Sign acquisition and use following traumatic brain injury: case report

A case report is presented of an aphasic patient whose oral communication skills remained nonfunctional eight months after a traumatic head injury. After several unsuccessful attempts at using a variety of augmentative communication devices, manual signing was attempted. Several signs believed to be useful for communicating the patient's needs and wants were selected. The signs were introduced in a three-stage training procedure: imitation of a sign model, pointing to a picture of the concept signed, and producing the sign when presented with the pictured concept. A sign item was considered to be acquired when the patient had progressed through all three of the training stages. The patient acquired 47 signs over a five-month period, but was unable to use these signs in spontaneous, self-initiated communication. These findings illustrate the vast gap that exists between learning to produce a sign in response to a stimulus and using those signs for functional communication. The distinction between sign acquisition and sign use has largely been ignored in previous investigations of sign training with aphasic patients. Programming for generalization of acquired signs is a logical next step for future research on this topic.