Acquired brain injury in children and adolescents: Investigating assessments of communicative participation in daily life situations
Abstract
Aims The overall aim of this thesis was to explore assessments of communicative participation
in children and adolescents (hereafter: adolescents) with acquired brain injuries,
mainly through evaluations in the Communicative Effectiveness Index (CETI) and in
interviews with the participants. The aim was also to capture important changes in communication
over time. Five sub-studies were carried out, presented in Papers I-V.
Methods Paper I: Pragmatic evaluations were explored in eight participants with severe
brain injuries. The data were obtained in clinical surroundings by a speech language pathologist
and rehabilitation assistants, using clinically applied pragmatic taxonomy, the Pragmatic
Protocol (PP). Paper II: Descriptive and comparative methods were used to assess
the communication outcome in an adolescent with ABI. The investigations included linguistic
and cognitive test data and adolescent/parent evaluations of communication skills
in the CETI, post-injury and at follow-up. Video recordings to explore communication
management were analysed through self-evaluation and interview procedures. Paper III:
The contribution of CETI in the assessment of ABI was examined through parent evaluations
of communication in 30 adolescents, which were compared with linguistic, cognitive
and brain injury data. Paper IV: Assessments of daily communication skills delivered by
the parents of eight adolescents were compared with self-evaluations by the adolescents
themselves. Interview data were analysed in particular by applying activity-based communication
analysis, ACA (Allwood, 2013), and the theory of distributed cognition (Hutchins,
1995a). Paper V: Change scores in 30 adolescents between post-injury measurements and
follow-up results were estimated.
Results Paper I: Seven of eight participants with severe brain injuries were assessed as having
a highly reduced capacity to communicate within all the assessed pragmatic parameters
that involved speech and language skills. Paper II: Self-evaluation of the video recordings
and analyses of communication management in Paper II confirmed impaired communication,
related to language comprehension difficulties, high speech rate and the number of
speakers involved. Paper III: The CETI data showed that adolescents with more communication
difficulties, according to their parents, also obtained significantly lower scores in
tests of grammar comprehension and verbal IQ. The trend was similar for word comprehension,
naming and perceptual IQ, although this was not supported by significant results.
However, complex communicative interactions, such as fast conversations with several
speakers involved, were affected in all participants, including those with higher results in
linguistic and cognitive tests. As a result, complex communicative situations appeared to
be particularly vulnerable to the effects of the brain injuries, regardless of injury severity.
The aetiologies of the injuries did not affect the outcome in individual results. However,
the majority of adolescents with more communication difficulties according to parent
evaluations had left-hemisphere brain lesions. Paper IV: Overall high agreement between
the adolescent and parental assessments was found. However, complex communicative
situations more frequently received lower scores in the parental ratings. Analyses using
the ACA and distributed cognition models and interview data pointed to the usability of a systematic comparison of the shared views on communication after ABI in adolescence,
to increase knowledge of the participation perspective in real-life communication. Paper V:
The nature and extent of communication abilities after communication strategies applied
by the parents at home showed a significant increase in ability in 30 participants (p < .01),
but some tasks did not improve as much, even showing a reduction in capacity after the
one-year application of communication strategies, according to parental estimations.
Conclusions One general conclusion in this thesis is that evaluations of communication
abilities in adolescents with ABI benefit from analyses of interaction in everyday situations.
The data obtained in the clinical surroundings, in particular, the results from cognitive,
linguistic and cerebral lesion site data, appear to have a certain predictive value in terms
of the communication outcomes rated in the CETI, thereby strengthening the content
validity of the CETI in adolescent participants with ABI. The findings further point to the
important role parents play in exploring the adolescents’ communicative participation in
real life by sharing their opinions in interviews, based on the CETI results. The participation
perspective can be addressed in the self-assessments by the adolescents themselves,
as was shown in analyses of video recordings and in the interviews exploring the activitybased
communication analysis and distributed cognition perspectives. The mixed-method
design applied in this thesis could provide information which could contribute to shaping
fruitful individualised rehabilitation programmes in adolescents with ABI.
Parts of work
PAPER I
Fyrberg Å, Marchioni M, Emanuelson I. Severe acquired brain injury:
rehabilitation of communicative skills in children and adolescents. International
Journal of Rehabilitation Research. 2007 ; 30: 153-7.
::doi::10.1097/MRR.0b013e32813a2ee7 PAPER II
Fyrberg Å. Communication after traumatic brain injury in adolescence: a
single subject comparative study of two methods for analysis. Journal of
Interactional Research in Communication Disorders. 2013; 4: 57.
::doi::10.1558/jircd.v4i2.157 PAPER III
Fyrberg, Å, Horneman, G, Åsberg Johnels, J, Thunberg, G, Ahlsén, E.
Communication in children and adolescents after acquired brain injury –
an exploratory study.
Submitted to Journal of Rehabilitation Medicine, 2016. PAPER IV
Fyrberg, Å, Strid, K, Ahlsén, E, Thunberg, G. Everyday communication
in adolescents after acquired brain injuries – a comparative study of selfratings
and parent evaluations using the CETI. Accepted for publication
in Journal of Interactional Research in Communication Disorders, January 2017.
::doi::10.1558/jircd.30904 PAPER V
Fyrberg, Å, Strid, K, Ahlsén, E, Thunberg, G. Communication before and
after a home-based intervention in adolescents after acquired brain injury:
applying the CETI as an outcome measurement.
Manuscript.
Degree
Doctor of Philosophy
University
Göteborgs universitet. IT-fakulteten
Institution
Department of Applied Information Technology ; Institutionen för tillämpad informationsteknologi
Disputation
Friday February 24th, 2017, at 10:00 in Torg Grön, located at the fourth floor, Patricia building, Lindholmen Campus. Street address: Forskningsgången 6, Göteborg, Sweden.
Date of defence
2017-02-24
asa.fyrberg@vgregion.se
Date
2017-02-03Author
Fyrberg, Åsa
Keywords
communicative participation
acquired brain injury
children and adolescents
parental evaluations
self-assessments
Activity based Communication Analyses
cognitive and lingustic factors
Publication type
Doctoral thesis
ISBN
978-91-982069-9-9
Language
eng