Pragmatic language skills alter closed head injury: Ability to negotiate requests

Abstract

Closed head injuries (CHI) frequently result in a constellation of frontal lobe deficits such as poor abstraction, poor regulation of behaviour, and disinhibition. These deficits have ramifications for communication abilities despite intact primary language processes. This study focused on the ability of 2 CHI subjects to make requests in social contexts compared to 12 non-brain-damaged controls. The CHI subjects were found to retain a sensitivity to the various social factors influencing the form a request takes and to use these normally when the request was simple, conventional, and straightforward. They had difficulty, however, formulating their request indirectly in the form of a hint. Their attempts reflected a failure to appreciate logically related aspects of the request context and to use these in their request formulation. Alternatively, if they managed to formulate an indirect hint, they were unable to avoid completing the argument to the point of stating their requests baldly. These features were discussed in relationship to their known frontal lobe deficits.