Evaluation of communication competence in patients with closed head injury

Twenty closed head injured (CHI) and 15 control subjects (non-CHI) were selected from a hospital population and evaluated after all CHI subjects were alert and conscious. The test battery included an audiometric evaluation and 21 subtests of intelligence, verbal expressive and receptive language, articulation, auditory and visual short-term memory, oral agility, automatic speech, writing, reading, and simple mathematics. The CHI subjects performed significantly less well than the control group on all subtests except articulation and five of the subtests of reading, writing, and mathematics. Additionally, the less severely involved CHI subjects performed significantly better than the more severely involved CHI subjects on the subtest, Automatized Sequences, and, to a lesser degree, Oral Agility. The implications are that CHI has an immediate generalized effect upon the cerebral mechanisms subserving intelligence, speech, language, memory, and specific writing, reading, and arithmetic skills and that the differences seen in automatic speech and oral-motor skills appear to be dependent upon the severity of the traumatic head injury. I recommend that all CHI patients undergo assessment for communication competence regardless of the level of severity of the trauma.