RESUMEN
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, χ2(3) = 6.044, p = .017, ε2 = .03, for global coherence. Word count differed significantly between the mTBI + PTSD (Mdn = 135) and NBI (Mdn = 195) groups, χ2(3) = 7.968, p = .006, ε2 = .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.
Asunto(s)
Conmoción Encefálica , Trastornos por Estrés Postraumático , Veteranos , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/psicología , Cognición , Comunicación , Humanos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Veteranos/psicologíaRESUMEN
Purpose Coordination of communicative behavior supports shared understanding in conversation. The current study brings together analysis of two speech coordination strategies, entrainment and compensation of articulation, in a preliminary investigation into whether strategy organization is shaped by a challenging communicative context-conversing with a person who has a communication disorder. Method As an initial clinical test case, an automated measure of articulatory precision was analyzed in a corpus of spoken dialogue, where a confederate conversed with participants with traumatic brain injury (n = 28) and participants with no brain injury (n = 48). Results Overall, the confederate engaged in significant entrainment and high compensation (hyperarticulation) in conversations with participants with traumatic brain injury relative to significant entrainment and low compensation (hypoarticulation) in conversations with participants with no brain injury. Furthermore, the confederate's articulatory precision changed over the course of the conversations. Conclusions Findings suggest that the organization of conversational coordination is sensitive to context, supporting synergistic models of spoken dialogue. While corpus limitations are acknowledged, these initial results point to differences in the way in which speech strategies are realized in challenging communicative contexts, highlighting a viable and important target for investigation with clinical populations. A framework for investigating speech coordination strategies in tandem and ideas for advancing this line of inquiry serve as key contributions of this work.
Asunto(s)
Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Trastornos de la Comunicación , Lesiones Encefálicas/complicaciones , Lesiones Traumáticas del Encéfalo/complicaciones , Comunicación , Trastornos de la Comunicación/diagnóstico , Trastornos de la Comunicación/etiología , Humanos , HablaRESUMEN
Purpose: This study investigated changes in oral-verbal expressive language associated with improvements following 2 treatment periods of constraint-induced language therapy in 4 participants with stroke-induced chronic aphasia. Generalization of treatment to untrained materials and to discourse production was also analyzed, as was the durability of the treatment effect. Method: Participants with aphasia were assessed using standardized measures and discourse tasks at 3 to 4 time points to document behavioral changes throughout each of two 30-hr treatment periods of constraint-induced language therapy. Daily probes of trained and untrained materials were also administered. Results: Despite participant heterogeneity, behavioral results for each person with aphasia indicated a positive response to treatment following each treatment period indicated by performance on standardized tests, trained materials, or both. Treatment effects generalized to some degree to untrained stimuli and to discourse measures and were generally maintained at follow-up testing. Conclusions: Data support the utility of a 2nd treatment period. Results are relevant to rehabilitation in chronic aphasia, confirming that significant language gains continue well past the point of spontaneous recovery and can occur in a relatively short time period. Importantly, changes are not confined to a single treatment period, suggesting that people with aphasia may benefit from multiple doses of high-intensity treatment.
Asunto(s)
Afasia/rehabilitación , Terapia del Lenguaje/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/psicología , Anciano , Afasia/etiología , Enfermedad Crónica , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Accidente Cerebrovascular/complicaciones , Factores de Tiempo , Resultado del TratamientoRESUMEN
Some suggest that traumatic brain injury (TBI) produces dissociation between the macrolinguistic and microlinguistic levels of discourse production. This assumption is based primarily on studies that have found preserved intersentential cohesion and/or intra-sentential processing in narratives produced by these individuals. However, few studies exist, if any, that have investigated the relationship between these processes in TBI speakers who do demonstrate such microlinguistic impairments. This study investigated the relationship between impairments of intersentential cohesion and intra-sentential processing in the discourse of 15 speakers with severe TBI. The results demonstrated a significant relationship between the production of cohesive ties and instances of intra-sentential impairment that suggests that utilization of resources for adequate cohesion appears to negatively affect intra-sentential processing following TBI. We propose that macrolinguistic and microlinguistic processes are not independent of one another, as has been proposed, but share cognitive resources that support the planning and production of both local (microlinguistic) and long-distance (macrolinguistic) relationships expressed through discourse.
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Lesiones Encefálicas/complicaciones , Trastornos del Conocimiento/etiología , Trastornos del Lenguaje/etiología , Narración , Conducta Verbal/fisiología , Adulto , Análisis de Varianza , Femenino , Humanos , Lingüística , Masculino , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
This study examined the narrative discourse production and executive function (EF) abilities of 46 neuro-typical adults (18-98 years old). Two questions were addressed: Is the analysis of narrative structure sensitive to changes associated with aging? & What is the relationship between measures of narrative structure and EF? Narratives were elicited under two conditions and narrative structure was analyzed for the presence of organizing story grammar elements. Narrative structure was significantly correlated with age as well as linguistic and non-linguistic measures of EF. Factor analysis of story structure and EF variables yielded two factors reflecting constructs of output-fluidity and organizational-efficiency. These data suggest that narrative structure and EF represent aspects of goal-directed knowledge that are not bound by a traditional linguistic and non-linguistic division. Thus, narrative structure may represent a global and ecologically valid measure of goal-directed executive function knowledge that is also sensitive to changes associated with typical aging.
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Función Ejecutiva/fisiología , Conducta Verbal/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Narración , Pruebas Neuropsicológicas , LecturaRESUMEN
BACKGROUND: It is documented that individuals with closed head injury (CHI) demonstrate difficulty with narrative and conversational discourse. Effective conversational discourse requires a complex interaction of linguistic, cognitive, and social abilities [6]. Reduced attention and concentration are among the most common cognitive sequela following CHI [39]. AIMS: The present study investigated whether treatment of attention would facilitate conversational discourse for individuals with CHI. Two treatment protocols were investigated, the first social skills-based, and the second attention-based. It was hypothesized that attention training would improve not only attentional skills but also conversation, however social skills training, would only facilitate conversational skills. METHODS AND PROCEDURES: A single subject multiple treatments comparison design was employed with two individuals who were post-onset of CHI. Treatment effects on conversational performance were calculated using the f statistic [18] for measures of response appropriateness during conversations. OUTCOMES AND RESULTS: Effect sizes suggested that both treatments were active; however, the participants' performances were variable reducing the magnitude of change observed. Results indicated minimal change from baselines, only partially supporting the research hypotheses. CONCLUSIONS: Although the two treatment regimens had some effect on the participants' conversational performances it was not to the extent anticipated. The issues of candidacy for such treatments as well as the importance of incorporating natural contingencies into interventions for conversation training are discussed.
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Trastorno por Déficit de Atención con Hiperactividad , Comunicación , Traumatismos Cerrados de la Cabeza/complicaciones , Relaciones Interpersonales , Lingüística , Actividades Cotidianas , Adulto , Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/rehabilitación , Traumatismos Cerrados de la Cabeza/rehabilitación , Humanos , Pruebas Neuropsicológicas , Resultado del TratamientoRESUMEN
Non-linguistic cognitive skills have recently become an area of focus in aphasia research. One skill that has received in-depth investigation is the role of attention in language tasks. In applying the resource allocation theory to aphasic language deficits, researchers have described performance variablity in language tasks that may result from insufficient capacity, inefficient allocation, or inappropriate allocation of attentional resources [16]. The present study was designed as a follow-up to a recent study examining direct attention training as a treatment for reading impairment in mild aphasia [3]. A treatment program was implemented to target complex attention skills for an individual with mild reading difficulties secondary to aphasia. Results revealed modest gains in reading rate and comprehension. A decrease in the variability of comprehension of longer complex reading passages was noted, suggesting a more efficient allocation of the participant's attentional resources. The positive gains noted for this individual's reading skills were felt to be the result of improvement in allocation of attentional resources rather than improvement in linguistic skills. The findings of this study add to the growing body of literature pertaining to the value of expanding assessment and treatment protocols for individuals with aphasia to include both linguistic and cognitive measures.
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Afasia/psicología , Atención/fisiología , Terapia Cognitivo-Conductual/métodos , Dislexia/rehabilitación , Práctica Psicológica , Accidente Cerebrovascular/psicología , Dislexia/etiología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Currently, there is substantial evidence to support the assessment of communication, following traumatic brain injury (TBI), beyond what is included in standardized aphasia or child language batteries. The sensitivity of discourse analyses for delineating subtle cognitive-communicative deficits is well established in the research literature. A variety of useful monologic and conversational discourse measures have been identified including productivity, efficiency, content accuracy and organization, story grammar and coherence, and topic management. Disruption of discourse may persist for years after TBI and appears to have a negative impact on quality of life. Although discourse analyses have great potential for clinical application for individuals with TBI, their widespread use has been limited by time and training constraints. A further limitation is that there is no empirical evidence to guide the treatment of discourse deficits. There is need for the development and investigation of theoretically based interventions.
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Lesiones Encefálicas/complicaciones , Trastornos de la Comunicación/etiología , Trastornos de la Comunicación/terapia , Necesidades y Demandas de Servicios de Salud , Logopedia/métodos , Trastornos del Conocimiento/etiología , Progresión de la Enfermedad , Humanos , Trastornos del Lenguaje/etiología , Índice de Severidad de la Enfermedad , Conducta SocialRESUMEN
The evaluation of auditory-visual speech perception is not typically undertaken in the assessment of aphasia; however, treatment approaches utilise bimodal presentations. Research demonstrates that auditory and visual information are integrated for speech perception. The strongest evidence of this cross-modal integration is the McGurk effect. This indirect measure of integration shows that presentation of conflicting tokens may change perception (e.g. auditory /bi/ + visual /gi/ = /di/). The purpose of this study was to investigate the ability of a person with mild aphasia to identify tokens presented in auditory-only, visual-only and auditory-visual conditions. It was hypothesized that performance would be best in the bimodal condition and that presence of the McGurk effect would demonstrate integration of speech information. Findings did not support the hypotheses. It is suspected that successful integration of AV speech information was limited by a perseverative response pattern. This case study suggests the use of bisensory speech information may be impaired in adults with aphasia.
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Afasia/psicología , Percepción del Habla , Percepción Visual , Estimulación Acústica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Lectura de los Labios , MasculinoRESUMEN
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.
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Traumatismos Cerrados de la Cabeza/complicaciones , Trastornos del Lenguaje/etiología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Lógica , Masculino , Narración , Pruebas Neuropsicológicas , Estadísticas no ParamétricasRESUMEN
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.
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Lesiones Encefálicas/rehabilitación , Trastornos del Lenguaje/rehabilitación , Conducta Verbal , Adulto , Lesiones Encefálicas/psicología , Estudios de Casos y Controles , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/rehabilitación , Humanos , Masculino , Proyectos Piloto , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Narratives were elicited in two story tasks, retelling and generation, from two groups of adults, 55 with closed head injury (CHI) and 47 non-brain-injured (NBI), recruited from rehabilitation facilities in three northeastern states. Participants were classified, on the basis of their socioeconomic status (SES), as professional, skilled worker, or unskilled worker. Narratives were analyzed using five discourse measures at the levels of sentence production, intersentential cohesion, and story grammar. Discourse performance was then compared across groups, tasks, and SES levels. Discourse performance of the CHI group was also compared with their scores from the Wisconsin Card Sorting Test, a measure of executive functioning. Results indicated that two discourse measures distinguished the groups. The CHI participants produced significantly fewer words per T-unit and fewer T-units within episode structure than did the NBI group, which was attributed to difficulties with content organization. Performance on all five discourse measures differed for the story retelling versus the story generation tasks for both CHI and NBI groups. All participants produced longer and more grammatically complex T-units in the story generation task than in story retelling. However, cohesive adequacy and story grammar were better in the story retelling task than in the story generation task. It was therefore concluded that story generation was a more challenging task than story retelling for both groups. The only significant difference noted for SES involved the measure of intersentential cohesion. The unskilled workers demonstrated poorer cohesive adequacy than either the skilled workers or professionals, regardless of group or story task. Finally, modest correlations were noted between the discourse performance of the CHI group and scores from the Wisconsin Card Sorting Test in both story tasks.