Discipline of Speech Pathology, The University of Sydney, New South Wales, Australia.
Graduate School of Health, University of Technology Sydney, New South Wales, Australia.
Am J Speech Lang Pathol. 2019 Nov 19;28(4):1463-1478. doi: 10.1044/2019_AJSLP-18-0204. Epub 2019 Sep 4.
Purpose The interrelationship between psychosocial outcomes and discourse after severe traumatic brain injury remains largely unknown. This study examines outcomes relating to work, relationships, and independence within the context of discourse recovery across the 1st year post-injury. Method An inception cohort comprising 57 participants with severe traumatic brain injury was assessed at 3, 6, 9, and 12 months post-injury. Outcomes were measured with the Sydney Psychosocial Reintegration Scale-2 (Tate et al., 2012; Tate, Simpson, Loo, & Lane-Brown, 2011), and discourse was evaluated with Main Concept Analysis of a narrative retell. Correlation and linear regression analyses were utilized. Results Significant correlations were found between psychosocial outcomes reported by relatives and discourse performance across the 1st year. The 6-month discourse scores significantly predicted the 12-month psychosocial outcomes reported by relatives. Initial discourse severity and recovery pattern also informed outcomes. Conclusions Discourse disorders have a strong relationship with everyday outcomes relating to work, relationships, and independence as reported by relatives. Six months post-injury is a beneficial time for assessment, education, and service planning. Age, years of education, and aphasia may mediate recovery and outcomes. A clinical decision tree is offered to support goal setting. Supplemental Material https://doi.org/10.23641/asha.9755444.
严重创伤性脑损伤后心理社会结局与话语之间的相互关系在很大程度上尚不清楚。本研究在损伤后 1 年内,考察了与工作、人际关系和独立性相关的结局,并探讨了话语恢复情况。
本研究纳入了一个包含 57 名严重创伤性脑损伤患者的队列研究,在损伤后 3、6、9 和 12 个月进行评估。采用悉尼心理社会再融入量表-2(Tate 等人,2012;Tate、Simpson、Loo 和 Lane-Brown,2011)评估结局,采用主要概念分析进行叙事复述评估话语。采用相关性和线性回归分析。
在损伤后 1 年内,亲属报告的心理社会结局与话语表现之间存在显著相关性。6 个月的话语评分可显著预测 12 个月亲属报告的心理社会结局。初始话语严重程度和恢复模式也会影响结局。
言语障碍与亲属报告的与工作、人际关系和独立性相关的日常结局密切相关。损伤后 6 个月是评估、教育和服务规划的有益时机。年龄、受教育年限和失语症可能会影响恢复和结局。本研究提供了一个临床决策树来支持目标设定。