Perceptions About Writing by Adults With Moderate or Severe Traumatic Brain Injury

Abstract

Purpose: Writing challenges can cause ongoing distress and limit resumption of pre-injury activities following traumatic brain injury (TBI); however, little TBI research or clinical practice addresses written communication. Understanding the writing perceptions and experiences of adults engaged in intensive, inpatient rehabilitation following hospital discharge for TBI is an initial step in addressing this situation. Method: Transcendental phenomenology served to structure this qualitative research. Six adults between 2 and 6 months post-TBI participated in a common experience of writing about a personal memorable event. Standardized test scores and symptom ratings provided descriptive information about participants. Additionally, participants completed the Neurobehavioral Symptom Inventory and NASA Task Load Index and engaged in semistructured interviews to describe writing perceptions and experiences. Results: Data analysis revealed themes and subthemes about writing perceptions, challenges, and support strategies. Participants varied in their perceptions of post-injury writing changes. Test results revealed areas of challenge for all participants, but only half reported awareness of writing changes. Those aware of changes differed from other participants regarding word retrieval, memory, and concentration as well as overall effort expended, frustration, and performance quality. Although all participants relied on writing supports, only one had adjusted multiple writing strategies following injury. Conclusions: Some adults with TBI are aware of writing changes while receiving posthospital, inpatient rehabilitation services, but others deny such changes. This differs from reports concerning later recovery stages, perhaps because few functional writing opportunities arise during rehabilitation. Application of compensatory strategies specific to post-injury writing challenges is unlikely while awareness remains limited.

Written discourse in diagnosis for acquired neurogenic communication disorders: current evidence and future directions

“…Among 102 variables identified, only 13 measures (12.7%) (discourse level and general quality of writing domains in Table 3 ) were related to assessing writing skills beyond the sentence level. Translating and organizing ideas into a message in writing is challenging in people with brain injury ( Wheeler et al, 2014 ; Dinnes and Hux, 2022 ). As with studies regarding spoken discourse, additional efforts must be made to conduct in-depth investigations of multilevel aspects of written discourse to form a clearer picture of the mechanisms in different patient populations.…”