Differences in Narrative Discourse Ability in Traumatic Brain Injury and a Neurotypical Comparison Group: Influence of Age, Education, and Sex.

OBJECTIVE

To examine the influence of traumatic brain injury (TBI) on narrative discourse comprehension and production of individuals with TBI compared with a non-brain-injured (NBI) group. Furthermore, this work investigated the potential influence of sociodemographic factors (ie, age, education, sex) on narrative discourse performance.

DESIGN

Case-control design.

SETTING

General community.

PARTICIPANTS

A total of 44 adults (N=44) were grouped into 2 age- and education-matched cohorts. The TBI group comprised 21 participants with mild-moderate cognitive impairment, and the NBI comprised 23 participants.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Narrative discourse outcomes were measured by 2 comprehension measures (Discourse Comprehension Test, picture story comprehension task) and 2 production measures (story grammar, story completeness). Four univariate analyses of covariance were performed with age, education, and sex as covariates. The analyses of covariance were performed using parameter estimates with robust standard errors, and boxplots were constructed to understand differences between cohorts for each discourse measure.

RESULTS

No sociodemographic variables (ie, the covariates) were significant for any of the 4 discourse measures. The NBI group outperformed the TBI group on the Discourse Comprehension Test (P=.003, 95% CI [1.46-6.82], partial η2=0.20), Picture Story Comprehension (P=.005, 95% CI [0.61-3.26], partial η2=0.18), and story completeness (P=.005; 95% CI [0.43-2.26]; partial η2=0.21). Effect sizes were large across these 3 discourse measures. No significant difference between groups was found for story grammar (P=.440; 95% CI [-0.11-0.25]; partial η2=0.02).

CONCLUSIONS

TBI disrupts both narrative discourse comprehension and production ability. Findings underscore the need to evaluate both narrative comprehension and production performance after TBI. Age, education, and sex did not influence discourse outcomes.