were distinguished, one with high and one with low linguistic cohesion among sentences. As expected, we found interactions between aphasic and nonaphasic behavior, such that aphasic patients made relatively more errors on the verbal versions and right-hemisphere patients on the pictorial version. High versus low linguistic cohesion, however, had no differential impact. It is concluded that brain-damaged patients when processing texts generally rely on macro- rather than on microstructure information. Furthermore, two control tests were administered: the Token Test and a sentence-to-picture matching task with either descriptive or nondescriptive stimulus sentences. Various patterns of correlation between these control tests and the Scrambled Story Test were found. The findings are interpreted in terms of a differential involvement of descriptive versus pragmatic processing strategies.
Hair loss is a common problem that may affect both males and females in all age groups. Although androgenetic alopecia (common baldness) is the most frequently occurring type of hair loss, hair loss can result from a variety of local and systemic conditions. A detailed history, complete physical examination and directed use of laboratory tests are indicated in making the diagnosis. Specialized tests such as "hair pluck" and scalp biopsy may also be required. Treatment is focused on removing the cause of secondary hair loss, patient education and specific interventions for individual types of alopecia. All treatment strategies should address the significant cosmetic and psychologic impact of hair loss.
Two closed-head-injured subjects and 12 non-brain-damaged controls explained a novel procedure to a blindfolded third person. Their productions were transcribed and scored by nine judges on ratings scales based on Grice's maxims of quantity and manner. The two closed-head injury (CHI) productions were significantly inferior to the controls, both being rated as disorganized, confusing, and ineffective. While one subject's production was considered overly repetitive, the other had too little detail. In order to specify, more exactly, the nature of the deficits, a cohesion analysis and an analysis of informational content were performed. The cohesion analysis suggested that the CHI productions were generally similar to the controls. The informational analysis was more revealing. Judgements of detail and repetitiveness were reflected in the number of new and repeated propositions. Errors in sequencing and inclusion of irrelevant propositions contributed to the disorganized and confusing nature of the texts. The results were interpreted within the framework of frontal lobe deficits in monitoring and regulation of performance.
A standardized rule-based scoring system, the Correct Information Unit (CIU) analysis, was used to evaluate the informativeness and efficiency of the connected speech of 20 non-brain-damaged adults and 20 adults with aphasia in response to 10 elicitation stimuli. The interjudge reliability of the scoring system proved to be high, as did the session-to-session stability of performance on measures. There was a significant difference between the non-brain-damaged and aphasic speakers on each of the five measures derived from CIU and word counts. However, the three calculated measures (words per minute, percent CIUs, and CIUs per minute) more dependably separated aphasic from non-brain-damaged speakers on an individual basis than the two counts (number of words and number of CIUs).
Aphasic patients have been generally assumed to produce coherent narratives, despite their numerous surface structure deficits. The current study is designed to analyze three types of coherence violations (i.e., information gaps, repetitions of propositions, and irrelevant propositions) in the narratives of mildly impaired conduction, anomic, and Wernicke's aphasics. Results reveal that the three aphasic groups produce qualitatively different patterns of coherence violations. It is hypothesized that these coherence violations reflect adaptive strategies used by the aphasic patients to compensate for their underlying impairments. While the anomic and conduction aphasics appear to compensate for surface structure deficits, the Wernicke's aphasics seem to have an underlying coherence deficit.
Deficits in pragmatic communication ability have a significant impact on functional outcome from traumatic brain injury (TBI), particularly during adolescence, when sophisticated social communication skills are developing. There are few published tests designed to assess pragmatic skills in this age group. In the present study, four tasks designed to tap various aspects of pragmatic communication ability were administered to three brain-injured adolescents and 36 of their uninjured peers aged 15-18 years. The tasks evaluated the ability to negotiate, hint, describe a simple procedure, and understand sarcasm. The four tasks were found to tap distinct aspects of pragmatic ability in control subjects. Further, within the control group, task performance was related more to non-verbal reasoning ability than vocabulary skills. Scores for two of the three TBI subjects were poorer than those of their peers, while a third mildly injured subject performed within normal limits. Pragmatic task scores were consistent with the results of neuropsychological testing in the three TBI subjects. Implications for clinical management and recommendations for future research are discussed.
Approximately 2 million head injuries occur each year in the United States, producing a brain injury rate of 175 to 200 per 100,000 population and causing as many as 56,000 deaths per year. The economic and emotional toll of this public health burden is staggering. By identifying risk factors, perhaps effective legislation and environmental and educational intervention strategies can be developed to prevent brain injury.