Conversational discourse in closed-head-injured and non-brain-injured adults

Abstract

Background: Functional communication requires proficiency in the adaptation of language to varied contexts. Recent research has demonstrated that individuals with traumatic brain injury (TBI) experience difficulty with communicative effectiveness across a variety of discourse genres. Analysis of conversation following TBI is of particular interest because of its importance in the process of socialisation. The development and maintenance of social relationships has been noted to be difficult for individuals with TBI. It has been suggested that these interactional difficulties are the result of social skills deficits which may be a reflection of impaired language use. A variety of analyses have been applied to samples of conversation from individuals with TBI. These analyses have included pragmatic rating scales, exchange structure analysis, Conversation Analysis, as well as measures of topic initiation, topic maintenance, and response appropriateness. Overall, individuals with TBI have been noted to have difficulties with topic management and expressing information in a logical fashion. Further, their conversations have been rated as less interesting, less appropriate, and more effortful. Aims: The present study sought to validate the clinical utility of Blank and Franklin's (1980) procedure for analysis of conversation with larger groups of TBI and non-brain-injured individuals. Methods & Procedures: The examiner engaged 32 closed-head-injured (CHI) and 43 nonbrain-injured adults in individual conversations. The conversational performance of each participant, as well as the examiner, were analysed for various dimensions of response appropriateness and topic initiation. Outcomes & Results: Results indicated that the individuals with CHI were dependent on the examiner to maintain the flow of the conversation and that they often contributed information that did not facilitate the social interaction. It was also noted that the examiner compensated by asking more questions and introducing more topics in conversations with the individuals with CHI. In contrast, the conversations with the non-brain-injured controls were characterised by a shared responsibility for sustaining the interactional flow. Conclusions: In general these findings are consistent with previous investigations of conversational skills of individuals with TBI. Blank and Franklin's analysis procedure for conversation did delineate differences between the participant groups and in the examiner's performance when interacting with these individuals. However, it is important to note that the tenor of the conversational interactions (i.e., the status and roles of the participants) may have constrained the individuals with CHI and therefore their apparent dependence on the examiner may not have been solely the result of their brain injuries.