Discourse analyses with closed head injured adults: evidence for differing patterns of deficits

To better characterize the verbal impairments of higher level closed head injured (CHI) adults, we used narrative stories to longitudinally sample their discourse abilities. Stories were analyzed at the levels of intersentential cohesion and story grammar. Two differing patterns of deficits that emerged are described. In the first, a CHI subject demonstrated excessive verbalization characterized by poorly organized, but task-appropriate, content. In the second, a CHI subject demonstrated fair to good organization but little appropriate content. Prognostically, the presence of appropriate, although disorganized, content was an early indication that the subject was able to appreciate potential relationships of characters in the stimulus picture. The second pattern represented a more severe cognitive dysfunction. This subject's attempts at stories, although well organized, were merely elaborate descriptions of the picture. Discourse analyses appear to be well suited for the assessment of CHI adults.