Characterizing Narrative Discourse in Posttraumatic Amnesia and Early Recovery After Severe Traumatic Brain Injury

Following severe traumatic brain injury (TBI), individuals experience a transient period of confusion known as posttraumatic amnesia (PTA). Few empirical speech-language pathology studies have described language and cognitive-communication features during PTA or examined their early recovery. International guidelines recommend routine monitoring of communication during PTA; however, standardized speech-language pathology assessments are generally unsuitable for use during PTA. Narrative tasks offer a structured and repeatable approach to capture clinically meaningful changes. The purpose of this research was to describe narrative discourse characteristics in adults with severe TBI during PTA and examine how performance changed following PTA resolution.

Nine adults with severe TBI admitted to an inpatient rehabilitation setting completed a narrative task during PTA and again after resolution of PTA. Language samples were analyzed across multiple levels, with descriptive analyses used to characterize performance and patterns of change. Discourse performance during PTA was compared descriptively to published data, providing reference data for microlinguistic measures and story grammar in adults without brain injury and adults with TBI who were not in PTA, where data were available.

All participants demonstrated confused, disorganized narratives during PTA, although the degree and profile of impairment varied markedly across individuals. Macrostructural analyses provided the most meaningful and sensitive indicators of change, with several participants showing clearer narrative structure and increased production of relevant content post-PTA.

A narrative task has the potential to provide insight into the communication ability of patients in PTA, particularly in relation to change over time. This may help to guide decisions about the most appropriate timing for formal speech-language pathology assessment and intervention.