创伤性脑损伤患者讲述的重要事件回顾中的见解。
Insights From Important Event Recounts Told by People With Traumatic Brain Injury.
机构信息
The University of Sydney, New South Wales, Australia.
The University of Newcastle, New South Wales, Australia.
出版信息
J Speech Lang Hear Res. 2024 Sep 12;67(9):3064-3080. doi: 10.1044/2024_JSLHR-23-00595. Epub 2024 Aug 8.
PURPOSE
Communication can be chronically impacted by severe traumatic brain injury (TBI), yet there is a critical lack of research investigating communication recovery beyond 12 months postinjury with discourse measures. This longitudinal study aimed to investigate quantitative and qualitative changes in recounts produced by a group of people with severe TBI up to 2 years postinjury.
METHOD
A prospective observational design with an inception cohort was adopted. Thirty-four participants with severe TBI were asked to produce an important event recount at 6, 12, and 24 months postinjury. A mixed-methods approach comprised a quantitative analysis of microlinguistic and macrostructural measures, using the automated discourse command EVAL in Computerized Language Analysis (CLAN) and the CLAN Collaborative Commentary tool, respectively. Statistical analysis included a repeated-measures analysis of variance and the Friedman test. An independent qualitative content analysis was also conducted.
RESULTS
The measures revealed significant differences between 6 and 24 months, indicating a protracted recovery trajectory. The microlinguistic analysis showed increased use of revision and repetition over time. The macrostructural analysis indicated changes with orientation to recount characters, evaluative comments, and the number of events or complexity of the recount. The content analysis revealed categories of (a) childhood events, (b) family and relationships, (c) career and education, and (d) grief and loss. Topics at 6 months focused on childhood events and holidays, whereas career and education predominated at 24 months.
CONCLUSIONS
This is the first study to explore important event recounts told by people with severe TBI as they recovered. Participants showed discourse recovery beyond 12 months, highlighting the need for equivalent timing of service provision. The important event recount shows good potential as an ecologically valid assessment tool to evaluate communication recovery that can also be integrated with advances in computerized analysis. Analyses additionally provided insights into potential therapy targets and content categories for chronic discourse impairments.
SUPPLEMENTAL MATERIAL
目的
严重创伤性脑损伤（TBI）会长期影响沟通能力，但对于损伤后 12 个月以上的患者，使用话语测量方法来研究沟通恢复情况的研究极为缺乏。本纵向研究旨在调查一组严重 TBI 患者在损伤后长达 2 年内讲述重要事件时，其在定量和定性方面的变化。
方法
采用前瞻性观察设计和起始队列。34 名严重 TBI 患者在损伤后 6、12 和 24 个月时被要求讲述一个重要事件。使用计算机语言分析（CLAN）中的自动话语命令 EVAL 和 CLAN 协作评论工具分别对微观语言和宏观结构措施进行定量分析。统计分析包括重复测量方差分析和 Friedman 检验。还进行了独立的定性内容分析。
结果
这些措施显示 6 个月和 24 个月之间存在显著差异，表明恢复轨迹较长。微观语言分析表明，随着时间的推移，修订和重复的使用有所增加。宏观结构分析表明，讲述者对事件人物、评价性评论以及讲述的事件数量或复杂程度的取向发生了变化。内容分析揭示了以下几类内容：（a）童年事件，（b）家庭和人际关系，（c）职业和教育，以及（d）悲伤和失落。6 个月时的主题集中在童年事件和假期上，而 24 个月时的主题则主要集中在职业和教育上。
结论
这是第一项探索严重 TBI 患者在康复过程中讲述重要事件的研究。参与者在 12 个月后表现出话语恢复，这突出表明需要提供等效的服务提供时间。重要事件讲述具有很好的潜力，可作为评估沟通恢复的生态有效评估工具，并且还可以与计算机分析的进步相结合。分析还提供了有关慢性话语障碍的潜在治疗目标和内容类别的见解。
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