Service de Rééducation Neurologique, Hôpital Swynghedauw, CHRU, Lille, France.
Eur J Neurol. 2010 Jul;17(7):922-9. doi: 10.1111/j.1468-1331.2009.02945.x. Epub 2010 Jan 22.
Communication disorders have been reported following severe traumatic brain injury. However, we have little information about patient behaviour during dyadic interaction. Here, we analyzed conversation at the rehabilitation and chronic phase post traumatic brain injury (TBI), to define the main mechanisms of verbal and non-verbal communication disorders and relationship with other cognitive difficulties.
Sixteen patients were evaluated at the rehabilitation phase (2-12 months) and 18 at the chronic phase (after 2 years) following severe TBI. They were compared with equivalent groups of matching (gender, age, education level) control subjects. We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics, verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics, non-verbal feedback). We also investigated executive functions (Stroop test, trail-making test, categorical evocation), language (Montreal-Toulouse protocol) and behaviour (Neurobehavioural Rating Scale). Verbal communication disorders were relatively equivalent at the rehabilitation and chronic phases.
Patients were impaired (P < or = 0.01) in their participation to communication, especially in greeting behaviour. Verbal communication was mostly affected by difficulties in producing fluent and intelligible language and using pragmatics (responding to open questions, presenting new information and introducing new themes, organizing discourse and adapting to interlocutor knowledge). Non-verbal communication was impaired by difficulties in using pragmatics (mostly adapted prosody). Participation and verbal communication correlated with the executive functions, language and behavioural assessment.
Disorders of social communication justify systematic assessment in patients with TBI.
严重创伤性脑损伤后可出现沟通障碍。然而，我们对患者在双人际互动期间的行为知之甚少。在这里，我们分析了创伤性脑损伤（TBI）后康复期和慢性期的对话，以确定言语和非言语交流障碍的主要机制及其与其他认知困难的关系。
16 名患者在严重 TBI 后 2-12 个月的康复期和 18 名患者在 2 年后的慢性期接受评估。将他们与匹配的性别、年龄、教育程度的对照组进行比较。我们使用里尔沟通测试，它包括三个部分：沟通参与（问候、注意力、参与）、言语沟通（言语理解、言语输出、可理解性、单词生成、句法、言语语用、言语反馈）和非言语沟通（理解手势、情感表达、产生手势、语用、非言语反馈）。我们还研究了执行功能（斯特鲁普测试、轨迹生成测试、类别唤起）、语言（蒙特利尔-图卢兹协议）和行为（神经行为评定量表）。在康复和慢性阶段，言语交流障碍相对相等。
患者在沟通参与方面存在障碍（P≤0.01），尤其是问候行为。言语交流主要受流畅和可理解语言的产生以及语用学的影响（回答开放式问题、呈现新信息和引入新主题、组织话语和适应对话者的知识）。非言语交流受到语用学（主要是适应韵律）的影响。参与和言语交流与执行功能、语言和行为评估相关。
社交沟通障碍需要对 TBI 患者进行系统评估。
