Discourse-based treatment in mild traumatic brain injury.

BACKGROUND: Individuals with traumatic brain injury (TBI) present with numerous discourse deficits associated with impairments to the linguistic system and other cognitive systems. Individuals with TBI may produce discourse that is lacking important information and poorly organized, as well as containing numerous coherence disrupting elements. Yet there are few studies directly addressing discourse deficits in individuals with TBI to guide clinicians.

AIMS: The purpose of the study was to determine if discourse processing treatment improved the discourse production in individual with TBI. Aims of the study included determining if the discourse processing treatment improved completeness and informativeness in TBI discourse samples.

METHODS & PROCEDURES: The study included three participants with mild-to-moderate TBI. The study utilized an A-B with maintenance design that incorporated components of functional practice, structured cues in the form of comprehension questions and story guide, and meta-cognitive and meta-linguistic processes. Discourse samples were obtained for baseline, treatment, and maintenance one-week and one-month post treatment. Stimuli included 12 sequential pictures, as well as a single picture and a recount probe.

OUTCOMES & RESULTS: All participants demonstrated small gains in completeness and informativeness for treated items, and 2 of 3 participants demonstrated a medium therapeutic effect for untreated stimuli. Participants also produced discourse with fewer errors for both treated and untreated stimuli after treatment with no therapeutic effect to a small effect for the generalization stimuli.

CONCLUSIONS: The study demonstrated that the discourse processing treatment is capable of producing small therapeutic effects that persisted one-month post treatment in adults with mild-to-moderate TBI.