Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress.

Abstract

Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD. Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness. Results revealed a significant difference between the mTBI (Mdn = 3.33) and NBI (Mdn = 3.50) groups, χ2(3) = 6.044, p = .017, ε2 = .03, for global coherence. Word count differed significantly between the mTBI + PTSD (Mdn = 135) and NBI (Mdn = 195) groups, χ2(3) = 7.968, p = .006, ε2 = .06. No other group differences were observed. Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.