Interaction of discourse processing impairments, communicative participation, and verbal executive functions in people with chronic traumatic brain injury

Abstract

IntroductionEspecially in the chronic phase, individuals with traumatic brain injury (TBI) (IwTBI) may still have impairments at the discourse level, even if these remain undetected by conventional aphasia tests. As a consequence, IwTBI may be impaired in conversational behavior and disadvantaged in their socio-communicative participation. Even though handling discourse is thought to be a basic requirement for participation and quality of life, only a handful of test procedures assessing discourse disorders have been developed so far. The MAKRO Screening is a recently developed screening tool designed to assess discourse impairments. The test construction is based on psycholinguistic frameworks and the concept of macro-rules, which refer to cognitive functions responsible for organizing and reducing complex information (e.g., propositional content) in discourse.AimThe aim of our study was to investigate discourse processing in IwTBI in different tasks and to assess problems in communicative participation in the post-acute and chronic phase. In this context, we also aimed to analyze the influence of the severity of the initial impairment and the verbal executive abilities on the discourse performance. Additionally, the impact of macrolinguistic discourse impairments and verbal fluency on perceived communicative participation was targeted in our analysis.MethodsData from 23 IwTBI (moderate to severe) and 23 healthy control subjects have been analyzed. They completed two subtests of the MAKRO screening: Text production and Inferences. Discourse performance was examined in relation to measures of semantic fluency and verbal task-switching. Socio-communicative problems were evaluated with the German version of the La Trobe Communication Questionnaire (LCQ).ResultsIwTBI showed lower test results than the control group in the two subtests of the MAKRO-Screening. Difficulties in picture-based narrative text production also indicated greater perceived difficulties in communicative participation (LCQ). We also found that the subject’s performance on the MAKRO-Screening subtests can partly be explained by underlying dysexecutive symptoms (in terms of verbal fluency and verbal task switching) and the severity of their injury. The preliminary results of our study show that cognitive-linguistic symptoms in IwTBI are also evident in the chronic phase. These can be detected with procedures referring to the discourse level, such as the MAKRO-Screening. The assessment of discourse performance should be an integral part in the rehabilitation of IwTBI in order to detect cognitive-linguistic communication disorders and to evaluate their impact on socio-communicative participation.

Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations

“…What is more, language disorders and aphasia evaluation should be addressed by clinicians, since the incidence is quite frequent, ranging from 2% to 32% [78,79], and involves difficulties in naming and word-finding, sentence comprehension, or sentence production [79]. For this reason, in many cases, the use of aphasia batteries, which evaluate vocabulary and grammatical abilities at the single-word and sentence levels, may not be sensitive to the evaluation of these impairments [30,32,62].…”

“…Commonly, the most used assessment tools for language impairment in TBI patients include the Western Aphasia Battery-Revised (WAB-R) [30], the Aachener Aphasia Test (AAT) [62], the Boston Diagnostic Aphasia Examination (BDAE) [32], and the Boston Naming Test (BNT) [31]. In specific situations, clinicians can administer the BDAE test, which is considered the most representative to tailor assessment process and reduce testing time (especially in patients with TBI that often have AD), while preserving diagnostic sensitivity [32].…”

“…In specific situations, clinicians can administer the BDAE test, which is considered the most representative to tailor assessment process and reduce testing time (especially in patients with TBI that often have AD), while preserving diagnostic sensitivity [32]. Rather than aphasia, about 80% of individuals with TBI have disorders in the interactional use of language and at discourse level [62]. These impairments are subsumed under the term "Cognitive Communication Disorders (CCD) [63] that demonstrates how "discourses are more than just a string of sentences", with verbal macrostructures that are realized as either monologues or interactive dialogues.…”

Clinical efficacy of scalp electroacupuncture combined with rehabilitation training for aphasia after head injury and its effect on patients’ language function and quality of life: An observational study

“…It has been pointed out in studies that about 75% of cranial trauma patients are accompanied by aphasia, which brings communication difficulties, emotional abnormalities, and some psychological disorders that not only reduce the quality of life, but also impose a heavy burden on families and the society. [4][5][6] The language function of patients with brain injury-induced aphasia may recover to some extent after persisted rehabilitation training, so the therapeutic measure of hospitals for such patients is performing appropriate rehabilitation training. [7][8][9] Scalp electroacupuncture is a method to recover the language function of patients with head injury-induced aphasia by stimulating the nerve in the head, which has been reported in researches.…”

Prediction of voluntary movements of the upper extremities by resting state‐brain regional glucose metabolism in patients with chronic severe brain injury: A pilot study

“…The costs associated with severe TBI (sTBI) treatment and rehabilitation have been calculated to be US $400,000 per case, taking into account disability and loss of productivity (Rosenfeld et al, 2012 ). In the chronic phase after sTBI, most patients with a chronic disorder of consciousness have difficulty communicating (Büttner‐Kunert et al, 2022 ; Marklund et al, 2019 ; Moretta et al, 2014 ). This includes patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) (Edlow et al, 2021 ; Thibaut et al, 2019 ).…”