- Title
- Speech pathology assessment of cognitive communication during early recovery following traumatic brain injury
- Creator
- Steel, Joanne
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2014
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- There has been little previous empirical study on the nature of cognitive communication impairments during PTA and early recovery after severe traumatic brain injury (TBI). After injury there is a period of post-traumatic amnesia (PTA), which may last from minutes to months. During PTA communication may be disordered due to disruption of cognitive, language and behavioural functions. It is not known how relevant the cognitive communication impairments evident during PTA are to ongoing function. The impairments may result from the generalised cognitive disruption of PTA or may be early predictors of persisting communication disorder. The current research aimed to increase understanding of the nature of communication dysfunction during PTA and to explore the potential means and utility of assessing cognitive communication impairments in the early stages of recovery. This mixed-methods two-stage study explored the question of speech pathology assessment of cognitive communication during PTA and in the early period of recovery. In Stage I an investigation of current speech pathology practice was conducted, using a mixed-methods design to generate data from an online questionnaire and in-depth interviews. Quantitative data (e.g. percentage of the sample who conducted assessment during PTA, number of speech pathologists using formal tests during PTA) was integrated with qualitative analysis (e.g. thematic coding) of open-ended survey responses and interview data. Forty-five survey respondents and 10 interviewees participated in the investigation of current practice. Speech pathologists indicated that they were actively involved with patients during the course of PTA. The majority undertook mainly informal assessment methods while the patient was in PTA and then commenced formal assessment processes on emergence. Clinicians provided details of their assessment practice, and gave rationales for their decision-making. Following the investigation of current practice, in Stage II six case studies were conducted of patients’ communication while they were in PTA, or at PTA emergence for one participant, and at a later follow up session. Cognitive communication was assessed with systematic sampling, repeated over the course of PTA, and once at three months after emergence. Measures included were derived from discourse analysis, nature of performance on language and cognitive communication assessment tasks, and global ratings of social communication from the perspective of the rehabilitation team and family. The aim was to examine the pattern of resolution of communication deficits relative to performance and status on the Westmead PTA scale, and to describe the association of impairments evident during PTA to later function. It was found that cognitive communication assessment was feasible and informative during PTA and early recovery, using a combination of qualitative and quantitative assessment methods. Confused language was evident during PTA, but this resolved for all participants by the later stages of PTA. In general, each participant’s cognitive communication impairment profile during PTA resembled that at follow up, but with increased severity during PTA. The current research contributes to the limited speech pathology literature on assessment of cognitive communication in the early stages of recovery after TBI. The potential benefit of improved assessment practice with this population has not been widely investigated. Early identification of communication problems may assist with planning of speech pathology services and may ultimately help people with traumatic brain injury at risk of developing long-term cognitive communication difficulties.
- Subject
- post-traumatic amnesia; traumatic brain injury; early recovery; cognitive communication assessment; discourse analysis
- Identifier
- http://hdl.handle.net/1959.13/1059150
- Identifier
- uon:16536
- Rights
- Copyright 2014 Joanne Steel
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | Attachment02 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | SOURCE1 | Abstract | 325 KB | Adobe Acrobat PDF | View Details Download |