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

BACKGROUND: Although previous research studies have defined several prognostic factors that affect cognitive-communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive-communication impairment in complicated mild TBI (mTBI) specifically. AIMS: To determine which demographic and trauma-related factors are associated with cognitive-communication performance in the early recovery phase of acute care following a complicated mTBI. METHODS & PROCEDURES: Demographic and accident-related data as well as the scores on cognitive-communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism. OUTCOMES & RESULTS: Females performed better than males on letter-category naming, while those more advanced in age performed worse on most cognitive-communication measures. Patients with higher education achieved better confrontation and letter-category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming. CONCLUSIONS & IMPLICATIONS: Cognitive-communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury-related factors affect cognitive-communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper adds What is already known on the subject In early acute recovery studies including all severity of TBI, cognitive-communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury-related variables predict cognitive-communication performance after a complicated mTBI specifically. What this paper adds to existing knowledge We confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive-communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive-communication skills in this group of patients. What are the potential or actual clinical implications of this work? The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive-communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care.

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

PURPOSE: Little is known about cognitive-communication skills post mild traumatic brain injury (mTBI). We aimed to determine how performance on cognitive-communication measures in the acute recovery period relates to early outcome following complicated mTBI. METHOD: Results of language and communication skill measures, demographic and accident-related data, length of stay (LOS), Glasgow Outcome Scale-Extended (GOSE) scores and discharge destinations were retrospectively gathered for 128 admitted patients with complicated mTBI. RESULTS: More than half of the individuals required rehabilitation services post discharge from hospital with over a third needing in-patient rehabilitation. Patients with poorer skills in auditory comprehension, verbal reasoning, confrontation naming, verbal fluency and conversational discourse were more likely to require in-patient rehabilitation. Subjects with worse skills in naming, conversational discourse and letter-category verbal fluency had a greater chance of being referred to out-patient rehabilitation services. Thus patients with both auditory comprehension and oral expression deficits were more likely to require in-patient services whereas those who had oral expression deficits but no significant difficulty in auditory comprehension were more often referred to out-patient services. Also, worse conversational discourse skills and semantic-category naming ability were related to lower GOSE scores and the chance of a longer LOS was greater when letter-category naming was poorer. CONCLUSION: The likelihood of individuals requiring rehabilitation services post mTBI was related to performance on several oral expression and auditory comprehension measures. It is therefore important to evaluate cognitive-communication skills early to determine rehabilitation needs.

Early reading comprehension and speed of reading impairments in individuals with uncomplicated and complicated mild traumatic brain injury.

PURPOSE: Several studies have investigated cognitive-communication disorders affecting oral expression skills following TBI but very few have dealt with reading comprehension abilities. The current study aims to measure reading comprehension and speed of reading in adults with uncomplicated and complicated mild traumatic brain injury (TBI) and to determine which demographic and TBI-related variables are predictive of their performance. METHOD: The performances of three groups of participants were compared on the Chapman-Cook Speed of Reading Test (CCSRT). The CCSRT was administered in an acute care setting to 85 hospitalized participants with mild TBI showing traumatic cerebral lesions (complicated mild TBI), to 15 hospitalized participants with uncomplicated mild TBI (no cerebral lesions) and to 68 adults without TBI. Linear regression analyses were performed to determine which variables among sex, age, education, TBI severity (measured by the Glasgow Coma Scale score), speed of processing skills, and site of cerebral lesions significantly predicted CCSRT performances. RESULTS: The control group showed a lower percentage of errors than both TBI groups. On the total score of the CCSRT, the uncomplicated and complicated TBI groups performed worse than the control group. Moreover, as age and speed of processing skills increased, and education decreased, the odds of having a lower score on the CCSRT increased. CONCLUSION: These findings suggest that reading abilities are compromised after mild TBI. Furthermore, the CCSRT may be a useful bedside tool for clinicians who work with individuals with mild TBI.

Acute prediction of outcome and cognitive-communication impairments following traumatic brain injury: The influence of age, education and site of lesion.

BACKGROUND: Communication impairment following a traumatic brain injury (TBI) has been well documented, yet information regarding communication skills in the acute period following the injury is limited in the literature. Also, little is known about the influence of TBI severity (mild, moderate or severe) on cognitive-communication impairments and how these impairments are related to short-term functional outcome. The goal of this study was to assess the performance of adults with mild, moderate and severe TBI on different language tests and to determine how this performance is related to functional capacity. We also aimed to explore which variables among age, sex, education, TBI severity and site of cerebral damage would predict initial language impairments. METHODS: Several language tests were administered to a sample of 145 adult patients with TBI of a range of severities admitted to an acute care service and to 113 healthy participants from the community. RESULTS: TBI patients of a range of severities performed poorly on all language tests in comparison to the healthy controls. In addition, patients with mild TBI performed better than the moderate and severe groups, except on the reading test and on the semantic naming test. In addition, their performance on verbal fluency, conversational discourse and procedural discourse tasks predicted acute functional outcome. Finally, age, education and TBI severity and site of lesion predicted some language performance. A left temporal lesion was associated with poorer performance in conversational discourse and auditory comprehension tasks, a left frontal lesion with a decrease in the verbal fluency results and a right parietal lesion with decreased auditory comprehension and reasoning skills. CONCLUSION: Health care professionals working in the acute care setting should be aware of the possible presence of cognitive-communication impairments in patients with TBI, even for those with mild TBI. These deficits can lead to functional communication problems and assistance may be required for tasks frequently encountered in acute care requiring intact comprehension and expression.