Current Practices regarding Discourse Analysis and Treatment Following Non-Aphasic Brain Injury: A Qualitative Study

IntroductionDiscourse can be defined as any language that is beyond the boundaries of isolated sentences and is aimed at conveying a message among communication partners (Ska, Duong and Joanette, 2004; Ulatowska and Olness, 2004). Discourse production deficits are a hallmark of aphasia (Armstrong, 2000). However, they also occur in non-aphasic acquired brain injuries (ABI), such as right hemisphere stroke and traumatic brain injury (TBI) (Myers, 1993). Deficits in discourse production disrupt the ability to successfully produce conversation and may have a negative impact on a person's quality of life (Marsh and Knight, 1991; Marsh, Knight and Godfrey, 1990). Functional outcome studies following stroke have proposed that recovery of discourse abilities is critical to achieving a good quality of life after rehabilitation (Clarke et al. 2002; Mackenzie and Chang, 2002). Furthermore, significant correlations between discourse variables and social integration have been identified following neurological injury, indicating that discourse production deficits negatively affect a person's ability to reintegrate into the community (Galski, Tompkins and Johnston, 1998).Previous studies examining discourse production following ABI, in the absence of aphasia, have identified common deficits in the areas of global coherence, topic maintenance, and cohesion. Global coherence refers to the manner in which discourse is organized with respect to an overall goal, plan, theme or topic and is based on the listener's perception of the discourse sample (Glosser and Deser, 1991). Global coherence is one construct of discourse production that is particularly vulnerable to the effects of ABI (Brady, Armstrong and Mackenzie, 2005; Carlomagno et al., 2011; Hough and Barrow, 2003; Marini et al., 2011; Van Leer and Turkstra, 1999). Topic maintenance is a similar construct to global coherence and deficits are a common impairment following ABI (Bryan, 1988; Glosser and Deser, 1991). Deficits in topic maintenance include the use of inappropriate remarks related to the discourse (Bryan, 1998; Myers, 1993) and tangential speech (Myers, 1999; Rehak, Kaplan, and Gardner, 1992; Trupe and Hillis, 1985). Cohesion refers to the connection of semantic relations between parts of a discourse narrative and occurs when the interpretation of some element is dependent on the interpretation of another element within the text (Halliday and Hasan, 1976). Like global coherence, cohesion is a common discourse impairment following ABI (Davis, O'Neil-Pirozzi and Coon, 1997; Ewing-Cobbs et al., 1998; Hartley and Jensen, 1991; Marini et al., 2011; Mentis and Prutting, 1987).Although discourse production deficits following ABI have been documented, few researchers have examined the current practices of speechlanguage pathologists related to their assessment and treatment of individuals with ABI. Duff and colleagues (2002) surveyed a cohort of speech-language pathologists to identify their assessment and treatment strategies when working with individuals with mild TBI. Results indicated that speechlanguage pathologists used a variety of assessment measures, including standardized and non-standardized protocols. Two of the three most frequently used assessment tools were instruments developed for assessing the communication of individuals with aphasia, the Boston Diagnostic Aphasia Battery (BDAE; Goodglass, Kaplan and Barresi, 2001) and the Boston Naming Test (BNT-2; Kaplan, Goodglass and Weintraub, 2001). However, the use of these tests may not be a valid approach for assessing cognitive communication deficits and discourse production in persons with TBI since these tools were not designed for that purpose (Duff, Proctor and Haley, 2002). Aphasia assessment batteries historically focus language production at the word and sentence level, and so do not provide a systematic assessment of between sentence level processes of discourse, such as cohesion and coherence, and commonly impacted by ABI (Duff, Proctor and Haley, 2002). …