Improved comprehension of irony and indirect requests following a severe traumatic brain injury: two case studies

Figures & data

Figure 1. Study design

Note. This study used an ABA design with three phases: Pre-treatment (A₁), including two assessments (Pre-1 and Pre-2 – baselines (twice), secondary measures, neuropsychological and pragmatic assessment, and control task); Treatment (B), comprising training with the explicit therapy using written stories; Post-treatment (A₂), including two assessments (Post and Follow-up – baselines, secondary measures, and control task).

Table 1. Sociodemographic characteristics, neuropsychological and pragmatic data for both participants (P1 and P2)

	P1	P2
Sociodemographic characteristics
Age (years) Gender Handedness Education (years) Time post-onset (months)	42 M R 15 11	51 M R 12 47
Neuropsychological data
Language + Global scale – DTLA (/100) + Spoken picture naming – Grémots (/36) + Oral comprehension of sentences – TICS (/12) + Written comprehension of sentences – TICS (/12)	92 31 11 12	98 32 12 12
Episodic/working memory Digit span forward Digit span backward Corsi block-tapping test – Forward span Rey Auditory Verbal Learning Test (RAVLT)    Total recall (/75)    Recognition (/15)    Delayed recall (/15) Rey–Osterrieth complex figure (RCFT)    Immediate recall (/36)    Delayed recall (/36) Semantic memory Pyramid and Palm Tree Test – pictures (/52)	4** 4 5 51* 15 11 + 1 intrusion * 22 22 48	7 5 6 48* 13* 10* 15.5 14 48
Executive functions Verbal fluency    Phonemic    Semantic Trail Making Test    Part A (sec)    Part B (sec) Stroop Test    Words (sec)    Colors (sec)    Interference (sec)	16 33 34 78 48 76 141	12 23 41 104 38 65 124
Social cognition Geneva Social Cognition Scale (GeSoCS)    Social cognition (/20)    Eyes emotion (/20)    Non-verbal ToM (/20)    Inferences (/20)	16** 18 17** 8**	18 18 17** 18
Pragmatic data Narrative discourse – MEC-P    Main ideas recall (/11)    Total comprehension (/16)    Inference (/1) – Indirect speech acts comprehension – MEC (/40) Metaphor comprehension– MEC (/40) – Irony comprehension – IRRI (/12) – Hint comprehension – IRRI (/12)	6 8** 0** 15** 31** 5** 6*	9 14 1 36 21** 10** 5**

Note. ** indicates a score below the norm (≥ 1.6 SD or below the 5th percentile); * indicates a score between the 6th and 16th percentile; + and – precede the tests used for inclusion and exclusion criteria, with + the tests to be preserved (scores > 16th percentile) and – the tests to be impaired (at least one performance < 5th percentile).

Figure 2. Example of a story with the treatment steps

Figure 3. Performance of participants P1 and P2 on both lists (treated, untreated) during the three treatment phases (A₁ pre-treatment, B treatment and A₂ post-treatment)

Table 2. Correct answers for each communicative intention in the written intention task for the two lists (treated, untreated) in the four assessment sessions for both participants (P1 and P2)

		Assessments
Intention	List	P1				P2
		Pre-1	Pre-2	Post	FU	Pre-1	Pre-2	Post	FU
Irony (/12; /14)	Treated list	4	3	9	9	4	4	7	6
	Untreated list	5	6	5	9	2	2	6	3
Indirect requests (/12; /10)	Treated list	5	8	11	12	1	1	6	5
	Untreated list	4	6	9	6	2	2	5	5
Lies (/4; /4)	Treated list	3	3	3	3	1	1	2	1
	Untreated list	3	2	4	3	0	1	1	2
Faux pas (/6; /2)	Treated list	3	2	6	5	1	2	2	2
	Untreated list	3	2	2	3	1	0	1	2
Literal (/4; /2)	Treated list	0	0	2	3	0	0	0	2
	Untreated list	2	0	3	4	2	2	2	2
No faux pas (/2; /2)	Treated list	0	0	2	2	0	0	0	2
	Untreated list	0	0	0	2	0	2	0	2
Total (/40; /34)	Treated list	15	16	33	34	7	8	17	18
	Untreated list	17	16	23	27	7	9	15	16

Note. Bold font indicates an improvement over the pre-treatment assessments; FU = one-month follow-up

Table 3. Results on generalisation measures in ecological situations, cognitive processes likely to underlie nonliteral language comprehension, and the control task during the three treatment phases for both participants (P1 and P2)

	P1							P2
Test	Pre	Post	FU	Pre vs post p-value	Pre vs FU p-value	Post vs FU p-value		Pre	Post	FU	Pre vs post p-value	Pre vs FU p-value	Post vs FU p-value
Ecological generalisation Video – total (/37) Questionnaires: ERF-CS (/140) Theory of mind (/96)	22 42 57	30 43 58	32--	.0807 .9147 .9028	.0234--	.6027--		25 0 49	26 0 58	23 0 58	.8318 1 .2765	.6795 1 .2765	.5314 1 1
Cognitive processes Hayling inhibition (/16) Alternate fluency PASAT-R (/60) TOM-15 1^st order (/8) TOM-15 2^nd order (/7)	6 13 42 8 5	6 14 46 8 6	7 15 46 8 6	1- .4913 1 .5483	.7482- .4913 1 .4583	.7482- 1 1 1		7 12 39 8 5	7 16 50 8 6	6 15 53 8 7	1- .0531 1 .5483	.7482- .0103 1 .1795	.7482- .5207 1 .4483
Control task TLC-2 (/12) Mental rotation (time, sec.)	7	7	8	1	.7004	.7004		42	44	41	-	-	-

Note. Bold font indicates significant difference; FU = one-month follow-up.