COMPETENCE IN DISCOURSE AS A MEASURE OF SOCIAL INTEGRATION AND QUALITY-OF-LIFE IN PERSONS WITH TRAUMATIC BRAIN INJURY

Persisting difficulties in communication are a serious handicap faced by many after traumatic brain injury (TBI) and a major barrier to comm unity reintegration. Conventional approaches to the study of communica tion problems after TBI have focused on the form of language productio n and expression, usually in terms of phonological, semantic and synta ctical features. Most TBI patients, however, perform overall within no rmal ranges on these conventional indicators. More recently, attention was focused on language in its naturally-occurring form, that is, dis course, which is heavily influenced by linguistic, cognitive and socia l skills. Because most TBI patients are left with residual deficits in these areas, study of discourse abilities seem to be particularly sui ted to understanding their problems in communication and facilitating eventual reintegration into the community. This study was designed to determine if and how the conversational discourse of TBI patients diff ers from a matched non-TBI group and whether any identified variables are related to measures of outcome as measured by community integratio n and quality of life. Additionally, the study was designed to explore the relationship between TBI and features of discourse across convers ational, narrative, procedural genres. TBI patients (n = 30) from an o ut-patient brain injury programme were compared to matched controls (n = 10) in the three discourse genres. Bivariate and multivariate analy ses evaluated 23 measures of discourse efficiency, complexity, topic m anagement, information and pragmatic behaviours in each genre as well as measures of psyshosocial adjustment, particularly social integratio n and quality of life. Results indicated that TBIs were significantly different from controls on several measures of discourse and psychosoc ial adjustment. A number of other features of discourse were found to correlate significantly with social integration and quality of life. I nterestingly, discourse variables appeared to correlate with social in tegration more strongly than age, gender, education, and other convent ional psychosocial factors. Contrary to prediction, features of conver sational discourse did not correlate more strongly than other types of discourse with social integration and quality of life. Discussion cen tred on the apparent comorbidity of features in everyday discourse and psychosocial deteriminants that were associated with quality of life and social integration.