Language deficits following closed-head injury (CHI) are widely considered as impairments secondary to the cognitive disruptions common to closed-head injury. In addition, the use of standardized measures to assess the functioning of the language system in closed-head injury has mostly been limited to aphasia test batteries which examine primary language functions only. This has resulted in generalizations as to the integrity of the language system following closed-head injury, and as a consequence, consideration of the contribution of the language system to the achievement of communicative competence in this population has been minimized. This paper presents a framework in which the functional language system is identified as a hierarchical system containing primary and higher-order language processes involved in reciprocal relationships with cognitive functions at each level. A group of 25 closed-head injury subjects and 23 demographically matched control subjects were examined for linguistic proficiency using a battery of standardized tests which investigated the language system across a hierarchy of complexity, structure and predictability. In addition, 23 of the closed-head subjects were administered a comprehensive neuropsychological test battery in order to determine the nature and extent of concomitant impairments in cognitive processes and their relationship with impairments in the language system. The language battery was found to consistently discriminate between the control and clinical groups indicating that the linguistic system is significantly impaired following CHI, with the lexical-semantic system being the most vulnerable to disruption. A strong influential relationship between language and cognitive processes was statistically confirmed and the nature of the relationship between aspects of language and cognition further delineated.

This study examined variability in the interrelationship between language skill and neuropsychological function within a group of 25 severe closed head injury (CHI) subjects and 23 matched controls. All subjects underwent a battery of standardized language and neuropsychological tests. Cluster analyses were conducted to determine whether the CHI sample was universally or differentially impaired. Further subgroup analysis using a Q-type factor analysis outlined the differences in performance profiles within the group of CHI subjects. Results support the hypothesis that while some deficits were common to all CHI subjects, impairments delineated by whole group analysis do not necessarily represent universal impairments. In particular, ability to perform tasks involving auditory comprehension, naming, verbal memory, visual memory and visuospatial skills appeared to be important components in group differentiation. The cognitive-linguistic impairments which were common to all CHI subjects and considered to be the 'cardinal' cognitive-linguistic deficits following severe CHI were deficits in lexical-semantic and sentential semantic skills, verbal fluency, complex auditory comprehension, and attentional operations. Profile analysis revealed the existence of a double dissociation between performances on naming and verbal memory tasks and performances on visually related cognitive tasks. Results are discussed with reference to findings on previous studies of subgroups in the CHI population.

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Objective Ahead of the convergence of two major paediatric services, we examined evidence-based practice (EBP) self-efficacy, outcome expectancy, knowledge and use among allied health (AH) staff in two major Queensland (Qld) paediatric services. This was to determine whether any differences existed based on organisational affiliation, profession and any previous training to inform a strategy to enhance AH EBP within the new organisational setting. Methods All AH staff from the two Brisbane (Qld) tertiary paediatric hospitals were invited to participate in the survey. Using a cross-sectional design, EBP self-efficacy, outcome expectancy, knowledge and use, as well as previous EBP training, were assessed with an online survey. Background demographic information obtained included professional discipline and hospital. Results One hundred and thirty-eight health practitioners completed the survey (37% response rate). Most practitioners had accessed EBP training. Mean scores for EBP attitudes (self-efficacy and outcome expectancy) and knowledge were higher than for EBP use scores. Greater variation was observed across professional disciplines than organisations. Training impacted positively on EBP measures but explained a small proportion of total variance in regression models. Conclusions The results underscore the need to provide organisational supports to AH staff for EBP implementation. Strategies other than training are required to maximally enhance EBP attitudes. The new organisational structure provides an opportunity for this cultural shift to occur. What is known about the topic? Factors affecting the EBP capabilities of AH professionals are complex and are associated with institutional culture and barriers, personal self-belief and individual experience and ability, and can exist at clinician, team and organisational levels. What does this paper add? The data from the present study confirm the emerging literature examining various AH professional groups’ EBP behaviours and ratings with a large and diverse cohort from a variety of backgrounds and across organisations. Respondents possessed a positive attitude towards EBP and moderate EBP knowledge, with these scores exceeding EBP use scores. Organisational affiliation had little impact on EBP measures. What are the implications for practitioners? Although the results of the present study highlight the importance of training in literature searching, EBP and research design and/or analysis, the findings also indicated that strategies other than training are required to maximally enhance EBP attitudes and use by AH staff. To harness the positive approach AH staff have to EBP, strategies such as incorporation of EBP principles and plans in departmental meetings and strategic reviews, as well as strengthening organisational governance in relation to EBP and research, must be developed within the new organisational structure and context; a powerful, but often overlooked, enabler of EBP.