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LCCA Exam Revision > Functional approaches in TBI > Flashcards

Functional approaches in TBI Flashcards

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1
Q

what type of disorder is TBI?

A

cognitive-linguistic

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2
Q

what is communication affected by? is this more similar to aphasia or dementia?

A

Communication is affected as much or more so by cognitive impairments (e.g. executive function deficit) than linguistic impairments

more similar to dementia in this regard

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3
Q

what kind of disorder is TBI from a linguistics perspective?

A

pragmatic disorder

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4
Q

how does TBI being a pragmatic disorder manifest itself?

A

Rules governing how language is used/rules governing socially appropriate talk/behaviour are impaired

For some people with TBI most levels of linguistic ability (e.g. grammatical, lexical, phonological abilities) are relatively intact but it is how they use language and perhaps how they behave more generally that highlights them as atypical

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5
Q

why might TBI raise quite particular psychosocial issues and other issues at the ICF levels of activities and participation

A

lacking insight into condition (with implications for rehabilitation),

sense of ‘self’ impacted on,

sometimes quite young

implications for relationships and family life

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6
Q

3 main functional approaches for TBI

A

Discourse Analysis

Conversation analysis

Psychosocial approach

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7
Q

where was discourse analysis developed?

A

within linguistics

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8
Q

what data makes up discourse analysis?

A

When applied clinically, data is comprised mostly of monologues or some kind of dialogic talk with a clinician or researcher rather than spontaneous conversation with their SO at home

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9
Q

benefit of discourse analysis

A

Lends itself well to coding and quantification

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10
Q

what two areas has discourse analysis been used to investigate in TBI?

A

politeness

coherence and cohesion

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11
Q

who researched politeness in TBI

A

Togher & Hand (1998)

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12
Q

which research did Togher & Hand (1998) base their politeness studies on?

A

Halliday (1994) - Systemic Functional Linguistics research

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13
Q

which parts of Halliday’s SFL research did Togher & Hand (1998) use?

A

the interpersonal metafunction of language (i.e. how language is used between participants)

Level of modality expressed

the tenor of the discourse i.e. (i.e. the negotiation of social relationships between participants)

politeness markers

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14
Q

what is modality?

A

use of modal verbs, modal adjuncts and comment adjuncts

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15
Q

what does increased modality signify?

A

The greater the modality expressed, the less definite the speaker is

generally increased modality is considered more polite

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16
Q

what is tenor in discourse?

A

the intonation we use and how this relates to our pereived directness

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17
Q

how is tenor used to come across as more/less direct

A

Statements with falling intonation = direct/definite

Statements/tag questions with rising intonation = less direct/more polite

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18
Q

what are the politeness markers? (5)

A

Finite modal verbs (will, would, could, should, might, must)

Modal adjuncts (probably, possibly, just)

Comment adjuncts (i think)

Yes/No tags (hasn’t he?)

Incongruent realisations of the interrogative form (You don’t know what time they go or anything?)

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19
Q

where did Togher & Hand (1998) gather their data from?

A

Gathered data from role-played phone calls and compares TBI and non-TBI speakers

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20
Q

what are Togher & Hand’s findings

A

Generally speakers with TBI used significantly less politeness markers per clause than control subjects

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21
Q

what are Togher & Hand’s hypotheses

A

People with TBI expressing literal concepts and having difficulty with production and comprehension of abstract or complex language

People with TBI having neuropsychological impairments relating to planning, monitoring, social cognition and judgement

These 2 hypotheses are NOT mutually exclusive so CAN occur in the same person simultaneously

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22
Q

what is cohesion

A

how 2 or more sentences are shown to be linked through the language.

Occurs when the interpretation of one discourse element is dependent on another element

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23
Q

how is cohesion shown?

A

Shown through anaphoric pronouns, demonstratives, ellipsis, conjunctions

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24
Q

what is coherence?

A

the link and meaning between an utterance and what has been said previously and is the result of appropriate topic maintenance.

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25
2 types of coherence
local global
26
what is local coherence
topical relation between an utterance and the immediately preceding utterance
27
what is global coherence
topical relation between an utterance and the general topic
28
who researched cohesion and coherence in TBI using DA (2)
Ellis et. al., (2016) Glosser & Deser (1990)
29
what did Ellis et. al., (2016) find
 A number of studies indicate that people with TBI do worse in global coherence than normals
30
what did Glosser & Deser (1990) find
In measures of coherence in conversational discourse, people with TBI were significantly impaired compared to controls Global coherence worse than local coherence so often drift off topic Neuropsychologically, coherence is likely to rely on eg semantic memory and also simultaneous attention and mental manipulation of several items of information Both cohesion and coherence, but especially coherence, can impact on the person with TBI’s ability to successfully produce successful topical talk
31
where was conversation analysis developed
within sociology
32
where is data gathered from for CA
When applied clinically, the data is commonly spontaneous conversation at home with significant others
33
is CA qualatative or quantitative
Primarily a qualitative approach - looks for patterns across different people with the same disorder to establish how the disorder impacts on aspects of conversation (eg turns, sequences, topic, repair)
34
what was CA used to research about TBI?
turns and sequences topic inappropriate behaviour compensatory strategies
35
who used CA to research about turns and sequences in TBI (2)
Mann et. al., 2015 Denman & Wilkinson, 2011
36
findings of Mann et. al., 2015 research (3)
Test questions were a notable type of turn and sequence often used by CP - attempts by CP to get PwTBI to participate in conversation through means of eliciting displays of knowledge and memory that are already known to the CP  Praise noted for correct answers - unusual in typical conversation Both TBI conversations and typical conversations use CP’s questions to initiate and maintain topics. However, topic talk in TBI conversations seems laboured and requires more work by the CP due to the fact that the person with TBI doesn’t respond, gives minimal responses or produces ‘disaffiliative’ responses such as complaints
37
findings of Denman & Wilkinson (2011) research
increased use of CP questions can cause difficulties in TBI talk
38
why can increased use of CP questions cause difficulties in TBI talk
put the person with TBI ‘on the spot’ to talk now produce a certain action in talk (an answer) have enough cognitive and linguistic abilities which they can draw on quickly to produce a relevant answer. Questions can do more than just elicit an answer - some produce other actions such as proposals which may be difficult for PwTBI if they may it find difficult to, or not want to, sign up to at that moment Pursuing these questions can lead to the man with TBI appealing to the CP to not push him to provide a particular answer. In this instance, that appeal can contain touching, a problematic behaviour engaged in by this man with TB
39
which questions are especially difficult for someone with TBI
why questions
40
who used CA to research topic in TBI (2)
Body & Parker, 2005 Frankel & Penn, 2007
41
findings of Body & Parker, 2005 research
Topic bias/repetitiveness = common problem in talk of PwTBI inappropriate repetition of the same topic with the same person Can be diverted off favoured topic but regularly returns to it Often launches into new/repeated topics abruptly CP’s commonly repsond with continuers which implicitly encourage PwTBI to continue and thus they implicitly collaborate with him in his topic bias 
42
findings of Frankel & Penn, 2007 research
Examined perseveration in two people with TBI talking to health care professionals noted 2 types of perseveration - recurrent and stuck-in Linked the different topic difficulties to different patterns of neuropsychological deficit as highlighted by Barkley’s (1997) model of executive functioning and self-regulation
43
what is recurrent perseveration
the inappropriate occurrence of part or all of a previous response after a different intervening response’.
44
how does recurrent perseveration affect conversation?
Affects aspects of AA’s topic behaviour e.g. topic initiation and maintenance.  displayed topic bias in that he recurrently asked for information about current time and place  Other conversational abilities, such as turn-taking, appeared to be relatively good
45
what is stuck-in perseveration
inappropriate maintenance of a framework of response after introduction of a new task’
46
how does stuck-in perseveration affect conversation?
in conversation this took the form of difficulty in changing/shifting topic  Again, other conversational abilities, such as turn-taking, appeared to be relatively good
47
how does recurrent perseveration relate to Barkley’s (1997) model of executive functioning and self-regulation
presented with a significant interference control deficit with poor resistance to distraction  (ie failure to maintain attention, remain focused and pursue goal-directed behaviour)
48
how does stuck-in perseveration relate to Barkley’s (1997) model of executive functioning and self-regulation
presented with normal interference control but poor behavioural inhibition  (ie he could sustain attention and withstand interference but had difficulty with set switching and with disengaging from an ongoing stimulus to move to another)
49
who used CA to study inappropriate behaviour
Denman & Wilkinson, 2011
50
which type of inappropriate behaviour did Denman & Wilkinson, 2011 observe
Inappropriate behaviour in the form of touching women
51
what was observed about inappropriate behaviour
In this example, touching was always part of a turn at talk, not occurring in isolation - therefore touching was not linked to physical opportunity but to a social/interactional opportunity - when PwTBI had occasion to appeal to CP for something Intervention could focus on assisting Joan to cut down on opportunities Richard has to appeal to her about these kinds of issues
52
who used CA to investigate compensatory strategies in TBI
Penn & Cleary, 1988 Barnes, 2012
53
finding of Penn & Cleary, 1988 research
People with TBI can use compensatory strategies to try and compensate for their linguistic/cognitive impairments
54
which compensatory strategies were noted by Penn & Cleary, 1988
direct reported speech short conversational turns (e.g. 'mm') pronominalisation (i.e. use of semantically vague linguistic forms)
55
what is interesting about these compensatory strategies + references
all seen in some cases of dementia Hamilton, 1994; Kindell et. al., 2013
56
findings of Barnes, 2012 research
Compensation/adaptation does not just happen in the person with TBI’s talk/behaviour; it can also occur in the conversation partner’s PwTBI has difficulty in remembering details to do with daily activities so uses diary as an external aide CP noticeably structures the planning discussion in slightly unusual ways
57
how did Barnes, 2012 find that the CP used compensatory strategies
Talking PwTBI through individual stages of planning Uses test questions, proposals and directives to guide PwTBI’s behaviour Therefore, PwTBI has role in planning but since he needs scaffolding to think through issues, CP is strongly structuring conversation and leading planning
58
what 2 areas were researched about TBI using the psychosocial approach?
stress/depression self, self-awareness and relationships
59
who researched stress/depression in TBI?
Douglas and Spellacy, 2000 Verhaege et. al., 2005
60
findings of Douglas and Spellacy, 2000
Studied people with TBI and primary caregivers in home, 3-10years post-onset 57% PwTBI showed significant signs of depression 60% carers showed significant signs of depression
61
findings of Verhaege et. al., 2005
Families with young children particularly vulnerable to stress when a parent has a TBI young children may ‘lose’ a parent and have to ‘compete’ with the person with TBI for the attention of the non-TBI parent) Partners can get particularly stressed
62
who investigated self-awareness and relationships in TBI
Port et. al., 2002 Douglas, 2015
63
findings of Port et. al., 2002
PwTBI have less insights into some of their impairments than their SOs This lack of insight can impact on rehabilitation
64
findings of Douglas, 2015
Relationships with family and friends important for linking PwTBI to wider society Sometimes lose all friendships - family relationships more likely to remain than friendships

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