EBP Compendium: Summary of Systematic Review

Academy of Neurologic Communication Disorders and Sciences; American Speech-Language-Hearing Association; Department of Veterans Affairs
Nonstandardized Assessment Approaches for Individuals with Traumatic Brain Injuries
Coelho, C., Ylvisaker, M., et al. (2005).
Semin Speech Lang, 26(4), 223-241.

Indicators of Review Quality:

Description: This is a review of studies of nonstandardized procedures, published expert opinion, and a survey of speech-language pathologists who work with individuals with cognitive-communication disorders pertaining to the use of non-standardized assessments for individuals with traumatic brain injury (TBI). The review is part of a series by the Academy of Neurologic Communication Disorders and Sciences Practice devoted to the management of TBI.

Question(s) Addressed:

Question not specifically stated.

Population: Individuals with traumatic brain injury

Intervention/Assessment: Nonstandardized assessments

Number of Studies Included: 19

Years Included: Not stated

Findings:

Conclusions:

• Assessment/Diagnosis
• Assessment Areas
  • Cognitive-Communicaiton (Adults)
    • “There is substantial evidence to support the assessment of communication beyond what is included in standardized aphasia or child language batteries” (p. 237).
    • Specifically, the evidence supports 1) inclusion of the analysis of productivity and efficiency of verbal output, content accuracy and organization, grammar, and coherence to assess monologic discourse and the analyses of initiation and manipulation of content to assess conversational discourse and 2) the use of dynamic assessment and collaborative contextualized hypothesis testing to plan and determine interventions.
    • The authors conclude that “checklists pertaining to the communication environment and environmental demands have face validity” and “checklists related to the assessment of communication partners have apparent content validity” (p. 238). Further study of checklist assessments is warranted and findings should be interpreted with caution.
    • Further research is also warranted to develop measures to assess social cognition.
  • Cognitive-Communication (Children)
    • Discourse Analysis
      • General Findings
        • “The interpretation of discourse analyses must consider context factors” such as the nature of the social interaction, the modality of the discourse, and the relationship and roles of the persons involved in the conversation (p. 231).
      • Monolofic Discourse
        • “Overall, the measures of verbal productivity and efficiency, content accuracy and organization, story grammar, and coherence were all noted to be sensitive measures of impaired discourse performance after TBI” (p. 228).
        • “It appears that measuring the amount and organization of content was more important in distinguishing impaired from normal discourse than measures of language form” (p. 229).
        • “When monologic discourse is assessed, the literature to date supports inclusion of analyses of productivity and efficiency of verbal output, content accuracy and organization, story grammar, and coherence” (p. 237).
      • Conversational Discourse
        • Individuals with TBI presented with “decreased initiation and maintenance of conversational topics and errors of content conveyed during conversation, including findings of verbal disruptions and problems with word finding, errors in the transfer of information, and decreased response adequacy” (p. 230).
        • “Conversations of individuals with TBI were characterized by more turns and shorter, less complex utterances” (p. 230).
        • Data from pragmatic scales “revealed that, regardless of injury severity, individuals with TBI demonstrated a higher incidence of pragmatic errors than normal controls” (p. 230).
        • The variety of measures used to analyze conversational discourse included measures of initiation and measures of manipulation of content.
        • “Overall, measures of content and topic management appeared most useful for identifying conversational impairments” (p. 231).
        • “For conversational discourse, analyses should include measures of initiation and manipulation of content during interactions. In all instances, it is critical to consider the potential influences of context (i.e., nature of the social interaction, modality by which the discourse is produced, and the relationship and roles of participants in the interaction)” (p. 237). 
• Assessment Instruments
• Cognitive-Communicaiton (Children)
• Discourse Analysis
• General Findings
  • “When the primary goals of assessment are to identify real-world disability and to plan and monitor intervention, office-bound language and neuropsychological testing must be supplemented by nonstandardized, real-world assessment” (p. 227).
  • A survey by the authors of this systematic review suggested that nonstandardized techniques were common amongst clinicians working with individuals with TBI.
  • “There is a need for further research to establish the ecological validity of discourse measures outside the experimental settings in which data are typically collected” (p. 231).
• Monologic Discourse
  • A review of 18 studies of monologic discourse in individuals with TBI identified the following “analysis procedures for which consistent findings of impairment have been reported: analyses of productivity and efficiency of verbal output, content accuracy and organization, story grammar and coherence” (p. 230).
  • A review of 18 studies of monologic discourse in individuals with TBI identified the following analysis procedures for which inconsistent findings of impairment have been reported: syntax, grammatical complexity, and cohesion.
  • “Measures of conversational discourse appear better able to discriminate TBI and on brain-injured groups than measures of monologic discourse. This may be accounted for by the interactive nature of conversation as well as social factors that appear to make this genre more sensitive to the cognitive-communicative impairments of individuals with TBI” (p. 231).
• Conversational Discourse
  • "Although these [conversational discourse] scales are potentially useful tools for rating communicative behaviors, most require training to achieve acceptable reliability, many are not well defined and have checklist items that do not represent continuous variables, and none are supported by adequate data on ‘normal’ performance" (p. 229).
  • "Pragmatic rating scales identified subtle communication impairments in the presence of near-normal scores on standardized language batteries" (p. 230).
  • "Pragmatic rating scales are useful in that they may capture real-world communication difficulties. However, most scales require a period of training before they can be used reliably and many scales are weak in basic psychometric properties" (p. 231).
  • "Measures of conversational discourse appear better able to discriminate TBI and on brain-injured groups than measures of monologic discourse. This may be accounted for by the interactive nature of conversation as well as social factors that appear to make this genre more sensitive to the cognitive-communicative impairments of individuals with TBI" (p. 231). 

Keywords: Brain Injury

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Added to Compendium: February 2012