CONVERSATIONAL DISCOURSE ABILITIES FOLLOWING SEVERE TRAUMATIC BRAIN INJURY - A FOLLOW-UP-STUDY

The major aim of this study was to describe the conversational abiliti es of a group of severely injured TBI speakers, at a minimum of 2 year s post-injury. The association between conversational impair ment and (a) selected measures of executive function and (b) psychosocial handi cap was also examined. Twenty-four members of the group of 26 severely injured TBI speakers who had initially been assessed between 3 and 6 months post-injury were reviewed at a minimum of 2 years post-injury ( mean = 2 years, 10 months). At initial assessment, TBI speakers were c ompared with non-TBI orthopaedic patients and with a group of universi ty students. At follow-up, however, they were compared only with the o rthopaedic patients. Conversational assessment was carried out using a modified form of Damico's Clinical Discourse Analysis. As a group, th e TBI speakers' conversational abilities did not improve over time. Th ere was, however, at subgroup (n = 8) of speakers who did improve, and these could be distinguished by greater initial severity of injury an d a significantly longer period of speech-language pathology intervent ion than the speakers who either remained the same or worsened over ti me. Modest associations between conversational discourse skills and me asures of executive function and a measure of psychosocial handicap we re identified. These findings indicate that disruptions in conversatio n persist into the longer term. More assiduous efforts may need to be made to (a) identify subtle discourse changes in the early months afte r injury and (b) engage TBI speakers in speech-language pathology serv ices. Such services are also required over a longer time frame, in com munity-based models of service provision.