Factors that predict two year post-trauma communication outcomes for adults with severe traumatic brain injury

Background: Understanding factors that predict communication outcomes and influence communication recovery may facilitate effective intervention that improves a person with TBI’s capacity to engage in rehabilitation, maintain social relationships and achieve vocational goals.

Objectives: This study examines communication recovery following severe traumatic brain injury (TBI) by addressing the research questions: (1) What factors predict communication recovery at two years post-injury?; and (2) What associations exist between pre-injury demographic factors, injury severity, post-injury communication impairments and two year communication outcomes?

Method: 57 participants, aged 16- 67 years, with severe TBI attended comprehensive communication assessments at three months, six months post-injury and two years post injury. Predictor measures included pre-injury (gender, age, pre-morbid education), injury (PTA, GCS) and post-injury (diagnosis of aphasia, dysarthria, conversation discourse, cognitive communication and neuropsychological) data. For two year outcomes, perceived communication skills were measured using the LaTrobe Communication Questionnaire (LCQ-Other; Douglas et al., 2000). The Sydney Psychosocial Reintegration Scale (SPRS-2; Tate, 2011) provided self and other reports of psychosocial participation. Conversational participation and support outcomes were evaluated with observational ratings (Adapted Kagan Rating Scales; Togher et al., 2010).

Findings: Multiple regression analyses indicated that pre-injury and injury measures predicted communication partners’ perceptions of psychosocial outcomes (p< .05) with pre-morbid education the only independent predictor of recovery (accounting for 17% variance). Non parametric statistical comparisons showed perceived communication skills outcomes were significantly correlated with information speed/memory and executive functioning skills at six months post injury (rho= -.507; rho= -.384 p˂.01). Self-reported psychosocial outcomes were significantly, positively correlated with pre-injury education (rho=.319, p<.05) and with six month aphasia and information processing speed/memory (rho=.387, rho=.339, p<.05) scores. Diverse factors were associated with other-reported psychosocial outcomes including: pre-injury education (rho=.378, p˂.05); duration of PTA (rho=-.432); three month executive functions (rho=.396, p<.05); three and six month information processing speed/ memory (rho=.570, rho=.546, p<.01); three and six month aphasia (rho=.435; rho=.497 p<.05, p<.01 respectively); six month dysarthria scores (rho=.334, p<.05) and cognitive communication activity skills (rho=.706, p<.01). Conversation participation outcomes were strongly correlated with three month information processing speed/memory (rho=.538, p<.05) and six month aphasia (rho=.663, p<.01), dysarthria (rho=.556, p<.01) and cognitive communication activity (rho=.707, p<.01).

Conclusion: Findings indicate premorbid education and subacute communication and neuropsychological status are key factors in determining communication recovery.