Attentional deficits and conversational discourse in closed-head injury

Date of Completion

January 2005


Health Sciences, Rehabilitation and Therapy|Health Sciences, Speech Pathology




Persisting deficits in conversational skills are a contributing factor to poor psychosocial adjustment and social isolation following closed-head injury (CHI). Therefore, conversational discourse may be more clinically relevant for the CHI population in terms of long-term outcomes than other genres of discourse. Effective communication skills require the integrity of a number of cognitive abilities that are frequently disrupted following CHI. Chronic cognitive deficits contribute to long-term dysfunction and have also been correlated with poor outcome in individuals with CHI. However, there is a paucity of empirical information regarding the role that underlying cognitive abilities may play in the conversational discourse deficits observed in individuals with CHI. Although treatment studies have suggested that training of specific skills does not generalize to functional tasks, no treatment study to date has utilized performance on a functional communicative task, such as conversational discourse, as an outcome measure. The present study investigated whether improvements in a specific cognitive ability attention, would facilitate conversational discourse for three individuals with CHI. A single subject A-B-A-C-A multiple treatments comparison design was employed. Three individuals with CHI participated in two treatments, one attention-based and one social skills-based. It was hypothesized that attention training would provide the greater benefit by improving attention as well as conversational discourse while social skills training would improve only conversation. Treatment effect sizes suggest that both treatments were active; however, performances of all three participants were variable throughout the study reducing the magnitude of change observed. Overall, the results of this study suggest that the two treatment regimens, whether presented in isolation or in combination had some effect on each of the participant's conversational performances though not to the extent anticipated. Therefore, it is unclear at this time if the APT-II, the IPR, or the combination of both treatments is the most effective approach to treating conversational discourse deficits in this population. Continued research regarding the treatment of cognitive deficits as a means to improving conversational discourse performance in individuals with CHI is needed. Implications for clinical practice and future research are discussed. ^