Narrative discourse following severe traumatic brain injury: a longitudinal follow-up

Abstract

This paper describes the narrative discourse abilities of a group of severely traumatically brain injured (TBI) speakers at two intervals post-injury. At initial assessment (between 3 and 6 months post-injury) a group of 26 TBI speakers were assessed using a picture description task. The performance of two control groups was also examined. The ®rst control group was comprised of 26 non-TBI orthopaedically injured speakers and the second control group comprised 26 university students. These control groups were selected in order to examine the possibility that premorbid demographic factors can in¯uence the discourse skills of TBI speakers. Measures of interest included content (number and type of story grammar elements present), communicative e¬ciency (syllables per story grammar element) and pragmatic performance (errors on a modi®ed version of Damico's Clinical Discourse AnalysisÐthe CDA-M). The measure which most clearly separated the performance of the TBI speakers from that of the controls on an initial assessment was the CDA-M. At follow-up, a mean of 2 years 10 months post-injury, 24 of the TBI speakers were seen for review. Results at follow-up revealed signi®cant improvement over time and the performance of the TBI speakers could no longer be diåerentiated from that of the orthopaedic patients included in the initial study. The ®ndings are discussed with respect to the implications for narrative discourse sampling and measurement, in relation to severity and chronicity of brain injury.

Exploring the factor structure of the La Trobe Communication Questionnaire: Insights into the nature of communication deficits following traumatic brain injury

“…With respect to neural substrates, both these processes, attentional control and task management, are mediated by the prefrontal cortex and its circuitry (Miller, 2000). Again, these behaviours have been reported by previous researchers in the area (e.g., Galski, Tompkins, & Johnston, 1998;McDonald & Pearce, 1996;Snow et al, 1999). Further, the validity of Factor 4 was supported by significant correlations with severity of injury for both self and close other reports.…”

“…Given the complexity and unpredictability of everyday discourse, no single tool or procedure is likely to provide clinicians with an ecologically valid representation of a client's conversational competence (Douglas, Bracy, & Snow, in press;. Many methods have been applied to discourse analysis following TBI, including analysis of cohesion (Hartley & Jensen, 1991;Mentis & Prutting, 1991), story grammar (Coelho, Liles, & Duffy, 1995;Snow, Douglas, & Ponsford, 1999), sociolinguistic analysis (Togher, 2000;Togher et al, 1997), and Clinical Discourse Analysis (Snow et al, 1997(Snow et al, , 1998. All of these methods require elicitation of representative discourse samples and transcription in order to apply specific analysis protocols.…”

What's the story? An exploration of narrative language abilities in male juvenile offenders

“…This picture stimulus 2 has been used in previous studies investigating language impairment, e.g. in people with traumatic brain injury (Hartley & Jensen, 1991;Snow et al, 1999) and in people recovering from stroke (e.g. Davis et al, 1997).…”

“…interactive) discourse is difficult to standardise, and timeconsuming to measure (Snow et al, 1999) narratives have been identified as a potentially more efficient measure of spoken language. According to Stein and Glenn (1979) well developed narrative comprises seven logically sequenced story grammar elements (a setting, an initiating event, an internal response, a plan of action, an attempt at action, direct consequences of this action, and protagonists' reactions).…”

“…Liles et al, 1995), students with learning disorders (Roth & Spekman, 1986), adults who have sustained traumatic brain injury (e.g. Hartley & Jensen, 1991;Snow et al, 1999), and adults with language disorders secondary to stroke (e.g. Bottenberg & Lemme, 1991).…”