Abstract
This paper analyzes the research done on adults who have experienced Traumatic Brain Injury (TBI), children who have experienced TBI, and the effect this has on pragmatics and linguistic abilities. Two studies were conducted. One, between thirty people of normal cognitive functioning, and a second group, with fifteen children between the ages of 4-6. Both studies attempt to prove that there are evident language deficits in people with TBI, as opposed to healthy individuals. Between both studies, there are numerous tests done that attempt to understand all parts of traumatic brain injury. In this paper particularly, the tests try to understand language in TBI patients.
The effect of Traumatic Brain Injury on Pragmatic and Linguistic Abilities
Traumatic brain injury (TBI) is defined as, “that which occurs when an external mechanical force causes brain dysfunction”. (Mayo Clinic, 2014). TBI’s normally occur because of a blow or traumatic force to the head or body. Something that penetrates the skull, like a bullet, glass, etc, can also cause this type of injury. Traumatic brain injury can range from mild to severe, and the more serious types of TBI’s can cause bleeding, bruising, long-term problems to the brain, as well as death.
According to the Brain Injury Association of America (2015), there are several types of brain injuries, including: diffuse axonal injury, concussion, contusion, coup-contre coup injury, second impact syndrome, open and closed head injuries, penetrating injury, shaken baby syndrome, and locked in syndrome.
Symptoms of TBI are categorized in physical, sensory, and cognitive categories for mild and moderate to severe TBI. For mild traumatic brain injury, some physical symptoms are loss of consciousness for a few seconds to a few minutes, headache, nausea or vomiting, and fatigue. Physical symptoms for moderate to severe TBI persons are episodes of repeated vomiting or nausea, persistent headache that worsens, convulsions or seizures, and weakness or numbness in fingers and toes. For mild TBI, sensory symptoms can include blurred vision, ringing in the ears, and memory or concentration problems. Cognitive symptoms for mild TBI is memory or concentration problems, mood changes or mood swings, and feeling depressed or anxious. For mild to moderately severe TBI, there may be profound confusion, agitation or other unusual behavior, slurred speech, and/or coma and other disorders of consciousness. (Mayo Clinic citation).
According to American Speech-Language-Hearing Association, (ASHA), an individual with pragmatic problems may say inappropriate or unrelated things during conversations, tell stories in a disorganized way, and/or have little variety in language use. (ASHA, 2016). Linguistic problems can be any lexical, syntactic, or semantic problems depending on their context.
From the research done and what has been said above, this paper is seeking to find if there is actually a connection between traumatic brain injury and pragmatic and linguistic performance in a variety of age groups. I support the idea that there is a link between the two.
Current Research
In the first study that was investigated, Bosco, F., Angleri, R., Sacco, K., & Bara, B. (2013, August ), a research group sought to investigate the pragmatic abilities of individuals with traumatic brain injury. There were two groups that participated in this study. (Group A and Group B.) Group A was composed of individuals who had TBI, and the second group was a control group. Control group in this study means, a group of people who do not have TBI. Thirty participants were in the TBI group. Everyone in this group had a closed-head injury, and there were twenty-four males and six females. There was a wide range of ages in this group, with the youngest participant being 20, and the eldest 68. All participants in the study had moderate to severe head injuries.
In the control group, Group B, there were thirty healthy participants. These individuals were composed of twenty-four males and six females, just like Group A. The ages were also almost identical in this group.
Measures had to be taken to judge neuropsychological abilities. All thirty people in Group A were given a neuropsychological battery test. These tests included: The Mini-Mental State Examination, which was administered to help screen for cognitive abilities. Each participant had to make a 24/30 or below, because anything higher than that would have shown that the said participant would have had normal cognitive functioning. The Denomination scale of the Achener Aphasie Test was administered to test for the existence of linguistics deficits. Last, the Token Test was used to screen for problems with linguistic comprehension.
Communication tasks were administered as well. The goal was to investigate the participants’ capability to comprehend and produce explicit pragmatic skills. Specifically, these included standard communication acts, deceit, and irony. These tasks originated from the Assessment Battery of Communication, or ABaCo. This is a pragmatic test that has been employed to analyze the communication performance of specific people who are affected from traumatic brain injury. Within this, there were four tests that were administered. Linguistic comprehension and production tasks, and extralinguistic comprehension and production tasks. These tasks were played out by actors and actresses on a video. Participants who watched the videos were judged based on four factors: expression, actor’s meaning, violation, and purpose. In the expression act, the participants had to actually recognize what the actor in the video expressed, and not just simply repeating what the actor said. If imitation happened, the participant would not get a score at all. For “Actor’s Meaning”, the participant was told to explain what the actor’s gesture or what the actor said insinuated. For purpose of violation, the participant was supposed to explain they “why” of the video. For example, the participant should have answered why the actor produced a particular communication act.
Production tasks were the last section to be administered. In these tasks, the administrator of the study gave short videos for the participants to view. The videos showed two people who were talking to each other, and one actor would say something to the other. The video would be stopped right after this, however, and the participants had to attempt to gain the perspective of the other person, and answer what the actor was saying.
To compare performance between Group A and Group B, a T-Test and analysis of variance was used. Logistic regression was also used to detect intermediate errors.
The results showed that people who suffered from traumatic brain injury showed communicative problems on all pragmatic tasks that were administered. The control group, Group B, performed much higher on these tasks. Group A performed significantly worse than the healthy Group B on linguistic and extralinguistic tasks. They performed worse on each section as opposed to the non-TBI individuals. To go into detail, the mean score for linguistic comprehension production in Group A was 0.72, as opposed to the control group which was 0.95. Extralinguistic comprehension showed a significant difference, with Group A performing with a mean of 0.62, and the control group having a mean of 0.89. In Group A, there were not any similarities between age, years of education, time after the onset of the traumatic brain injury, and scores on pragmatic tasks. There were no outliers.
The results from this study infer that pragmatic difficulties occur at several stages of comprehension and production process. This study also showed that a thorough evaluation of communication abilities could potentially be administered to classify communication problems, as well as communication strengths that a person with traumatic brain injury may have. Not only did this study further the statement that TBI has an effect on pragmatic abilities, but also provides some information on how to go about testing for particular pragmatic skills.
This study provided adequate information about the types of tests administered, how they were administered, and what each test meant. The two groups were similar in age, but within each group, differed in age and gender, which is crucial for a study like this to be able to be unbiased.
In another study, Morse, S., Haritou, F., Ong, K., Anderson, V., Catroppa, C., & Rosenfeld, J. (1999, December), a group wanted to study the correlation between TBI and the effect it has on the development of young children. Using a prospective, cross-sectional design, the comparison of language abilities of young children following head injuries was monitored. Fifteen children who had suffered TBI, were divided into three separate groups. These groups were labeled mild, moderate, and severe. The fifteen children were between the ages of 4-6. These children were released from the study if there was any record of a previous brain injury, as this would skew the results. A control group was also studied. These children matched the age of the brain injury group, and were healthy individuals. The two groups, the one that had TBI, and the control group, were assessed over a three-month period.
Several measures were done to test language ability after traumatic brain injury. Injury and demographic variables, adaptive functioning, intellectual measures, and language measures and language analysis were all tested. The language measures consisted of tests of receptive as well as expressive language. To test receptive language, or how a child is listening and understanding what is being asked, several tests were used. One of these was the Peabody Picture Vocabulary Test-Revised (PPVT-R). This is a test of single world vocabulary comprehension. The Test of Auditory Comprehension of Language-Revised, was also administered. This is composed of three subtests, which audits comprehension word classes and relations, grammatical morphemes, and elaborated sentences. To calculate expressive language, two tests were administered. One, the Expressive One-Word Picture Vocabulary Test, was a naming confrontation task. This is where vocabulary words were graded based on their difficulty level. The last expressive language task, the Bus Story, is a story repetition assessment that uses a visual cartoon stril to help patients with recall. Children listen to a story that is not very difficult, and they are then told to retell the story using their own words.
Language analysis was tested. The subgroups that were tested were syntactic complexity, MLU, and discourse. In other terms, the test was designed to compare speech complexity from the group of children who had TBI, versus the group of healthy children.
What the results showed from this study was that there was a drastic difference in language abilities between the group with TBI and the non-TBI group. Out of the traumatic brain injury groups severe, moderate, and mild, the severe group had significantly lower scores on all language tests, as well as communication abilities. The severe TBI group had fewer communication units per 10-minute sample than the mild and moderate traumatic brain injury groups.
Overall, what was shown by this test was that out of mild, moderate, and severe traumatic brain injury groups, the severe group had the most substantial differences in language and linguistic analyses compared to other groups, and especially compared to the control group. This test was administered to test and understand language and linguistic abilities by measuring spontaneous language samples, analysis of syntax, as well as conversational discourse. Syntactic analysis measures showed that the severe TBI group were more likely to produce utterances that were unintelligible, non-verbal, and did not necessarily make sense with what was being asked. Ironically, the severe head injury group showed more minor utterance problems than multiple utterance problems. However, the severe TBI group had expressive language deficits that were far from syntactically complex. When conversational discourse was examined, there was quite a wide range of variation in the number of communication units, or CUs, in each category. The severe traumatic brain injury group again, showed more mistakes in their conversational units than any other group.
This study did find that there are indeed differences in language among “healthy” children and children with traumatic brain injury. The strengths for this study were that it showed that not only is the traditional, standard tests good to identify language differences, but also that free speech conversation samples are also important. This study did come to a conclusion, however it was tested on a small group.
Summary and Discussion
From both research articles, it is evident that there is a difference in language abilities between patients with TBI, and healthy individuals. The research that has been done also shows that no matter what age, the results do not change. Adults and children alike, both are seen having difficulties with language if they have been diagnosed as having a traumatic brain injury.
However, each article did not come without its flaws. The problems that I am seeing for the first research article mentioned is, that each test was administered in a standardized, formal fashion. This could skew results if patients felt that they had pressure on them. The study using children had these somewhat “formal” tests, but also conducted a language sample which could portray a child’s language in a more natural setting. I do not necessarily believe that the results would have changed much if the adults in the first study were given tasks in a more comfortable way, however, for some individuals, the more formal the test, the more likely the individual may provide unreliable scores due to the stress and pressure of the testing.
One strength for the first test done with adults, and a weakness for the test done with children, is that the latter test was conducted in 1999, whereas the test administered with adults was done in 2013. Both had essentially the same results, however I believe there needs to be a more updated research conducted that studies children who have traumatic brain injury.
An evident strength of using children in the second study from ages 4-6, is that by seeing the language deficits in the younger population, the researchers can easily move these children to therapy quickly. Above all else, the researchers who conducted the study can identify if there will be long-term language effects from TBI since the children are so young. The younger population could come with its weaknesses though, because a four-year-old may not understand what is being asked of them like an older child could. However, I still think that testing children from ages 4-6 has more advantages. I think it is incredibly important to understand what is going on in a child’s language early on.
It was very interesting to me that the second study done with the children divided into “mild, moderate, and severe” TBI patients, whereas the study using adults did not. Perhaps this could have been done to the adults since there was such a wide age range. If the researchers had divided the adults in this way, the results could have been more descriptive, showing the pragmatic abilities of severe TBI patients versus the mild TBI patients. If another study was to be done, it would possibly be a good idea to split up the traumatic brain injury patients up based on their severity, just to see the potential of more descriptive results.
Both studies did well with having a range of ages, a variety of genders, and matching this with the control group. It appears to be that both studies were unbiased, and had various tests to come to the conclusion that both studies did.
Conclusion
Though there were a few minor weaknesses from both studies of TBI and pragmatic and linguistic abilities, each came to a conclusion that matched my initial belief. Both of the researches did in fact find a link between traumatic brain injury and pragmatic and linguistic abilities. There was an evident difference in pragmatic abilities between healthy adults and TBI adults, as well as definite language deficits between healthy children and children who had TBI. Through various formal tests and language samples, I did find from my research that there is a link between traumatic brain injury and language abilities. After reading this research, I believe that there could be more accurate tests done. Perhaps tests that are in a more naturalistic setting, and that will truly show off a patient’s communication abilities.
The next step in this process is to take this knowledge about language deficits in people suffering from traumatic brain injury, and study the best ways to treat these individuals. Although there is still more work to be done, I am content with knowing that the research done showing that there is a link between TBI and language is a good start.