Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress

Jennifer Rae Myers; Nancy Pearl Solomon; Rael T Lange; Louis M French; Sara M Lippa; Tracey A Brickell; Shelby Staines; Jenna Nelson; Doug S Brungart; Carl A Coelho

doi:10.1044/2021_AJSLP-20-00281

Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress

Am J Speech Lang Pathol. 2022 Jan 18;31(1):84-98. doi: 10.1044/2021_AJSLP-20-00281. Epub 2021 Dec 21.

Authors

Jennifer Rae Myers¹, Nancy Pearl Solomon^{1

2}, Rael T Lange^{3

4

5

6

7}, Louis M French^{2

3

4}, Sara M Lippa⁴, Tracey A Brickell^{2

3

4

6

7}, Shelby Staines⁸, Jenna Nelson⁹, Doug S Brungart^{1

2}, Carl A Coelho⁸

Affiliations

¹ National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD.
² Uniformed Services University of the Health Sciences, Bethesda, MD.
³ Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD.
⁴ National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD.
⁵ University of British Columbia, Vancouver, British Columbia, Canada.
⁶ General Dynamics Information Technology, Falls Church, VA.
⁷ Center of Excellence on Post-Traumatic Stress Disorder, Ottawa, Ontario, Canada.
⁸ University of Connecticut, Storrs.
⁹ University of Maryland, College Park.

PMID: 34932411
DOI: 10.1044/2021_AJSLP-20-00281

Abstract

Purpose: Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD.

Method: Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness.

Results: Results revealed a significant difference between the mTBI (Mdn = 3.33) and NBI (Mdn = 3.50) groups, χ²(3) = 6.044, p = .017, ε² = .03, for global coherence. Word count differed significantly between the mTBI + PTSD (Mdn = 135) and NBI (Mdn = 195) groups, χ²(3) = 7.968, p = .006, ε² = .06. No other group differences were observed.

Discussion: Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Brain Concussion* / complications
Brain Concussion* / diagnosis
Brain Concussion* / psychology
Cognition
Communication
Humans
Stress Disorders, Post-Traumatic* / complications
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / psychology
Veterans* / psychology