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BACKGROUND: Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. AIMS: The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. METHODS AND PROCEDURES: A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. OUTCOMES AND RESULTS: The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. CONCLUSIONS AND IMPLICATIONS: The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. WHAT THIS PAPER ADDS: What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.
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PURPOSE: Narration within a story grammar framework requires speakers to organize characters and events logically. Despite abundant research characterizing narrative deficits following a traumatic brain injury (TBI), the evolution of narrative story grammar over the first 2 years post-TBI has rarely been explored. This study analyzed story grammar in complex narratives of adults with and without severe TBI to (a) examine between-group differences and (b) investigate longitudinal changes over the first 2 years post-TBI. METHOD: Story grammar analyses of Cinderella narratives from 57 participants with TBI and 57 participants with no brain injury yielded measures of productivity (total number of episodes, total number of story grammar elements), elaboration (total number of elaborated-complete episodes, mean number of episodic elements per episode), and completeness (total number of incomplete episodes). Mann-Whitney U tests compared measures across groups; generalized estimating equation (GEE) models identified predictors of change, including recovery time (3, 6, 9, 12, and 24 months post-TBI) and demographic/injury-related characteristics. RESULTS: Between-group differences were statistically significant for all productivity and elaboration measures at 3, 6, and 9 months post-TBI; one productivity measure and one elaboration measure at 12 months; and none of the measures at 24 months. GEE models showed significant improvements in all productivity and elaboration measures over the first 24 months post-TBI, with educational attainment and duration of posttraumatic amnesia affecting recovery. Incomplete episodes only showed between-group differences at 12 months and did not capture recovery. CONCLUSION: Productivity and elaboration are key story grammar variables that (a) differentiate complex narration in individuals with and without severe TBI and (b) capture narrative improvements over the first 2 years post-TBI. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25148999.
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Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Trastornos del Lenguaje , Adulto , Humanos , Trastornos del Lenguaje/diagnóstico , Trastornos del Lenguaje/etiología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/diagnóstico , Narración , EscolaridadRESUMEN
PURPOSE: Communication can be chronically impacted by severe traumatic brain injury (TBI), yet there is a critical lack of research investigating communication recovery beyond 12 months postinjury with discourse measures. This longitudinal study aimed to investigate quantitative and qualitative changes in important event recounts produced by a group of people with severe TBI up to 2 years postinjury. METHOD: A prospective observational design with an inception cohort was adopted. Thirty-four participants with severe TBI were asked to produce an important event recount at 6, 12, and 24 months postinjury. A mixed-methods approach comprised a quantitative analysis of microlinguistic and macrostructural measures, using the automated discourse command EVAL in Computerized Language Analysis (CLAN) and the CLAN Collaborative Commentary tool, respectively. Statistical analysis included a repeated-measures analysis of variance and the Friedman test. An independent qualitative content analysis was also conducted. RESULTS: The measures revealed significant differences between 6 and 24 months, indicating a protracted recovery trajectory. The microlinguistic analysis showed increased use of revision and repetition over time. The macrostructural analysis indicated changes with orientation to recount characters, evaluative comments, and the number of events or complexity of the recount. The content analysis revealed categories of (a) childhood events, (b) family and relationships, (c) career and education, and (d) grief and loss. Topics at 6 months focused on childhood events and holidays, whereas career and education predominated at 24 months. CONCLUSIONS: This is the first study to explore important event recounts told by people with severe TBI as they recovered. Participants showed discourse recovery beyond 12 months, highlighting the need for equivalent timing of service provision. The important event recount shows good potential as an ecologically valid assessment tool to evaluate communication recovery that can also be integrated with advances in computerized analysis. Analyses additionally provided insights into potential therapy targets and content categories for chronic discourse impairments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26499271.
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Introduction: Traumatic brain injury (TBI) negatively impacts social communication in part due to social cognitive difficulties, which may include reduced mental state term (MST) use in some discourse genres. As social cognitive difficulties can negatively impact relationships, employment, and meaningful everyday activities, assessing and treating these difficulties post-TBI is crucial. To address knowledge gaps, the present study examined MST use in the narrative retells of adults with and without severe TBI to compare between-group performance, evaluate changes over the first two years post-TBI, and investigate the impact of participant and injury-related variables. Methods: The total number of MSTs, ratio of MSTs to total utterances, and diversity of MSTs were identified in the Cinderella narratives of 57 participants with no brain injury and 57 with TBI at 3, 6, 9, 12, and 24-months post-TBI. Results: Reduced MST use in participants with TBI was found at 3, 6, 9, and 12-months post-TBI, but these reductions disappeared when story length (total utterances) was accounted for. Further, MST diversity did not differ between groups. Similarly, although the total number of MSTs increased over time post-TBI, no changes were observed in the ratio of MSTs to total utterances or MST diversity over time. Injury severity (post-traumatic amnesia duration), years of education, and verbal reasoning abilities were all related to MST use. Discussion: Overall, although individuals used fewer MSTs in complex story retells across the first year following severe TBI, this reduction reflected impoverished story content, rather than the use of a lower ratio of MSTs. Further, key prognostic factors related to MST use included injury severity, educational attainment, and verbal reasoning ability. These findings have important implications for social communication assessment and treatment targeting social cognition post-TBI.
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PRIMARY OBJECTIVE: To investigate casual conversations with friends following severe traumatic brain injury (TBI). METHODS: Nine participants with severe TBI were matched by age, gender and education to nine control participants. Each participant also invited a friend to partake in the study. Participants were recorded engaging in a brief casual conversation with a friend. The resulting discourse was analysed using Exchange Structure Analysis (ESA). Rates of information giving, information requesting and communication repair and negotiation were collated. Non-parametric statistical analyses were performed. RESULTS: Participants with and without TBI obtained similar rates of information giving and information requesting. The friends of the participants with TBI produced significantly lower rates of information giving measures when compared to the controls, but achieved comparable rates of information requesting and communication repair and negotiation measures. Participants with TBI were observed to produce tangential language and to have difficulties identifying communication breakdown, asking questions and engaging in conversational joking. CONCLUSIONS: People with TBI are able to engage in casual conversations with friends in a similar way to matched controls. Friends of people with TBI are often restricted in contributing information in conversations. Further research is needed to specify the facilitative and restrictive communication behaviours so that they may be translated to clinical practise.