Speech and Hearing Sciences ETDs

Publication Date

Fall 11-13-2017


Purpose: There are few longitudinal data charting recovery of discourse skills following severe traumatic brain injury (TBI). Limited knowledge about the trajectory of discourse recovery and the best tools for assessing communication abilities in persons with TBI (PWTBIs) restricts detection of communication impairment and the ability to make informed prognostic judgments following TBI. This study sought to contribute longitudinal data to the research base, using clinically efficient measures that are sensitive to communication deficits associated with TBI and that use nuanced scoring systems to provide detailed characterization of discourse.

Methods: Twenty-three PWTBIs completed picture description tasks at 3 (or 6) months, 12 months, and 24 months post-injury. Discourse samples were orthographically transcribed and segmented into utterances according to the Codes for Human Analysis of Transcripts (CHAT) software manual guidelines. Main Concept Analysis (MCA) and Coherence Analysis (CohA) were used to describe the informativeness, efficiency, and organization of each sample. Group changes in performance on these measures over time were documented.

Results: Significant recovery of discourse abilities occurred within the first year following TBI, with output becoming more informative and more organized at 12 months post-injury compared to 3/6 months post-injury. Discourse remained more informative at 24 months post-injury compared to 3/6 months post-injury. A non-significant decline in organization from 12 to 24 months post-injury resulted in failure to maintain significant gains in this area. Discourse efficiency did not change significantly across any timepoints and there were no significant changes occurring from 12 to 24 months post-injury.

Conclusions: The measures used in this study detected and described recovery of discourse skills following TBI. The bulk of recovery occurred within 1 year of injury and various aspects of communication (informativeness, efficiency and organization) appeared to follow distinct recovery trajectories. More research is needed to investigate factors that impact recovery patterns and the relationship between communication deficits following TBI and life participation. Such studies will further inform prognostic judgments, allocation of rehabilitation resources, and research programming.

Degree Name

Speech-Language Pathology

Level of Degree


Department Name

Speech and Hearing Sciences

First Committee Member (Chair)

Jessica Richardson

Second Committee Member

Richard Arenas

Third Committee Member

Katharine Blaker




cognitive-communication, discourse, traumatic brain injury, longitudinal, recovery

Document Type