Towards a conceptualization of language and cognitive impairment in closed-head injury: use of clinical measures

Abstract

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.

Hemispheric and executive influences on low-level language processing after traumatic brain injury

“…Several groups have reported that inferencing is difficult for people with TBI. Hinchliffe et al (1998) found that their TBI group was significantly impaired relative to controls on a test of inference-making. A knowledge-based inferencing task constructed by led to similar results.…”

“…The observations of clinicians were in direct contrast to these results-they report that communication with these people is often difficult. The general feeling reported was that, in the face of little or no deficit found during testing, people with TBI could exhibit marked problems when having a communication, though these problems were not well described (Hagen, 1984;Hinchliffe, Murdoch, & Chenery, 1998).…”

“…These deficits do not seem to limit themselves to children or adults with new-onset TBI, but are also found in people with TBI in later stages of recovery in what few studies do exist in the literature. Hinchliffe et al (1998) has shown poorer performance on reading comprehension of sentences, as well as ambiguous sentences and sentence comprehension tasks hinging on semantic features. Butler-Hinz, Caplan, & Waters (1990) found syntactic comprehension deficits in persons with TBI similar to those found in their group with left hemisphere stroke.…”

“…Production deficits that have been described range from repetition of sentences in newly-injured adults (PayneJohnson, 1986) to construction of sentences under different conditions, by children and adolescents (Chapman et al, 2004;Dennis & Barnes, 1990) and adults still in the hospital for the TBI (Payne-Johnson, 1986). One study including sentence-level tests in adults slightly farther from injury (M = 4 months; Hinchliffe et al, 1998) reported no group differences between people with TBI and controls on sentence repetition and sentence construction (though the latter was rejected based on a marginal p-value of 0.052).…”

Treating reading comprehension deficits in sub-acute brain injury rehabilitation: Identifying clinical practice and management

“…Early in recovery, people with traumatic brain injury (pwTBI) have demonstrated deficits in reading vocabulary, literal and inferential reading comprehension 18 , and short discourse reading of up to four paragraphs 19 . Chronic, longer term reading changes for pwABI include deficits in text level reading comprehension 9,20 , comprehension of text coherence 9 and inferential reading comprehension 11 .…”