RESUMEN
UNLABELLED: Following severe traumatic brain injury (TBI), failure to adjust language to communication abilities has been described and attributed by many authors to executive function impairment. Interactional dysfunctions may damage family-based, social and vocational equilibrium, and they are of key importance in prognosis of rehabilitation outcome. In conversation, frequently occurring inappropriate formulations connote difficulties in discursive organization and are likely to include numerous digressions, if not confabulations. OBJECTIVE: The main objective of this study was to improve assessment of the non-verbal as well as the verbal aspects of the communication disorders observed in TBI subjects. We have developed and are proposing the grid for linguistic analysis (GALI) of free conversational interchange that constitutes an original French-language tool. We wish to demonstrate its validity as a means of measuring interactive skills in a given population. METHOD: We assessed 17 severely brain injured patients presenting executive dysfunction, who were compared with 34 matched and healthy individuals. Fifty-one 10-minute sequences of free conversation between study participants and therapists were filmed and analyzed by applying the GALI. Three independent raters coded the conversations. Inter-rater reproducibility was considered statistically satisfactory. RESULTS: The results successfully distinguished TBI patients from healthy subjects and thereby underscored the discriminatory value of the tool. A significant correlation was found between the patients' performances in executive tests and in the GALI. CONCLUSIONS: In severe TBI a social handicap results from several associated cognitive disorders. Interactive discourse analysis combining non-verbal with verbal aspects confirms the existence of difficulties in communication that are usually underestimated in classic formal language testing methods. The GALI is likely to meet speech therapists' need for reliable assessment of their patients' interactional difficulties and their consequences in social life.
Asunto(s)
Lesiones Encefálicas/psicología , Trastornos del Conocimiento/etiología , Trastornos de la Comunicación/diagnóstico , Función Ejecutiva , Adolescente , Adulto , Trastornos de la Comunicación/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
UNLABELLED: Following post-traumatic impairment in executive function, failure to adjust to communication situations often creates major obstacles to social and professional reintegration. The analysis of pathological verbal communication has been based on clinical scales since the 1980s, but that of nonverbal elements has been neglected, although their importance should be acknowledged. OBJECTIVE: The aim of this research was to study non-verbal aspects of communication in a case of executive-function impairment after traumatic brain injury. METHODS: During the patient's conversation with an interlocutor, all nonverbal parameters - coverbal gestures, gaze, posture, proxemics and facial expressions - were studied in as much an ecological way as possible, to closely approximate natural conversation conditions. Such an approach highlights the difficulties such patients experience in communicating, difficulties of a pragmatic kind, that have so far been overlooked by traditional investigations, which mainly take into account the formal linguistic aspects of language. RESULTS: The analysis of the patient's conversation revealed non-verbal dysfunctions, not only on a pragmatic and interactional level but also in terms of enunciation. Moreover, interactional adjustment phenomena were noted in the interlocutor's behaviour. CONCLUSION: The two inseparable aspects of communication - verbal and nonverbal - should be equally assessed in patients with communication difficulties; highlighting distortions in each area might bring about an improvement in the rehabilitation of such people.