Brain Injury

ISSN: 0269-9052 (Print) 1362-301X (Online) Journal homepage: https://www.tandfonline.com/loi/ibij20

Social communication assessment after traumatic

brain injury: a narrative review of innovations in
pragmatic and discourse assessment methods

Joanne Steel & Leanne Togher

To cite this article: Joanne Steel & Leanne Togher (2019) Social communication assessment after
traumatic brain injury: a narrative review of innovations in pragmatic and discourse assessment
methods, Brain Injury, 33:1, 48-61, DOI: 10.1080/02699052.2018.1531304

To link to this article: https://doi.org/10.1080/02699052.2018.1531304

Published online: 10 Oct 2018.

Submit your article to this journal

Article views: 1422

View related articles

View Crossmark data

Citing articles: 3 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=ibij20
BRAIN INJURY
2019, VOL. 33, NO. 1, 48–61
https://doi.org/10.1080/02699052.2018.1531304

Social communication assessment after traumatic brain injury: a narrative review of

innovations in pragmatic and discourse assessment methods
a,b b,c
Joanne Steel and Leanne Togher
a
Speech Pathology, The University of Technology, Sydney, Australia; bMoving Ahead, NHMRC Centre of Research Excellence in Brain Recovery,
School of Psychology, University of New South Wales,, Sydney, Australia; cSpeech Pathology, The University of Sydney, Sydney, Australia

ABSTRACT ARTICLE HISTORY

Background: Social communication assessment after traumatic brain injury (TBI) remains a challenging Received 4 January 2018
area within speech-language pathology (SLP) clinical practice. Difficulties include the lack of TBI-specific Revised 25 August 2018
standardized assessment instruments and limited knowledge and uptake of discourse assessment Accepted 27 August 2018
methods clinically. The aim of this paper was to review recent research literature reporting on innovative KEYWORDS
social communication and discourse assessment measures and methods, to guide evidence-based SLP Traumatic brain injury; social
practice and inform future research. communication assessment;
Main Contribution: This review describes novel standardized and non-standardized assessment tools pragmatic assessment;
for SLP use reported in TBI research literature from the past 15 years. Measures include published discourse analysis;
assessment batteries and pragmatic rating scales designed for use with adults with TBI, and novel speech-language pathology;
discourse tasks and protocols. cognitive communication
Conclusion: This paper delineates social communication assessment measures and discourse analyses
described in research literature that may be practical for SLPs to use with adults with TBI. The clinical
implications and utility of these measures are discussed. This should assist SLPs in decision-making on
social communication assessment for adults with TBI. Further research is needed to investigate transla-
tion of research knowledge on discourse assessment methods to SLP practice.

Introduction practice are well-established (6). There are now guidelines avail-
able from national professional bodies for SLPs working with
Extensive literature on traumatic brain injury (TBI) generated
adults with TBI, including from the USA (7–9), the UK (10),
over the past 25 years has confirmed that social and cognitive
Canada (11) and INCOG, an international team of researchers
communication impairments are common sequelae of injury.
and clinicians (12). Current recommendations for social and
Between 80% and 100% of people with TBI experience some
cognitive communication assessment after TBI include use of
degree of disability (1), which persists long-term for up to
standardized and non-standardized assessment measures (8,9),
60% of those affected (2). Impairments of social competence
consideration of communicative context, communication partner
after TBI include difficulties with language, pragmatic skills,
and communication needs (12). Standardized tests have been
social behaviours, and cognitive functions, affecting the ability
described as having ‘clearly defined procedures for administration’
to interact with others (verbally and non-verbally) in relation-
[9; p. 216], and may also be norm-referenced (i.e. test results may
ships, work and social situations (2–5). Social communication
be compared to scores from a normative sample) (9). Non-stan-
disability results from the breakdown in interactional use of
dardized assessment includes discourse analysis, functional assess-
language and cognitive functions. The benefits of timely social
ment measures, pragmatic and social communication rating scales
communication assessment include the potential for speech-
(from the perspectives of the SLP, person with TBI and familiar
language pathologists (SLPs) to identify ongoing difficulties,
communication partners) and subjective, descriptive reports
and create and modify intervention strategies, such as formu-
derived from SLP clinical observations of performance.
lating therapy targets, training communication partners, and
In SLP practice, decision-making regarding assessment will
providing information to treating staff and others.
depend on a range of individual factors relating to the patient,
Despite the recognized need, social communication assessment
context, clinician and the required purpose of assessment
after TBI has been challenging in speech-language pathology (SLP)
(13), including the clinical setting and the patient’s stage of
clinical practice. There is consensus that difficulties occur primar-
recovery and resources available. Assessment may be under-
ily at the level of interactional discourse (i.e. conversation level)
taken for diagnosis of disorder, to determine strengths and
rather than linguistic errors at word/sentence level as identified
weaknesses, for intervention planning and goal setting, as an
with aphasia following stroke. However, impairments in any or all
outcome measure, to determine work readiness and as a
component areas of speech, language and cognitive communica-
mechanism to increase insight for the person with TBI and
tion may contribute to social communication disability after TBI.
family into post-injury changes. Ultimately, there are limita-
The limitations of existing assessment tools for this area of SLP
tions around the diagnosis of social communication disorders

CONTACT Joanne Steel Joanne.Steel@uts.edu.au, PO Box 123 Broadway NSW 2007 AustraliaUniversity of Technology Sydney
© 2018 Taylor & Francis Group, LLC

relating to the nature of classifying social interaction as
impaired. A more relevant purpose may be for planning and
monitoring of functional individualized intervention post-
injury (6). Assessment for this reason needs to be valid,
reliable and feasible, and suitable for regular repetition over
time. In the years since Coelho, Ylvisaker and Turkstra’s
(2005) paper highlighted this need (8), extensive research
has reported on non-standardized assessment.
Models of social communication
Decision-making for assessment and intervention of social
communication in both research and clinical practice should
be underpinned by a theoretical model (14,15). In a recent
discussion paper, MacDonald (2017) provided a model for
conceptualizing social competence within seven domains,
encompassing pre-injury and injury factors, contextual, cog-
nitive, self-regulatory, communication, physical/sensory and
emotional/psychosocial factors. This conceptual model should
assist SLPs undertaking social competence assessment, by
ensuring that component processes involved in interaction
are considered as part of the assessment process. Body and
Perkins (2006) described a simple framework to guide cogni-
tive-linguistic assessment after TBI (16). The SLP assesses the
client’s function using a range of tools to evaluate the various
cognitive and linguistic domains, ‘cross-referencing’ to deter-
mine how the person performs with time and attention pres-
sures (16). Similarly, in Coelho et al.’s descriptions of
hypothesis testing in cognitive communication assessment
(6), the SLP’s observations on client performance are inte-
grated into a dynamic assessment approach. The SLP develops
hypotheses to determine which areas to investigate further
and the choice of assessment measures appropriate to the
purpose. This process is reliant on clinical reasoning and
expertise, and quality of suitable assessment measures.
For the purpose of this paper, social communication is
conceptualized as the functional outcome of communicative
factors between communication partners (17), and the focus
of the paper will be on reporting of production of social
communication (i.e. speaking and writing) rather than social
cognition and understanding of social cues and inferences,
while acknowledging the integral nature of these functions
within all communication.
Uptake of recommendations
In practice, there are challenges with clinical adherence to TBI
cognitive communication guidelines and recommendations,
with one issue being access to evidence-based, TBI-specific
assessment tools or reliable discourse assessment measures. In
the 2005 Academy of Neurological Communication Disorders
and Sciences (ANCDS) review of cognitive communication
assessment after TBI, authors commented on the lack of TBI-
specific tools for cognitive-communication disorders (9). Since
then, several new measures are worthy of discussion in relation
to improving social communication assessment. Literature from
more than two decades has reported on assessment of discourse
produced by people with TBI relative to non-injured peers, and
described types of analyses used for social communication
BRAIN INJURY 49
difficulties after TBI. However, the clinical use of methods
described in these research studies is reportedly not high (18).
From surveys of current practice (18–21) it appears that while
SLPs are aware of the importance of assessing functional/social
communication after TBI, they experience challenges in con-
forming with the guidelines stated above. A recent survey of SLP
practice with TBI found that only a minority of SLPs used
discourse analysis formally with people with TBI, and the most
widely used standardized tools for cognitive communication
assessment (including for pragmatics and discourse) were
designed for adults with aphasia (18). These measures may lack
sufficient sensitivity and specificity to detect changes in social
communication after TBI (19). Further, pragmatic skills were
assessed by 58.9% of SLPs, but tools for discourse/pragmatic
communication were only used by an average of 6.2% of SLP
across clinical settings (18). Most SLPs who did undertake dis-
course analysis used informal observation, with the La Trobe
Communication Questionnaire (LCQ) (22) being the most com-
monly used standardized tool (18). SLPs in acute and inpatient
rehabilitation settings were less likely to conduct discourse
assessment than those working in the community (18).
Few studies have elaborated on which discourse, social or
functional measures are in use clinically, or on how these
measures are being used. Reasons SLPs have reported for not
conducting discourse analysis have included lack of normative
data; time required for transcription and analysis, which may
be unfeasible in the hospital setting; and lack of knowledge on
assessment methods and analysis techniques (13,20,23). SLPs
have consistently reported feeling unprepared after university
study to address social and cognitive communication impair-
ments clinically (13,19,23). Additionally, there may be limited
opportunities for clinical SLPs to access research literature to
improve their knowledge of discourse analysis methods as
journal access is often subscription-access only.
To gain further understanding of the limited use of dis-
course assessment clinically by SLPs working in TBI, research
on its use with other clinical populations may be informative.
In a survey of SLP practice on discourse analysis for adults with
aphasia (24), most clinicians reported use of discourse analysis
as part of their assessment. However, only a minority recorded
the speech samples, and of those SLPs who transcribed sam-
ples, nearly half transcribed ‘online’ (i.e. while the person was
speaking). Similarly, a review of child language sampling (25)
found that SLPs tended to collect short language samples which
were infrequently recorded or transcribed and were analysed
informally. Despite the benefits of online or transcription-less
approaches to discourse assessment in time-saving (26),
there are several limitations. These include risk of rater bias
(e.g. influence of SLP preconceived expectations), selective
attention (e.g. noting partial elements of the discourse and
missing others) and error (in what is heard or understood at
the time). Transcription-less and online approaches are more
obviously suited to some types of analysis than others. While
main concepts may be ticked from a checklist while listening to
a sample (e.g. for the Cinderella story retell (27)), micro-lin-
guistic analyses generally require samples to be transcribed. The
benefits of transcription include increased accuracy, potential
for multiple levels of analysis, and capability for the compar-
ison of samples over time.
50 J. STEEL AND L. TOGHER

Assessment challenges people with TBI and their communication partners (e.g. (34)).
Therefore, the aim of this paper is to review innovative social
Social communication assessment after TBI is typically under-
communication assessments and recent research on discourse
taken using pragmatic rating scales (with clinician and/or self/
and non-standardized methods, to guide evidence-based prac-
other report), published language and/or cognitive commu-
tice and inform future research.
nication assessment tools, discourse analysis (in a range of
monologic or conversational tasks) and informal evaluation of
performance as part of SLP practice (18,28). Pragmatic rating Review of recent studies reporting on use of social
scales generally rely on listener judgements on constructs and assessment tools
performance of social communication, which presents a risk
A range of social competence assessments measures has been
that clinicians may pathologize discourse behaviours that are
reported in literature from the different disciplines working
‘normal’ for that individual (29). Consequently, recent
within TBI research (e.g. disciplines of psychology, occupa-
research has incorporated assessment tools that use self and/
tional therapy) (52). There are fewer instruments designed for
or familiar partner rating of social communication, such as
SLPs use with a focus on cognitive and social communication.
the La Trobe Communication Questionnaire (30). These tools
Many published SLP assessments for adults with TBI reported
are discussed below.
in studies from previous decades (53) are no longer in print
Difficulties with discourse assessment have been reported
and/or easily accessible (e.g. the Measure of Cognitive
in some depth previously (see (31)), and include issues with
Linguistic Abilities (MCLA) (54)) or are not commercially
sampling, analysis type and relationship between sampling
available, and subject matter in tests may become outdated.
and measurement of discourse (29). The limited reporting
Additionally, the environmental context of communication
on severity measures and use of norm-referencing in dis-
has changed considerably over this time, particularly for
course assessment makes validating and establishing relia-
younger people, for whom much social interaction occurs
bility for discourse measures problematic (32). There are also
via electronic means through texting and social media use
issues with available picture stimuli for discourse assessment.
(55,56) rather than face-to-face or verbally by telephone.
Many stimulus pictures described in research studies may be
This has been reflected in recent literature reporting on elec-
difficult to access (e.g. not commercially available), only
tronic communication for people with TBI on Facebook (57),
evident in published research papers, or designed for a
Twitter (58) and in internet chat rooms (59), although as yet
different purpose. As examples, the Flowerpot Incident
there is little empirical information on assessment of func-
(33), reported in several research studies (17,34–38), uses a
tions required for social media use. This paper summarizes
stimulus picture sequence taken from an English/German
recent research on innovations in standardized assessment
language teaching text, and reproductions of this image
tools and selected discourse tasks and literature on written
may be hard to decipher. Norman Rockwell picture stimuli
discourse assessment (see Table 1 for examples). The clinical
are also used in a number of studies (e.g. (39–41)) but may
utility of measures is presented in Table 2. Suggested use of
be less culturally relevant to non-USA or younger partici-
assessments has been derived from reported use in studies or
pants. Stimulus pictures also derive from older aphasia
from ‘Clinical Implications’ sections of published research,
assessment tools, or contain dated representations, for exam-
with examples from recent literature.
ple, The Cookie Theft (42), in which a mother wearing an
apron washes the dishes; or the Quarrel (43), where a woman
crashes her car after quarrelling with her husband. Despite Innovation in standardized assessment tools
these issues, these black and white aphasia drawings are used
A number of standardized assessment measures covering the
by SLPs (8), and have the benefit of a body of literature for
area of social and cognitive communication, pragmatic function
comparison to the client’s performance clinically. As part of
and discourse functions have been developed in recent years.
aphasia batteries, these pictures may have standardized
These assessments target social and cognitive behaviours and
administration rules and scoring criteria (e.g. target words,
functions typically affected by TBI and/or other acquired neu-
phrases or concepts), making them accessible for clinical use.
rological conditions, rather than aphasia following stroke, and a
Picture stimuli are also often taken from children’s materials,
few have been designed specifically for TBI. Some of these new
for example, Old McDonald had an Apartment House (44)
assessments can be considered to have linguistic theoretical
(e.g. (45)). In view of the predominance of young men
roots (e.g. the LCQ, which is based on Gricean principles
presenting on the caseload with TBI (46), these measures
(22)), while others are based on cognitive theory (e.g.
may be uninteresting and inappropriate. However, any new
Assessment Battery for Communication (ABaCO), originating
materials created will lack the important benefits of the
from Cognitive Pragmatic Theory (50)). These measures range
corpus of data from existing measures.
from task-based formats, where the client undertakes scored
activities under SLP supervision, such as in the Functional
Assessment of Verbal Reasoning and Executive Strategies
Aim
(FAVRES); to clinician-rated, self-rated, and other-rated beha-
Social communication measures and tasks have been reported vioural rating scales such as the LCQ and Pragmatic Profile of
as part of intervention studies (e.g. (47,48)), descriptions of Impairment in Communication (PPIC) (51); and measures of
test development and validation studies (e.g. (49–51)), and participation such as the Adapted Kagan Scales (90). A brief
for identifying characteristics of communication changes for description of a selection of recent measures follows.
 BRAIN INJURY 51

Table 1. Selection of discourse elicitation tasks and prompts used in studies.

First author and year Types of tasks for eliciting monologic and conversational samples
AphasiaBank/TBIBank protocol (60) Discourse protocol comprising:
(1) Free Speech Samples
A. Brain Injury Story and Coping
B. Important Event
(2) Picture Descriptions
A. Broken Window
B. Refused Umbrella
C. Cat Rescue
(3) Story Narrative
Cinderella story with picture book stimulus
(4) Procedural Discourse
How to make a Peanut Butter and Jelly Sandwich or another simple sandwich.
Body (1998) (61) Stimulus task was an audio recording of a story entitled ‘Real Money’, taken from the ‘Five Minute Fiction’ section of a
magazine, lasting 8 min 40 s. Participants were asked to verbally retell the story. The task aimed to:
(1) Stimulate a response with sufficient language to apply a variety of linguistic analyses
(2) Represent language processing demands required in everyday conversation
Bogart (2012) (62) Participants and their friends were instructed to converse about a topic of their choice, then the researcher left the room.
The aim was to elicit a natural conversation as close as possible to a usual interaction.
Coelho (2002; 2005) (39,63) Stimulus tasks included:
(1) Story retelling: The Bear and the Fly (retell the story after viewing a video on screen)
(2) Story generation: Norman Rockwell, the Runaway picture stimuli
(3) Casual conversation with examiner: ‘Why are you here in hospital today?’
Duff (2009) (64) Barrier game involving matching Chinese tangrams, played in pairs, analysing verbal play talk.
Finch (2017) (47) Three 10-min conversational samples involving three different discourse tasks with a familiar conversation partner, to
capture the usual communication skills of people with TBI and their conversation partners. The discourse tasks comprised
(1) Casual conversation (informal chatting about any topic)
(2) Purposeful conversation (joint discussion about their plans for the next 4 weeks)
(3) A problem-solving task (discussion about the function of an unfamiliar object).
Jones (2011) (65) An impromptu conversation and the TBI ‘Danger of Death’ story or accident narrative, both of which were elicited in a
conversation with an adult male confederate.
Le (2011) (45) Stimulus materials: A 16-frame picture story, ‘Old McDonald Had an Apartment House’ (44) displayed with no soundtrack on
a computer screen.
Meulenbroek (2013) (66) The VET: Use of four voicemail message scenarios to elicit language samples, with four voicemail recipient conditions based
on status and familiarity (subordinate, colleague, friend and superior), requiring participants to provide a message that:
(1) Presents new information
(2) Makes a request.
Snow (1997) (67) Procedural task: ‘Tell me all the steps involved in withdrawing money from a bank account, as if I had never done it before’.
Sohlberg (2014) (68) Four texts taken from Connexions (a non-profit online repository and access point for free educational content):
Participants were instructed to retell the text passage ‘as if you were telling someone everything you learned from the
passage you just read’.
Togher (1997) (69) Four telephone calls made by the person with TBI, designed to be enquiries for specific information, to:
(1) A therapist with whom they were currently working
(2) The bus timetable information service
(3) The police
(4) Their mothers.
Turkstra (2012) (70) Using the Mediated Discourse Elicitation Protocol (MDEP), participants engaged in:
(1) Ten minutes of conversation (client and clinician), on topics of mutual interest (e.g. sharing experiences, discussing
current events).
(2) Narrative discourse elicited using AphasiaBank story-generating prompts.
(3) Descriptive discourse elicited using AphasiaBank pictures.
(4) Procedural discourse, AphasiaBank procedural prompts
Youse (2011) (71) Conversation topics between examiner and participant:
(1) If you won the lottery, how would you spend the money?
(2) If you could meet a famous person, who would you like to meet?

The FAVRES (91) consists of four functional tasks that
simulate naturalistic activity-based encounters, requiring deci-
sion-making and reasoning. The person with TBI is required
to make primarily written responses and subsequently give
verbal explanations or rationales. The FAVRES tasks are
recognizable as being functional and related to real-life situa-
tions, and this measure has been used in research studies as an
outcome measure in an intervention study (47), and to iden-
tify features of cognitive communication disorder (92).
Performance on the FAVRES has been associated with return
to and maintaining employment (3,5,73). The scheduling
subtest of the FAVRES, for prediction of job re-entry and
workplace stability in particular, provides an easily recogniz-
able workplace-type activity that uses attention, memory,
executive function, and other cognitive and written language
skills, under time pressure, to emulate skills needed in the
workplace (73). Ecological factors are tested, such as time
taken to complete and providing verbal rationales for deci-
sions. These abilities are indicative of those that may be
required for job stability (3). In Rietdijk et al.’s study, Tasks
2 (Scheduling), 3 (Making a decision) and 4 (Building a case)
were all positively correlated with return to work, with tasks
requiring sustained attention being most predictive (5).
Potential issues with the predictive utility of the FAVRES for
return to work include high difficulty level of tasks, and
relevance to jobs with lower communication requirements
(3). However, in Rietdijk et al.’s study participant jobs ranged
from low to high skill, with the FAVRES being found pre-
dictive across the group, suggesting that these are core skills
required for employment (5).
A standardized test that includes conversational assess-
ment, the Montreal Evaluation of Communication (MEC or
 52
Table 2. Suggested clinical utility of example measures.
Potential Clinical Use Tool/Method Assessment/Type of Task Features lending to purpose First author (Year)
Evaluating skills for FAVRES Task 2: Scheduling Subtest tasks resemble real-life work activities. Avramovic (2017) (72)
return to work Task 3: Making a decision Activities use sustained attention processes. Isaki (2000) (73)
Task 4: Building a case
Total accuracy and rationale scores across tasks Examines high-level, integrative, communication skills required for employment. Rietdijk (2016) (5)
LCQ Comparison of ratings between self and other A discrepancy in awareness of communication impairments (between PwTBI and partner) Douglas (2016) (4)
may be indicative of likelihood of return to work
Procedural discourse Verbal description of how to make a sandwich Structured task may replicate skills required in work settings (e.g. telling others how to Stubbs (2018) (74)
task do a task).
Outcome measure ABaCo Standardized assessment Two forms available for test retest, norms available for English version. Bosco (2018) (75)
Pre- post- PPIC Observational rating scales Suitable for retesting, wide range of social behaviours with overall severity ratings in 10
Agnihotri (2014) Braden
J. STEEL AND L. TOGHER

intervention domains. (2010)

measures Finch (2017) (47,76,77)
LCQ Self- and Other-rating scales Rates frequency of behaviours, range of areas examined Braden (2010) (76)
Adapted Kagan Scales: Measures of participation of the person with TBI and Particularly suited to evaluating communication partner training as includes measures of Tu (2011) (78)
MPC, MSC support provided by communication partner support provided Mann (2015) (79)
Behn (2012) (80)
Measuring recovery ABaCo Standardized assessment Two parallel versions for retesting over time. Bosco (2012) (81)
Range of communicative areas and functions.
PPIC Observational rating scales Measures frequency of impaired social communication behaviours with 84 items. Steel (2017a) (82)
Includes severity rating in addition to frequency of behaviours in 10 domains.
Conversation analysis Damico’s Clinical Discourse Analysis (Modified) Frequency count of errors within defined parameters Snow (1998) (83)
Flowerpot Incident Narrative analysis, using story grammar elements, Able to reveal improvement over time on discourse measures, repeatable tasks. Snow (1999) (35)
(Narrative picture efficiency and Damico’s Clinical Discourse Analysis
sequence) (Modified)
Talkbank discourse Protocol of four types of discourse tasks Standardized tasks suitable for repetition over time Steel (2017b) (17)
protocol
Procedural discourse Steps for making peanut butter and jelly/vegemite and Simple structured task easily analysed Stubbs (2018) (74)
cheese sandwich Macrostructural analyses with steps provided in Stubbs (2018)
Identifying strengths ABaCo Standardized assessment Can create a profile of strengths and weaknesses, based on cognitive pragmatic theory to Bosco (2015) (84)
and weaknesses guide subsequent therapy approach.
Directions for Danger of Death story Measuring the construct of charisma: First minute of Describes a novel area of social communication potentially contributing to social Jones (2011) (65)
therapy or Accident Narrative narrative transcribed and rated for tonality, sound outcomes.
effects, gestures and audience engagement
Old McDonald had an Story Goodness (story grammar and story Examines structure and content of narratives. Can identify profiles of story-telling ability Le (2011a, b) (45,85)
Apartment House completeness rating) which suggests therapy directions.
(Narrative picture
sequence)
Flowerpot Incident Analysis of content, cohesion, fluency Discourse can be classified into three distinct profiles: Confused, Impoverished and Hartley (1992) (86)
(Narrative) Inefficient using this stimulus and analysis method
Giving and Requesting Conversations with communication partners in Takes into account genre as part of analysing conversations with different Togher (2000) (87)
Information different types of context: Analysed with Exchange communication partner to provide indications of the capabilities of the PwTBI.
(Conversation analysis) Structure Analysis
Talkbank discourse Main Concept analysis (MCA): Using three discourse Three tasks have normative data for main concepts. Richardson (2016) (27)
protocol tasks MCA can be used as a non-transcription-based tool.
picture sequence narrative, story retell (Cinderella) and
procedural discourse task.
Increasing insight LCQ Self- and Other-rating of social communication Can be educational on areas of communication affected after TBI. Allows for discussion of Braden (2010) (76)
behaviours areas of communication before and after injury with PwTBI and common communication
partner
LCQ with immediate Direct Review of LCQ by video review of conversation Immediate review avoids bias of retrospective recall of behaviours. Hoepner (2013) (88)
direct video review of between PwTBI and communication partner Enables common ground for PwTBI and partner for therapy planning.
conversation
Prognosis MEC Standardized pragmatic assessment Reported as feasible in the acute setting. Le Blanc (2014) (89)
Pragmatic ability rated on the MEC can contribute information on global outcome.
ABaCo: Assessment Battery for Communication; FAVRES: Functional Assessment of Verbal Reasoning and Executive Strategies; LCQ: La Trobe Communication Questionnaire; MEC: The Montreal Evaluation of Communication;
MPC: Measure of Participation in Conversation; MSC: Measure of Support in Conversation; PwTBI: person with TBI; TBI: traumatic brain injury.

D-MEC) (93) was designed for acute care assessment of
non-aphasic communication disorders (e.g. after right hemi-
sphere stroke, TBI and dementia). The MEC has been used
in TBI studies to examine social communication in the
acute setting (89,94). The MEC also has multiple tests of
social comprehension, including ability to understand indir-
ect language, humour and use of tone of voice, and the
Conversational Discourse subtest which takes place between
the clinician and the person with TBI and is rated by the
SLP with a checklist. Two conversation topics are elicited,
requiring a topic shift, and performance is scored on 17
pragmatic behaviours. The MEC checklist includes measures
of interest specific to TBI speakers, for example, ability for
self-correction of errors, imprecise expression of ideas and
inappropriate comments. Monitoring these areas of diffi-
culty over the course of recovery after TBI may provide
information on outcome (94). This tool may be useful to
measure pragmatic recovery, particularly in the acute and
early recovery period, where there are few TBI-specific tools
reported in use.
In other literature, the PPIC (originally the PFIC) (51) has
been used in a number of studies on social communication
after TBI (47,82). This clinician-rated assessment has 84 beha-
vioural items rated by frequency of occurrence, with a parallel
measure of the severity of impairment in each area, the
Feature Summary Scale (FSS). The FSS comprises 10 areas:
Literal Content, General Participation, Quantity, Quality,
Internal Relation, External Relation, Clarity of Expression,
Social Style, Subject Matter and Aesthetics. This additional
rating of severity adds a valuable component to the measure,
reflecting that the impact of a detrimental behaviour may not
necessarily be related to frequency of its occurrence. This scale
has been used as an outcome measure in an intervention
study by Finch, Cornwell, Copley, Doig, and Fleming (2017)
(47), as a measure of recovery (82), and as a primary outcome
measure in social communication intervention studies (76,95).
The PPIC administration requires use of videotaped interac-
tions, and therefore may be less practical in hospital settings,
however the inclusion of both frequency of behaviours and
severity ratings making this instrument useful for measuring
changes. While ratings of social behaviours may be subjective
as taken by SLP, scores may be averaged by two independent
raters to minimize rater bias. Despite its common use in TBI
research and potential for clinical use, this assessment is not
yet available for commercial use but may be obtained by
contacting the authors.
The LCQ is a pragmatic scale based on the theoretical
principles of Grice and Damico and cognitive communication
literature (96,97), and with good internal and test–retest relia-
bility (30). The LCQ has two forms, for self-ratings by the
person with TBI and also by a familiar communication part-
ner, to gain their views on changes in communication post-
TBI. Items are scored on a four-point scale from ‘never or
rarely’ to ‘usually or always’. Use of the LCQ has been wide-
spread in recent research studies (e.g. (22,30,47,82,88)), con-
forming with best practice guidelines on inclusion of the
perspectives of people most familiar with post-injury changes.
As the LCQ may be rated during an interview with the SLP, it
BRAIN INJURY 53
can also be useful for discussion with both the person with
TBI and the communication partner on potential areas
affected by TBI, and can contribute to gaining insight into
social communication changes post-injury (82). However,
since the LCQ is reliant on self and other awareness of com-
munication changes, it may be less useful during the early
stages of recovery, particularly in the hospital environment
(82). Changes in communication may become more apparent
to the person with TBI and partners after hospital discharge,
once the person with injury has attempted to resume work or
social activities (98). Therefore, the LCQ may be a more useful
outcome measure tool at later stages of recovery, when ratings
of the person with TBI and partner reflect their increased
insight into communication changes.
The Adapted Kagan Scales have been used in several recent
studies as an outcome measure for communication partner
training intervention after TBI (48,80,99,100), with good
interrater reliability reported (90). The scales comprise The
Measure of Participation in Conversation (MPC) scale, which
assesses how well the person with TBI is able to engage in
interactions, and the Measure of Support in Conversation
(MSC), which evaluates the ability of the communication
partner to acknowledge and reveal their partner’s competence.
As one of the few instruments evaluating participation in
conversation of both the person with TBI and their commu-
nication partner, there is an emphasis on the collaborative
aspects of conversation. This enables the SLP to delineate and
target areas for the communication partner to address to
support joint conversations. Techniques used in the scales
were based on Ylvisaker and colleagues’ theory on scaffolds
needed for conversation (101), and include developing colla-
borative intent, cognitive support, emotional support, positive
questioning style, and collaborative turn taking (90). This tool
enables examination of the conversation as a mutual activity,
rather than focusing the underlying cause of social commu-
nication impairments for the person with TBI. More recently,
the MPC and MSC have been used to rate joint video self-
modelling as a way of increasing insight into maladaptive
behaviours, for both the person with TBI and the commu-
nication partner (102), and to improve self-regulation.
Two recent measures have been developed in Italy. The
Assessment of Pragmatic Abilities and Cognitive Substrates
(APACS) (49) is norm-referenced and heavily based on the
cognitive underpinnings of pragmatic abilities. The APACS is
divided into two sections (production and comprehension)
and consists of six subtests. Pragmatic Production comprises:
(1) Interview and (2) Description, and Pragmatic
Comprehension consists of: (3) Narratives, (4) Figurative
Language 1, (5) Humour and (6) Figurative Language 2.
Tasks and materials involve production of autobiographical
narratives and photographic picture descriptions rated with
discourse checklists; understanding of non-literal information
in real news stories rated with comprehension questions;
multiple choice and verbal explanations. Although the
APACS was designed for adults with acquired communication
disorders, including TBI (49), much research literature report-
ing on this tool is based on adults with schizophrenia, and the
clinical utility of this tool for adults with TBI has not been
54 J. STEEL AND L. TOGHER
widely reported in English as yet. Another novel assessment
tool for cognitive pragmatics, the ABaCo (50,81,84), isunder-
pinned by Cognitive Pragmatics theory. The ABaCo uses
multimedia, consisting of both video and researcher prompts,
assessing linguistic, extralinguistic (i.e. use and understanding
of gestures), paralinguistic (i.e. prosodic) functions, context
and conversational scales. Communicative production
includes various speech acts (e.g. questions, requests, com-
mands, assertions), and identification and production of emo-
tive content and a conversation scale on a set topic being
analysed for social communicative functions (e.g. turn taking
and topic management). This has recently been normed on an
unimpaired population in English with a focus on politeness
markers (103). However, authors found regional differences
in politeness forms used by non-injured Southern and
Midwestern Americans (103), illustrating the difficulties in
delineating subtle differences in normal social communication
from impaired.
Rousseaux, Verigneaux and Kozlowski (2010) reported on
the Lille Communication Test (LCT) (104), developed to
assess verbal and non-verbal communication and gestures
(105). The LCT assesses social communication within three
domains: participation (e.g. greeting, attention and engage-
ment), verbal communication (e.g. verbal comprehension,
intelligibility, syntax, verbal pragmatics and feedback) and
non-verbal communication (e.g. understanding and produ-
cing gestures, affective expressivity, non-verbal pragmatics
and feedback). The LCT has been used to understand the
cognitive and behavioural correlates of impaired social com-
munication after stroke (106) and TBI (105). While the var-
ious functions assessed in this measure can be evaluated using
domain-specific tools (e.g. pragmatic rating scales), the LCT
allows for systematic assessment with a single standardized
tool. This may be of benefit for the purpose of repeated testing
over time, and the LCT has been reported with adults in the
rehabilitation (i.e. under 1 year) and chronic stages of injury
(over 2 years post-TBI) (105). Although use of this instrument
in the literature has mainly been in French, it appears promis-
ing for quantifying discourse characteristics of adults with
TBI, particularly regarding return to work (107).
Two screening tools for cognitive communication after
acquired brain injury have been developed recently.
Armstrong et al. (2017; 2018) (108,109) reported on a new
screening tool for Aboriginal Australians with acquired brain
injury, the Aboriginal Communication Assessment After
Brain Injury (ACAABI), and MacDonald (2015) (110) created
the Cognitive Communication Checklist for Acquired Brain
Injury (CCCABI). These are designed for use by non-SLP
professionals and have the potential to identify adults present-
ing in acute hospital settings requiring further rehabilitation
services, who may otherwise miss accessing SLP services. By
nature, these tools are for screening purposes only, and there-
fore do not examine functions in depth, and the ACAABI
targets a specific cultural group to enable access to rehabilita-
tion services. However, acknowledgement of cultural differ-
ences in social communication after acquired brain injury and
creation of appropriate assessment measures reflects a positive
move in assessment development.
Innovations in discourse tasks and measures
Several novel discourse tasks and protocols have also been
reported in the literature. Levels of analysis include, for
monologic tasks: microlinguistic (e.g. words per narrative,
T-units/C-units per narrative), microstructural (e.g. across
sentence analysis of cohesion and coherence), macrostuctural
(e.g. local and global coherence) and superstructural (e.g.
story grammar); and conversational levels (e.g. exchange
structure analysis) (31). Monologic assessment tasks typically
include picture descriptions; personal event narratives (e.g.
accident story, important event); story retell (based on audi-
tory or pictorial stimulus); story generation narratives (with
single image or picture sequences prompts); procedural tasks
(e.g. explain how to change a tyre, make a sandwich); or
expository task (producing a verbal or written argument).
Traditional conversational discourse elicitation techniques
have most commonly involved an examiner (often the SLP
or someone previously unknown to the person with TBI) and
used prompts to engage in conversation on topics such as
work, interests or current news events, often analysed with
rating scales. Recent innovative methods or materials
described in the literature include producing vocationally
relevant voicemail messages (66), measuring use of reported
speech (111), examination of pause time affecting quality of
utterances (112,113) and problem-solving scenarios underta-
ken jointly with friends (114). Selected examples of innovative
elicitation techniques are provided (see Table 1).
Meulenbroek and colleagues (2013; 2016) described a stan-
dardized elicitation procedure, The Functional Workplace
Elicitation Protocol (3,66) using the Voicemail Elicitation
Task (VET), designed for adults aiming for stable return to
work after TBI. In the VET, using one of four work-related
scenarios (e.g. requesting time off work to attend a family
event), the person with TBI is required to leave a voicemail
telephone message incorporating new information and a
request. Measures of interest included rating of information-
giving content, politeness markers and number of mazes.
These are items expected to have high relevance for workplace
communication, which needs to be timely, succinct and
appropriately pitched. Although a small study, the voicemail
elicitation task accurately identified employment outcomes in
two groups of people with TBI (stably employed and unstable
employment history). Using these methods, authors have
contributed to quantifying some of the communication skills
required for the work environment, and described a standar-
dized, functional and clinically replicable discourse task (66).
From a different perspective on the use of monologic
discourse, Jones and Turkstra’s (2011) study reported on
people with TBI producing their accident story but with a
focus on the manner of narrative performance (i.e. how the
story was told) rather than content (i.e. what was told) (65).
Authors analysed samples for the construct of charisma, by
focusing on the non-verbal aspects of story-telling that influ-
ence how engaging a listener perceives the person to be. In
elicited conversations based on accident narratives, 1-min
video samples were rated with Charismatic Leadership
Communication Scale (CLCS) and raters indicated whether
or not they would like to engage in conversation with the

speaker. The authors suggested that non-verbal functions,
including gesture and speech rate, had an effect on the per-
son’s charisma, which influenced how listeners felt about
engaging in conversation with that person. This research
delineates a novel approach by examining the ‘big picture’ of
discourse of adults with TBI, which may provide prediction of
long-term social outcomes and help identify directions for
therapy.
Studies have begun to address the issue of power balance
and roles within traditional discourse elicitation contexts,
where there may be unnaturalness and imbalance between
interactants (commonly the SLP and person with TBI).
Recent research on conversational discourse exchanges has
reported on samples between the person with TBI and famil-
iar communication partners, rather clinicians or other unfa-
miliar examiners (34,62,114). These studies have presented
discourse elicitation tasks designed to engage both commu-
nication partners and equalize the dynamics of interactions.
Kilov, Togher, Power and Turkstra (2009) examined discourse
produced in a problem-solving task to elicit conversation.
This task involved the person with TBI and a friend together
trying to determine the function of an unfamiliar object, with
the conversation sample analysed using generic structure
potential (114). Similarly, Jorgensen and Togher reported on
a meaningful narrative task produced between friends (34), by
retelling a video segment watched together. The work of
Togher and colleagues (e.g. (62,100)) has used Exchange
Structure Analysis (ESA) to describe the various contributions
of partners within conversation, and as an outcome measure
for communication partner training (34,62,78,100,115). In
ESA, communication exchanges are analysed by classifying
turns of speech or ‘moves’ according to their function, for
example, statements (giving information), questions
(demanding information), offers (giving service) and com-
mands (demanding service). These types of conversation ana-
lysis enable quantitative ratings across a range of measures
that may be used to guide therapy directions, as outcome
measures pre- and post-therapy, and to educate the person
with TBI and communication partners on their contribution
to successful interactions.
From a different perspective, in other research supporting
the need to include the communication partner within dis-
course analysis, Gordon, Rigon and Duff (2015) examined
conversations between the person with TBI and the examiner
for how well synchronized they were (i.e. similarity of words
and words per turn matched), and whether these became
more similar over the course of the session. Synchronicity
was reported to be indicative of development of rapport
(116). Further knowledge of constructs such as this may
help understand factors that contribute to the heterogeneity
of social outcomes for people with TBI.
Innovations in technology and written discourse
Studies have described use of technology within social com-
munication assessment. For example, participants have been
rated on ability to read and reply to email messages on the
computer, and on the quality of their written messages (i.e.
ability to generate ideas and number of discourse errors)
BRAIN INJURY 55
(117). Rietdijk, Power, Brunner and Togher (2017) (118)
found it was possible to use Skype to administer the LCQ
via teleconferencing for people with TBI, findings which have
considerable significance in view of the changing workforce
and availability of clinicians, for initial and ongoing assess-
ment. Sohlberg, Griffiths and Fickas (2014) described a task
involving people with TBI retelling a written passage taken
from a website with free educational content, which was
analysed for verbal output as well as comprehension (68).
Paraphrasing information after reading is a key skill for peo-
ple with TBI returning to study, and particularly relevant for
use of online information sources.
Computerized discourse analysis programs have been
reported in the literature, including CHAT and Computerized
Language Analysis (CLAN), part of CHILDES (CHIld Language
Data Exchange System) (119), which includes facility for gesture
analysis with ELAN software (120), and Systematic Analysis of
Language Transcripts (SALT) (121). There has not been wide-
spread SLP adoption of these programs clinically for adults with
acquired communication disorders (24), perhaps reflecting the
time required for transcription and/or formatting for analysis.
There has been published research on software programs
used to rate conversational discourse, although little that is
TBI-specific. Croteau and colleagues (2018) reported on
video analysis software for transcription-less evaluation of
conversation analysis (122). In this study, communication
partner training was evaluated using professional software,
Studiocode 10.5 (see www.vosaic.com/support/category/stu
diocode). This software, designed for employment and edu-
cational coaching and training rather than for communica-
tion disorders, was used to evaluate a communication
partner training intervention. Behaviours of interest were
programmed into the software and measured while replaying
a video of the conversational interactions, to generate quan-
titative data on performance pre and post intervention. In
Croteau et al.’s study, two different conversation situations
(questions on weekend activity, and a choice of problem-
solving topics) were recorded and coded for targeted beha-
viours (e.g. use of closed-ended questions). While use of this
software required time for programming and user training
(approximately two hours), there were clear benefits in time
saved from transcribing, and the technology enabled differ-
ent displays and syntheses of data of interest. The potential
for use of software designed for different populations but
addressing a comparable skill/behaviour base is largely
untapped. Although this study was conducted with a couple
affected by aphasia, the same model could be used for people
with TBI and their communication partners.
Other verbal and non-verbal factors have been measured in
research studies. Ellis and Peach (2009) (113) examined pause
time between sentences as an indicator of confusion after TBI.
Two sets of 27 sentences of increasing complexity were read
aloud by people with TBI and evaluated using computer
analysis of pauses. Measures of pause patterns were found to
be related to confused state after TBI, and results provided
information about the patient’s ability to plan sentences.
Turkstra Brehm and Montgomery (2006) reported on non-
verbal communication in their study of eye gaze and gesture.
These factors were measured during conversational dyads,
56 J. STEEL AND L. TOGHER
structured around questioning from the Relationship
Closeness Induction Task (123). In this structured task, the
questioner begins by asking impersonal questions and pro-
gresses to increasingly intimate questions. Measures of inter-
est in this study were turn boundaries, gestures and gaze, all
of which contribute to the success of social interactions. These
studies provide information on novel aspects of social com-
munication that may be quantified and provide direction for
intervention.
Surprisingly, in the context of the existing communicative
environment which incorporates text messages, email and
internet-based communication needs, a relatively small num-
ber of studies have reported on written discourse analysis.
Published assessment instruments, such as the FAVRES and
the MEC, include scoring for production of written samples,
and research studies have reported on these (e.g. (72)). In one
of the few studies with a primary focus on adult written
discourse analysis, Mortensen (2005) (124) reported using
personal letters written by people with TBI to examine generic
structure potential and semantic organization. The structure
of personal letters provided a useful format for intervention of
functional writing beyond commonly used basic list-based or
formulaic tasks (e.g. shopping lists, writing greeting card)
currently used clinically (124). Additionally, this task included
scope for different levels of analysis, and for people with all
levels of injury severity. In a study on the relationship between
communication and return to work, performance on written
tasks in the FAVRES was associated with employment out-
comes (5). Authors suggested the sustained attention required
for production of complex written material may be highly
representative of the work context, where the person may be
required to maintain attention over long periods of time and
work independently (5).
Discourse protocols
A further innovation in recent years has been the develop-
ment of standardized protocols for discourse-level social
communication assessment after TBI. Use of standardized
protocols in research studies can improve consistency in
reporting outcomes. Detailed description of assessment pro-
cedures and wider dissemination of instructional research
materials help to facilitate research translation to clinical
practice. The TalkBank system, incorporating Aphasia
Bank and TBIBank, was developed by paediatric and adult
Interagency Workgroups on Common Data Elements
(CDE) in Traumatic Brain Injury Research. The TBIBank
protocol is a battery of tests and discourse tasks suitable for
use with adults with TBI. The website provides guidance for
undertaking discourse tasks and has a standardized proto-
col, including picture stimuli, instructions and scoring, and
some norms for a range of analysis types (60), and support-
ing literature that has used the protocol (27,37). It is freely
available at through the Aphasia TalkBank website (http://
aphasia.talkbank.org/) and has been used in several inves-
tigative and intervention studies (17,34,70,125,126). The
development of a shared database of multimedia interac-
tions for adults with TBI will be beneficial to both research-
ers and clinical SLPs.
The AphasiaBank and TBIBank initiatives also have a large
corpus of shared samples from a range of clinical populations
and normative data. There are descriptive accounts of using
these normative data for some measures in the literature,
which may be useful for SLPs clinically. For example,
Richardson and Dalton (2016) provided normative samples
for Main Concepts checklists for three discourse tasks (a
picture sequence, procedural task, and Cinderella story retell)
in a non-injured sample producing 92 transcripts (27), which
may be used for diagnostic purposes clinically after TBI.
Likewise, Youse, Stout and Bosworth (2001) reported on
cohesive ties in verbal and written discourse samples from
college educated and non-college educated adults (127), which
may be informative for SLPs treating young adults with TBI.
As stated above, there are many issues with norming dis-
course samples, but addition of data generated by non-injured
speakers may contribute to SLP evaluation as part of the
assessment process.
Another protocol reported in the literature, the Mediated
Discourse Elicitation Protocol (MDEP) was developed by
Hengst and Duff (2007) (125). The stated aim of the MDEP
is to make sampling procedures for conversation more
balanced and natural. Traditionally, the clinician/examiner is
required to make minimal contribution when eliciting mono-
logic and conversational samples, to maximize control over
task parameters. The MDEP protocol encourages increased
participation by the examiner in the discourse sampling pro-
cess, with directions on how to achieve this. Ways to support
conversation during elicitation activities include providing
active responses (e.g. giving meaningful verbal and non-verbal
backchannelling), making topics personal and social, and par-
ticipating in interactional support. Conversation-based sam-
ples are elicited in four tasks: conversation, narrative, picture
description and procedural task, based on those in the
AphasiaBank protocol. The MDEP has been used in studies
examining different aspects of social communication, includ-
ing the role of reported speech (111) and synchronicity (116).
Discussion and suggestions for social communication
assessment
This review has highlighted a range of social communication
assessment measures and discourse analyses reported in
recent adult TBI research literature. Findings support a need
for increased translation of research knowledge on discourse
assessment methods to SLP practice. Ideally, this should con-
sist of a dual approach. Researchers should focus on ways to
make discourse analysis more feasible for clinical replication,
and SLPs require knowledge of and access to valid and reliable
assessment methods.
A greater understanding of the different analysis types suita-
ble for targeting areas of social communication would enable
SLPs to identify intervention approaches and implement indivi-
dualized practice. This would accord with recommended use of
the Ongoing, Contextualised, Collaborative Hypothesis Testing
assessment (OCCHTA) approach described by Ylvisaker and
Feeney in 1998 (e.g. (128)) and reported in Coelho et al. (2005)
(6). For example, with a client presenting with disorganized,
confused anecdotes, the SLP could use repeated measures of

story grammar analysis (e.g. using the Flowerpot Incident [as
scored in (129)] or with other stimulus) to monitor recovery
early after injury (17), to quantify discourse strengths and weak-
nesses (35) and to develop an individualized, personally mean-
ingful intervention program (128). For adults with chronic social
communication issues at the interactional level, the Adapted
Kagan Scales may be used to identify specific target areas pre-
intervention for the person with TBI and communication part-
ner, and as an outcome measure to evaluate success of commu-
nication partner treatment for improved conversations (80). To
enable this process, the SLP needs a knowledge of which tools,
tasks and analyses are most applicable, and access to materials
needed to undertake the assessment.
There have been several calls in research papers for further
education on discourse and social communication assessment
for SLPs working with adults with TBI (e.g. (19,21,23)). In
view of the persisting barriers to SLPs incorporating social
communication assessment into practice, further research is
needed into how to make discourse analysis more clinically
feasible. Frith et al.’s survey confirmed SLP preference for
‘broad-spectrum’ discourse measures clinically (e.g. pragmatic
rating scales or transcription-less methods) (18), rather than
fine-grained analysis of monologic and conversational abil-
ities. Using less detailed analyses may not capture the nuances
of social communication changes after TBI, nor provide ade-
quate information to direct intervention or quantify changes
following therapy programmes. SLP uptake and regular use of
discourse assessment methods may need more than just
increased education at university. Focused implementation
research for practising SLPs may be of benefit. In literature
on aphasia, Bryant et al. (2018) described a ‘Knowledge-to-
Action’ process to increase SLP knowledge of linguistic dis-
course analysis in aphasia, which used combined education
and training strategies in a programme with ongoing support
for clinicians (130). Such a programme focused on TBI may
begin to help SLPs’ ability to incorporate discourse analysis
techniques into their usual practice.
A priority for research will be in development and use of
technology in social communication assessment and interven-
tion after TBI. In addition to the transcription-less conversation
analysis software tools described above, there are other ways
that technology can improve the assessment process. For exam-
ple, there are computerized cognitive assessment applications in
use for adults with dementia and mild cognitive impairment
(see (131)), with capability to monitor and detect changes not
possible in non-electronic form, (e.g. response time, accurate
measurement and integrations of a range of variables). These
are used with people with dementia, but to our knowledge,
computerized assessment tools with these features are not com-
monly used by SLPs for adults with TBI. Additionally, further
research should focus on including electronic modes of com-
munication in social communication assessment, as these mod-
alities now form such an integral part of social functioning.
The influence of picture stimuli characteristics in dis-
course tasks requires further investigation, considering that
different types of images used may provide varied levels of
support. Despite the proliferation of different visual stimulus
tasks found in this review, there is little information on
which types of images could stimulate the most productive
BRAIN INJURY 57
responses, or which are preferred by people with TBI. In a
comparison of images used for AAC purposes for people
with TBI (132), participants focused for longer on photo-
graphic images than Boardmaker pictures, and preferred
photographs to iconic image types (132). Whether photo-
graphs or video stimulus images for discourse elicitation
would be helpful, or, conversely, distracting for people after
TBI is currently unknown. People with aphasia may have
difficulties processing symbolic pictorial images and com-
prehend photographs better (133), but this may not be an
issue after TBI. Further investigation into optimal visual
images types for discourse tasks might help with client
engagement in the assessment process.
There is a need for increased collaboration between SLPs
(and other professionals) working on social communication
and discourse analysis within different clinical areas or popu-
lations. This might include those working in aphasic discourse
analysis, and language sampling in child language disorders. It
is likely that there is much to learn on interactional analysis
methods from literature on second language teaching, devel-
opmental language disorder and educational teaching, and
from closer collaboration with other disciplines involved in
social cognition research and practice.
Conclusion
An individualized, tailor-made approach is clearly required
when working with people with social communication dif-
ficulties after TBI. This paper has summarized a selection,
by no means exhaustive, of social communication assess-
ment measures reported in adult TBI literature. Promising
tasks have been described in studies, with detailed, replic-
able methods of task administration and scoring. For clin-
icians seeking information on how to use discourse analysis
and social communication measures as part of their prac-
tice with people with TBI, some of these research methods
may be practical to use clinically. Improved social commu-
nication assessment practice may involve better SLP access
to a range of consistently used, TBI-specific measures based
on research evidence that make use of standardized proto-
cols and materials, preferably with normative measures
where appropriate. The materials and tasks described in
this review may help bridge the gap between research
literature and practice, and contribute to improved SLP
assessment with social communication after TBI.
Disclosure Statement
The authors report no declarations of interest.
ORCID
Joanne Steel http://orcid.org/0000-0002-5478-5865
Leanne Togher http://orcid.org/0000-0002-4518-6748
References
1. MacDonald S, Wiseman-Hakes C. Knowledge translation in ABI
rehabilitation: a model for consolidating and applying the
58 J. STEEL AND L. TOGHER
evidence for cognitive-communication interventions. Brain Inj.
2010;24(3):486–508. doi:10.3109/02699050903518118.
2. PonsfordJ, DowningM, Olver J, Ponsford M, Acher R, Carty M,
Spitz G. Longitudinal follow-up of patients with traumatic brain
injury: outcome at 2, 5, and 10-years post-injury. J Neurotrauma.
2014;31(1):64–77. doi:10.1089/neu.2013.2997.
3. Meulenbroek P, Turkstra LS. Job stability in skilled work and com-
munication ability after moderate-severe traumatic brain injury.
Disability and Rehabilitation: an International, Multidisciplinary
Journal. 2016;38(5):452–61. doi:10.3109/09638288.2015.1044621.
4. Douglas JM, Bracy CA, Snow PC. Return to work and social
communication ability following severe traumatic brain injury. J
Speech Lang Hear Res 2016;59(3):511–20. doi:10.1044/
2015_JSLHR-L-15-0025
5. Rietdijk R, Simpson G, Togher L, Power E, Gillett L. An
exploratory prospective study of the association between com-
munication skills and employment outcomes after severe trau-
matic brain injury. Brain Inj. 2013;27(7/8):812–18. doi:10.3109/
02699052.2013.775491.
6. Coelho CA, Ylvisaker M, Turkstra LS. Nonstandardized assess-
ment approaches for individuals with traumatic brain injuries.
Semin Speech Lang. 2005;26(4):223–41. doi:10.1055/s-2005-
922102.
7. American Speech-Language-Hearing Association. 2018 22/05/
2018. ASHA online Evidence Map: traumatic brain injury.
<https://www.asha.org/MapLanding.aspx?id=8589947062>. 22/
05/2018.
8. Coelho C, Ylvisaker M, Turkstra LS. Nonstandardized assess-
ment approaches for individuals with traumatic brain injuries.
Semin Speech Lang. 2005;26(4):223–1. doi:10.1055/s-2005-
922102.
9. Turkstra LS, Coelho C, Ylvisaker M. The use of standardized tests
for individuals with cognitive-communication disorders. Semin
Speech Lang. 2005;26(4):215–1. doi:10.1055/s-2005-922101.
10. Royal College of Speech and Language Therapists. Resource man-
ual for commissioning and planning services for speech language
and communication needs (SLCN): brain injury. UK: Royal
College of Speech and Language Therapists (RCSLT); 2010.
11. College of Audiologists and Speech-Language Pathologists of
Ontario (CASLPO). Preferred practice guideline for cognitive-
communication disorders. Ontario: CASLPO; 2002.
12. Togher L, Wiseman-Hakes C, Douglas J, Stergiou-Kita M,
Ponsford J, Teasell R, Bayley M, Turkstra LS. INCOG
Recommendations for management of cognition following trau-
matic brain injury, Part IV: cognitive communication. TheJournal
of Head Trauma Rehabilitation. 2014;29(4):353–68. doi:10.1097/
HTR.0000000000000071.
13. Steel J, Ferguson A, Spencer E, Togher L. Speech-language pathol-
ogists’ perspectives on cognitive communication assessment dur-
ing post-traumatic amnesia. Brain Inj. 2016;30(9):1131–42.
doi:10.1080/02699052.2016.1174785.
14. MacDonald S. Introducing the model of cognitive-communica-
tion competence: a model to guide evidence-based communica-
tion interventions after brain injury. Brain Inj. 2017; 31 (13-14):
1760–80. doi:10.1080/02699052.2017.1379613
15. Kennedy MR, DeRuyter F. Cognitive and language bases for
communication disorders. In: Beukelman DR, Yorkston KM, edi-
tors. Communication disorders following traumatic brain injury:
management of cognitive, language and motor impairments.
Austin: Pro-Ed; 1991. p. 124–90.
16. Body R, Perkins MR. Terminology and methodology in the assess-
ment of cognitive–linguistic disorders. Brain Impairment. 2006;7
(3):212–22. doi:10.1375/brim.7.3.212.
17. Steel J, Ferguson A, Spencer E, Togher L. Language and cognitive
communication disorder during post-traumatic amnesia: profiles
of recovery after TBI from three cases. Brain Inj. 2017b;31(13–
14):1889–902. doi:10.1080/02699052.2017.1373200.
18. Frith M, Togher L, Ferguson A, Levick W, Docking K.
Assessment practices of speech-language pathologists for cogni-
tive communication disorders following traumatic brain injury
in adults: an international survey. Brain Inj. 2014;28(13/
14):1657–66. doi:10.3109/02699052.2014.947619.
19. Duff MC, Proctor A, Haley K. Mild traumatic brain injury
(MTBI): assessment and treatment procedures used by speech-
language pathologists (SLPs). Brain Inj. 2002;16(9):773–87.
doi:10.1080/02699050210128870.
20. Steel J, Ferguson A, Spencer E, Togher L. Speech pathologists’
current practice with cognitive-communication assessment during
post-traumatic amnesia: a survey. Brain Inj. 2013;27(7/8):819–30.
doi:10.3109/02699052.2013.775492.
21. Riedeman S, Turkstra L. Knowledge, confidence, and practice
patterns of speech-language pathologists working with adults
with traumatic brain injury. Am J Speech-Language Pathol.
2018;27(1):181–91. doi:10.1044/2017_AJSLP-17-0011.
22. Douglas JM. Measuring perception of communicative ability: the
development and evaluation of the La Trobe communication
questionnaire. Aphasiology. 2000;14(3):251–68. doi:10.1080/
026870300401469.
23. Maddy KM, Howell DM, Capilouto GJ. Current practices regard-
ing discourse analysis and treatment following non-aphasic brain
injury: a qualitative study. J Interactional Res Commun Disord.
2015;6(2):211–36. doi:10.1558/jircd.v6i2.1905.
24. Bryant L, Spencer E, Ferguson A. Clinical use of linguistic dis-
course analysis for the assessment of language in aphasia.
Aphasiology. 2017;31(10):1105–26. doi:10.1080/02687038.2016.
1239013.
25. Westerveld MF, Claessen M. Clinician survey of language sam-
pling practices in Australia. Int J Speech Lang Pathol. 2014;16
(3):242–49. doi:10.3109/17549507.2013.871336.
26. Armstrong L, Brady M, Mackenzie C, Norrie J. Transcription-
less analysis of aphasic discourse: a clinician’s dream or a
possibility? Aphasiology. 2007;21(3–4):355–74. doi:10.1080/
02687030600911310.
27. Richardson JD, Dalton SG. Main concepts for three different
discourse tasks in a large non-clinical sample. Aphasiology.
2016;30(1):45–73. doi:10.1080/02687038.2015.1057891.
28. Finch E, Copley A, Cornwell P, Kelly C. Systematic review of
behavioral interventions targeting social communication difficul-
ties after traumatic brain injury. Arch Phys Med Rehabil. 2016;97
(8):1352–65. doi:10.1016/j.apmr.2015.11.005.
29. Snow PC, Douglas JM. Conceptual and methodological challenges
in discourse assessment with TBI speakers: towards an under-
standing. Brain Inj. 2000;14(5):397–415.
30. Douglas JM, Bracy CA, Snow PC. Measuring perceived commu-
nicative ability after traumatic brain injury: reliability and validity
of the La Trobe Communication Questionnaire. Journal Head
Trauma Rehabilitation. 2007;22(1):31–38.
31. Coelho CA. Management of discourse deficits following traumatic
brain injury: progress, caveats, and needs. Semin Speech Lang.
2007;28(2):122–28. doi:10.1055/s-2007-970570.
32. Elbourn E, Togher L, Kenny B, Power E. Strengthening the quality
of longitudinal research into cognitive-communication recovery
after traumatic brain injury: a systematic review. Int J Speech Lang
Pathol. 2017;19(1):1-16. doi:10.1080/17549507.2016.1193896
33. Kossatz HE, Schüßler I. So ein dackel!. In: Ingrid
Schüßler, Rosemary Tzschoppe, editors: Bildergeschichten für
den Sprachunterricht. Vol. 22. Munich: Tomus Verlag; 1982.
34. Jorgensen M, Togher L. Narrative after traumatic brain injury: a
comparison of monologic and jointly-produced discourse. Brain
Inj. 2009;23(9):727–40. doi:10.1080/02699050903133954.
35. Snow PC, Douglas JM, Ponsford JL. Narrative discourse following
severe traumatic brain injury: a longitudinal follow-up.
Aphasiology. 1999;13(7):529–51. doi:10.1080/026870399401993.
36. Davis GA, Coelho CA. Referential cohesion and logical coherence
of narration after closed head injury. Brain Lang. 2004;89(3):508–
23. doi:10.1016/j.bandl.2004.01.003.
37. Galetto V, Andreetta S, Zettin M, Marini A. Patterns of impair-
ment of narrative language in mild traumatic brain injury.
J Neurolinguistics. 2013;26(6):649–61. doi:10.1016/j.jneuroling.
2013.05.004.

38. Marini A, Zettin M, Galetto V. Cognitive correlates of narrative
impairment in moderate traumatic brain injury. Neuropsychologia.
2014;64:282–88. doi:10.1016/j.neuropsychologia.2014.09.042.
39. Coelho CA. Story narratives of adults with closed head injury and
non-brain-injured adults: influence of socioeconomic status, elici-
tation task, and executive functioning. J Speech, Lang Hearing
Res. 2002;45(6):1232–48. doi:10.1044/1092-4388(2002/099).
40. Youse KM, Coelho CA. Working memory and discourse produc-
tion abilities following closed-head injury. Brain Inj. 2005;19
(12):1001–09. doi:10.1080/02699050500109951.
41. Cannizzaro MS, Coelho CA. Treatment of story grammar follow-
ing traumatic brain injury: a pilot study. Brain Inj. 2002;16
(12):1065–73. doi:10.1080/02699050210155230.
42. Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination
(BDAE). Philadelphia: Lea and Febiger; 1983.
43. Nicholas L, Brookshire R. A system for quantifying the informa-
tiveness and efficiency of the connected speech of adults with
aphasia. J Speech Hear Res. 1993;36(2):338–50.
44. Barrett J. Old McDonald had an apartment house. New York, NY:
Atheneum; 1998.
45. Le K, Coelho C, Mozeiko J, Grafman J. Measuring goodness of
story narratives. J Speech, Lang Hearing Res. 2011a;54:118–26.
doi:10.1044/1092-4388(2010/09-0022).
46. Andelic N. The epidemiology of traumatic brain injury. Lancet
Neurol. 2013;12(1):28–29. doi:10.1016/S1474-4422(12)70294-6.
47. Finch E, Cornwell P, Copley A, Doig E, Fleming J. Remediation of
social communication impairments following traumatic brain
injury using metacognitive strategy intervention: a pilot study.
Brain Inj. 2017; 31 (13-14): 1830–39. doi:10.1080/
02699052.2017.1346284
48. Togher L, McDonald S, Tate R, Rietdijk R, Power E. The effec-
tiveness of social communication partner training for adults with
severe chronic TBI and their families using a measure of perceived
communication ability. NeuroRehabilitation. 2016;38(3):243–55.
doi:10.3233/NRE-151316.
49. Arcara G, Bambini V. A test for the Assessment of Pragmatic
Abilities and Cognitive Substrates (APACS): normative data and
psychometric properties. Front Psychol. 2016;7:70. doi:10.3389/
fpsyg.2016.00070.
50. Angeleri R, Bosco F, Zettin M, Sacco K, Colle L, Bara B.
Communicative impairment in traumatic brain injury: a complete
pragmatic assessment. Brain Lang. 2008;107(3):229–45.
doi:10.1016/j.bandl.2008.01.002.
51. Linscott R, Knight R, Godfrey H. The Profile of Functional
Impairment in Communication (PFIC): a measure of communi-
cation impairment for clinical use. Brain Inj. 1996;10(6):397–412.
52. Honan CA, McDonald S, Tate R, Ownsworth T, Togher L,
Fleming J, Anderson V, Morgan A, Catroppa C, Douglas J,
et al. Outcome instruments in moderate-to-severe adult trau-
matic brain injury: recommendations for use in psychosocial
research. Neuropsychol Rehabil, 2017;1–21. doi:10.1080/0960
2011.2017.1339616.
53. Turkstra L, Ylvisaker M, Coelho C, Kennedy M, Sohlberg MM,
Avery J, Yorkston K. Practice guidelines for standardized assess-
ment for persons with traumatic brain injury. J Med Speech Lang
Pathol. 2005;13(2):ix–xxviii.
54. Ellmo WJ, Graser J, Krchnavek B, Hauck K, Calabrese D. Measure
of Cognitive-Linguistic Abilities (MCLA). Vero Beach, Fla.: The
Speech Bin; 1995.
55. Brunner M, Hemsley B, Palmer S, Dann S, Togher L. Review of
the literature on the use of social media by people with traumatic
brain injury (TBI). Disabil Rehabil. 2015;37(17):1511–21.
doi:10.3109/09638288.2015.1045992.
56. Brunner M, Hemsley B, Togher L, Palmer S. Technology and its
role in rehabilitation for people with cognitive-communication
disability following a traumatic brain injury (TBI). Brain Inj.
2017;31(8):1028–1043 doi:10.1080/02699052.2017.1292429
57. Tsaousides T, Matsuzawa Y, Lebowitz M. Familiarity and preva-
lence of Facebook use for social networking among individuals
BRAIN INJURY 59
with traumatic brain injury. Brain Inj. 2011;25(12):1155–62.
doi:10.3109/02699052.2011.613086.
58. Brunner M, Hemsley B, Dann S, Togher L, Palmer S. Hashtag
#TBI: a content and network data analysis of tweets about
Traumatic Brain Injury. Brain Inj. 2018;32(1):49–63.
doi:10.1080/02699052.2017.1403047.
59. Kilov AM, Togher L, Power E, Turkstra L. Can teenagers with
traumatic brain injury use Internet chatrooms? A systematic
review of the literature and the Internet. Brain Inj. 2010;24
(10):1135–72. doi:10.3109/02699052.2010.490511.
60. MacWhinney B, Fromm D, Rose Y, Bernstein Ratner N. Fostering
human rights through talkbank. Int J Speech Lang Pathol. 2018;20
(1):115-119 doi:10.1080/17549507.2018.1392609
61. Body R, Perkins MR. Ecological validity in assessment of dis-
course in traumatic brain injury: ratings by clinicians and non-
clinicians. Brain Inj. 1998;12(11):963–76.
62. Bogart E, Togher L, Power E, Docking K. Casual conversations
between individuals with traumatic brain injury and their friends.
Brain Inj. 2012;26(3):221–33. doi:10.3109/02699052.2011.648711.
63. Coelho C, Grela B, Corso M, Gamble A, Feinn R.
Microlinguistic deficits in the narrative discourse of adults
with traumatic brain injury. Brain Inj. 2005;19(13):1139–45.
doi:10.1080/02699050500110678.
64. Duff MC, Hengst JA, Tranel D, Cohen NJ. Hippocampal amnesia
disrupts verbal play and the creative use of language in social
interaction. Aphasiology. 2009;27(7–8):926–39. doi:10.1080/
02687030802533748.
65. Jones CA, Turkstra LS. Selling the story: narratives and charisma
in adults with TBI. Brain Inj. 2011;25(9):844–57. doi:10.3109/
02699052.2011.585507.
66. Meulenbroek P, Togher L, Turkstra L. Functional workplace com-
munication elicitation for persons with traumatic brain injury. In:
Hough M, editor. Tucson (AZ).: University of Pittsburgh. 2013.
67. Snow P, Douglas J, Ponsford J. Procedural discourse following
traumatic brain injury. Aphasiology. 1997;11(10):947–67.
doi:10.1080/02687039708249421.
68. Sohlberg MM, Griffiths GG, Fickas S. An evaluation of reading
comprehension of expository text in adults with traumatic brain
injury. Am J Speech-Language Pathol. 2014;23(2):160–75.
doi:10.1044/2013_AJSLP-12-0005.
69. Togher L, Hand L, Code C. Analysing discourse in the traumatic
brain injury population: telephone interactions with different
communication partners. Brain Inj. 1997;11(3):169–90.
70. Turkstra LS, Quinn-Padron M, Johnson JE, Workinger MS,
Antoniotti N. In-person versus telehealth assessment of discourse
ability in adults with traumatic brain injury. J Head Trauma
Rehabil. 2012;27(6):424–32. doi:10.1097/HTR.0b013e31823346fc.
71. Youse KM, Gathof M, Fields RD, Lobianco TF, Bush HM,
Noffsinger JT. Conversational discourse analysis procedures: a
comparison of two paradigms. Aphasiology. 2011;25(1):106–18.
doi:10.1080/02687031003714467.
72. Avramovic P, Kenny B, Power E, McDonald S, Tate R, Hunt
L, MacDonald S, Heard R, Togher L. Exploring the relation-
ship between cognition and functional verbal reasoning in
adults with severe traumatic brain injury at six months post
injury. Brain Inj. 2017;31(4):502–16. doi:10.1080/
02699052.2017.1280854.
73. Isaki E, Turkstra L. Communication abilities and work re-entry
following traumatic brain injury. Brain Inj. 2000;14(5):441–53.
74. Stubbs E, Togher L, Kenny B, Fromm D, Forbes M, MacWhinney
B, McDonald S, Tate R, Turkstra L, Power E. Procedural discourse
performance in adults with severe traumatic brain injury at 3 and
6 months post injury. Brain Inj. 2018;32(2):167–81. doi:10.1080/
02699052.2017.1291989.
75. Bosco FM, Parola A, Angeleri R, Galetto V, Zettin M, Gabbatore I.
Improvement of communication skills after traumatic brain
injury: the Efficacy of the cognitive pragmatic treatment program
using the communicative activities of daily living. Arch Clin
Neuropsychol. 2018:acy041–acy041.
60 J. STEEL AND L. TOGHER
76. Braden C, Hawley L, Newman J, Morey C, Gerber D, Harrison-
Felix C. Social communication skills group treatment: a feasibility
study for persons with traumatic brain injury and comorbid
conditions. Brain Inj. 2010;24(11):1298–310. doi:10.3109/
02699052.2010.506859.
77. Agnihotri S, Gray J, Colantonio A, Polatajko H, Cameron D,
Wiseman-Hakes C, Rumney P, Keightley M. Arts-based social
skills interventions for adolescents with acquired brain injuries:
five case reports. Dev Neurorehabil. 2014;17(1):44–63.
doi:10.3109/17518423.2013.844739.
78. Tu LV, Togher L, Power E. The impact of communication partner
and discourse task on a person with traumatic brain injury: the
use of multiple perspectives. Brain Inj. 2011;25(6):560–80.
doi:10.3109/02699052.2011.571655.
79. Mann K, Power E, Barnes S, Togher L. Questioning in conversa-
tions before and after communication partner training for indivi-
duals with traumatic brain injury. Aphasiology. 2015;29(9):
1082–109. doi:10.1080/02687038.2015.1035226.
80. Behn N, Togher L, Power E, Heard R. Evaluating communica-
tion training for paid carers of people with traumatic brain
injury. Brain Inj. 2012;26(13/14):1702–15. doi:10.3109/02699
052.2012.722258.
81. Bosco FM, Angeleri R, Zuffranieri M, Bara BG, Sacco K.
Assessment Battery for Communication: development of two
equivalent forms. J Commun Disord. 2012;45(4):290–303.
doi:10.1016/j.jcomdis.2012.03.002.
82. Steel J, Ferguson A, Spencer E, Togher L. Social communication
assessment during post-traumatic amnesia and the post-acute
period after traumatic brain injury. Brain Inj. 2017a;31
(10):1320–30. doi:10.1080/02699052.2017.1332385.
83. Snow P, Douglas J, Ponsford J. Conversational discourse abilities
following severe traumatic brain injury: a follow-up study. Brain
Inj. 1998;12(11):911–35.
84. Bosco FM, Angeleri R, Sacco K, Bara BG. Explaining pragmatic
performance in traumatic brain injury: a process perspective on
communicative errors. Int J Lang Commun Disord. 2015;50
(1):63–83. doi:10.1111/1460-6984.12114.
85. Le K, Coelho C, Mozeiko J, Krueger F, Grafman J. Measuring
goodness of story narratives: implications for traumatic brain
injury. Aphasiology. 2011b;25(6/7):748–60. doi:10.1080/02687
038.2010.539696.
86. Hartley LL, Jensen PJ. Three discourse profiles of closed-head-
injury speakers: theoretical and clinical implications. Brain Inj.
1992;6(3):271–81.
87. Togher L. Giving information: the importance of context on
communicative opportunity for people with traumatic brain
injury. Aphasiology. 2000;14(4):365–90. doi:10.1080/02687030
0401414.
88. Hoepner JK, Turkstra LS. Video-based administration of the La
Trobe Communication Questionnaire for adults with traumatic
brain injury and their communication partners. Brain Inj. 2013;27
(4):464–72. doi:10.3109/02699052.2013.765600.
89. LeBlanc J, de Guise E, Champoux M-C, Couturier C,
Lamoureux J, Marcoux J, Maleki M, Feyz M. Early conversa-
tional discourse abilities following traumatic brain injury: an
acute predictive study. Brain Inj. 2014;28(7):951–58. doi:10.
3109/02699052.2014.888760.
90. Togher L, Power E, Tate R, McDonald S, Rietdijk R. Measuring the
social interactions of people with traumatic brain injury and their
communication partners: the adapted Kagan scales. Aphasiology.
2010;24(6–8):914–27. doi:10.1080/02687030903422478.
91. MacDonald S. Functional Assessment of Verbal Reasoning and
Executive Strategies (FAVRES). Guelph, ON: Clinical Publishing;
2005.
92. MacDonald S, Johnson CJ. Assessment of subtle cognitive-com-
munication deficits following acquired brain injury: A normative
study of the Functional Assessment of Verbal Reasoning and
Executive Strategies (FAVRES). Brain Inj. 2005;19(11):895–902.
93. Joanette Y, Ska B, Côté H. Protocole Montréal d’Évaluation de la
Communication. Isbergues: France Ortho Édition; 2004.
94. LeBlanc J, de Guise E, Champoux M-C, Couturier C, Lamoureux
J, Marcoux J, Maleki M, Feyz M. Acute evaluation of conversa-
tional discourse skills in traumatic brain injury. Int J Speech Lang
Pathol. 2014;16(6):582–93. doi:10.3109/17549507.2013.871335.
95. Dahlberg CA, Cusick CP, Hawley LA, Newman JK, Morey CE,
Harrison-Felix CL, Whiteneck GG. Treatment efficacy of social
communication skills training after traumatic brain injury: a ran-
domized treatment and deferred treatment controlled trial. Arch
Phys Med Rehabil. 2007;88(12):1561–73. doi:10.1016/j.
apmr.2007.07.033.
96. Damico JS. Clinical discourse analysis: a functional approach to
language assessment. In: Simon CS, editor. Communication skills
and classroom success: assessment of language-learning disabled
students. San Diego: College-Hill Press; 1985. p.165–204.
97. Grice HP. Logic and conversation. In: Cole P, Morgan JL, editors.
Syntax and semantics. Vol. 3. Speech Acts. New York: Academic
Press. 1975. p. 41–58.
98. Dahlberg C, Hawley L, Morey C, Newman J, Cusick CP,
Harrison-Felix C. Social communication skills in persons with
post-acute traumatic brain injury: three perspectives. Brain Inj.
2006;20(4):425–35. doi:10.1080/02699050600664574.
99. Togher L, McDonald S, Code C, Grant S. Training communica-
tion partners of people with traumatic brain injury: a randomised
controlled trial. Aphasiology. 2004;18(4):313–35. doi:10.1080/
02687030344000535.
100. Sim P, Power E, Togher L. Describing conversations between
individuals with traumatic brain injury (TBI) and communication
partners following communication partner training: using
exchange structure analysis. Brain Inj. 2013;27(6):717–42.
doi:10.3109/02699052.2013.775485.
101. Ylvisaker M, Feeney TJ, Urbanczyk B. Developing a positive
communication culture for rehabilitation: communication train-
ing for staff and family members. In: Durgin CJ, Schmidt ND,
editors. Staff development and clinical intervention in brain injury
rehabilitation. Gaithersburg, MD: Aspen; 1993. p. 57–81.
102. Hoepner JK, Olson SE. Joint video self-modeling as a conversa-
tional intervention for an individual with traumatic brain injury
and his everyday partner: a pilot investigation. Clin Arch
Commun Disord. 2018;3(1):22–41. doi:10.21849/
cacd.2018.00262.
103. Davis B, Guendouzi J, Savage M, Blackburn WL, Williams M.
Politeness strategies in response to prompted directives in a pre-
liminary English version of the ABaCO Battery. J Interactional
Res Commun Disord. 2015;6(2):115–29. doi:10.1558/jircd.
v7i1.26755.
104. Rousseaux M, Delacourt A, Wyrzykowski N, Lefeuvre M. TLC:
test Lillois de Communication. Isbergue: Ortho; 2001.
105. Rousseaux M, Verigneaux C, Kozlowski O. An analysis of
communication in conversation after severe traumatic brain
injury. Eur J Neurol. 2010;17(7):922–29. doi:10.1111/j.1468-
1331.2009.02945.x.
106. Rousseaux M, Daveluy W, Kozlowski O. Communication in con-
versation in stroke patients. J Neurol. 2010;257(7):1099–107.
doi:10.1007/s00415-010-5469-8.
107. Kozlowski Moreau O, Blin P, Guillemot M, Daveluy W, Deicas P.
Communication, social skills and quality of life after mild trau-
matic brain injury: a comparison of subjects with or without
complaints. Ann Phys Rehabil Med. 2015;58(Supplement 1):e148.
108. Armstrong EM, Ciccone N, Hersh D, Katzenellebogen J, Coffin J,
Thompson S, Flicker L, Hayward C, Woods D, McAllister M.
Development of the Aboriginal Communication Assessment
After Brain Injury (ACAABI): a screening tool for identifying
acquired communication disorders in Aboriginal Australians. Int
J Speech Lang Pathol. 2017;19(3):297–308. doi:10.1080/
17549507.2017.1290136.
109. Armstrong E, Ciccone N, Hersh D, Katzenellenbogen J,
Thompson S, Flicker L, Coffin J, Hayward C, Woods D,
McAllister M. The nature and piloting of a tool to screen for
acquired communication disorders in Aboriginal Australians
after brain injury: exploring culturally valid assessment to

improve rehabilitation pathways. Aphasiology. 2018;32(sup1):7–
8. doi:10.1080/02687038.2018.1484878.
110. MacDonald S. Cognitive Communication Checklist for Acquired
Brain Injury (CCCABI). Guelph, Ontario: CCD Publishing; 2015.
111. Covington N, Duff M. Intact reported speech use in traumatic
brain injury: how to think about ‘intact’ performance in the
context of heterogeneity. J Interactional Res Commun Disord.
2016;7(1):79–100. doi:10.1558/jircd.v7i1.2192.
112. Peach RK. Cognitive basis for sentence planning difficulties in
discourse after traumatic brain injury. Am J Speech-Language
Pathol. 2013;22(2):S285–97. doi:10.1044/1058-0360(2013/12-
0081).
113. Ellis C, Peach RK. Sentence planning following traumatic brain
injury. NeuroRehabilitation. 2009;24(3):255–66. doi:10.3233/NRE-
2009-0476.
114. Kilov AM, Togher L, Grant S. Problem solving with friends:
discourse participation and performance of individuals with and
without traumatic brain injury. Aphasiology. 2009;23(5):584–605.
doi:10.1080/02687030701855382.
115. Togher L, McDonald S, Tate R, Power E, Rietdijk R. Training
communication partners of people with traumatic brain injury:
reporting the protocol for a clinical trial. Brain Impairment.
2009;10(2):188–204. doi:10.1375/brim.10.2.188.
116. Gordon RG, Rigon A, Duff MC. Conversational synchrony in
the communicative interactions of individuals with traumatic
brain injury. Brain Inj. 2015;29(11):1300–08. doi:10.3109/
02699052.2015.1042408.
117. Sohlberg MM, Ehlhardt LA, Fickas S, Sutcliffe A. A pilot study
exploring electronic (or e-mail) mail in users with acquired cog-
nitive-linguistic impairments. Brain Inj. 2003;17(7):609–29.
doi:10.1080/0269905031000070189.
118. Rietdijk R, Power E, Brunner M, Togher L. Reliability of video-
conferencing administration of a communication questionnaire
to people with traumatic brain injury and their close others. J
Head Trauma Rehabil. 2017;32(6):E38–E44. doi:10.1097/
HTR.0000000000000282.
119. MacWhinney B. The CHILDES Project: tools for analyzing talk.
Mahwah, NJ: Lawrence Erlbaum Associates; 2000.
120. MacWhinney B, Fromm D. AphasiaBank as BigData. Semin
Speech Lang. 2016;37(1):10–22. doi:10.1055/s-0036-1571357.
121. Stronach ST, Turkstra LS. Theory of mind and use of cognitive
state terms by adolescents with traumatic brain injury. Aphasiology.
2008;22(10):1054–70. doi:10.1080/02687030701632187.
BRAIN INJURY 61
122. Croteau C, McMahon-Morin P, Le Dorze G, Power E, Fortier-
Blanc J, Davis GA. Exploration of a quantitative method for
measuring behaviors in conversation. Aphasiology. 2018;32
(3):247–63. doi:10.1080/02687038.2017.1350629.
123. Turkstra LS, Brehm SE, Montgomery EB Jr. Analysing conversa-
tional discourse after traumatic brain injury: isn’t it about time?.
Brain Impairment. 2006;7(3):234–45. doi:10.1375/brim.7.3.234.
124. Mortensen L. Written discourse and acquired brain impairment:
evaluation of structural and semantic features of personal letters
from a Systemic Functional Linguistic perspective. Clin Linguist
Phon. 2005;19(3):227–47. doi:10.1080/02699200410001698652.
125. Hengst JA, Duff MC. Clinicians as communication partners:
developing a mediated discourse elicitation protocol. Top Lang
Disord. 2007;27:37–49. doi:10.1097/00011363-200701000-00005.
126. Wilson BM, Proctor A. Written discourse of adolescents with
closed head injury. Brain Inj. 2002;16(11):1011–24. doi:10.1080/
02699050210147248.
127. Youse KM, Stout CE, Bosworth KE. Cohesion in discourse of
college-educated and non-college-educated adults: implications
for young adults with brain injury. Adv Speech Lang Pathol.
2001;3(2):97–107. doi:10.3109/14417040109003717.
128. Ylvisaker M, Feeney T. Collaborative brain injury intervention:
positive everyday routines. San Diego: Singular Publishing Group,
inc.; 1998.
129. Snow PC, Powell MB. What’s the story? An exploration of
narrative language abilities in male juvenile offenders.
Psychology, Crime & Law. 2005;11(3):239–53. doi:10.1080/
1068316042000209323.
130. Bryant L, Ferguson A, Valentine M, Spencer E. Implementation of
discourse analysis in aphasia: investigating the feasibility of a
Knowledge-to-Action intervention. Aphasiology. 2018:1–27.
doi:10.1080/02687038.2018.1454886.
131. Wild K, Howieson D, Webbe F, Seelye A, Kaye J. The status of
computerized cognitive testing in aging: a systematic review.
Alzheimer’s Dementia: Journal Alzheimer’s Association. 2008;4
(6):428–37. doi:10.1016/j.jalz.2008.07.003.
132. Thiessen A, Brown J, Beukelman D, Hux K, Myers A. Effect of
message type on the visual attention of adults with traumatic
brain injury. Am J Speech-Language Pathol. 2017;26(2):428–42.
doi:10.1044/2016_AJSLP-16-0024.
133. Brown J, Thiessen A. Using images with individuals with aphasia:
current research and clinical trends. Am J Speech-Language
Pathol. 2018;27(1S):504–15. doi:10.1044/2017_AJSLP-16-0190.