Narrative Discourse Treatment for Traumatic Brain Injury

Overseen By Karen Le, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Penetrating head injury, Developmental disability, Psychotic disorder, Neurological illness, Alcohol or substance abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method to help veterans with traumatic brain injury (TBI) enhance their communication skills. It aims to improve storytelling in both content and organization, making everyday communication smoother. The trial includes two groups: one receives special biweekly sessions of narrative discourse treatment (a therapy for improving storytelling and communication), while the other continues their usual care without added treatment. Veterans with mild to moderate TBI who face communication issues affecting daily activities and can identify a close contact for support might be a good fit. Participants need stable housing, basic technology for telehealth, and must speak English as their primary language. As an unphased trial, this study offers veterans a unique opportunity to explore innovative communication therapies tailored to their needs.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, it does mention that regular marijuana use that interferes with daily functioning is not allowed.

What prior data suggests that this narrative discourse treatment is safe for Veterans with TBI?

Research has shown that treatments focusing on storytelling for people with traumatic brain injury (TBI) have been explored. In one study, speech-language experts collaborated to enhance thinking and communication skills. These treatments aim to help participants organize and share stories more effectively.

While specific safety details for storytelling treatments are not provided in the studies, the treatment—centered on communication and storytelling—is non-invasive and generally manageable for participants. Similar treatments have not reported any major negative effects.

In summary, based on past research and the nature of the treatment, storytelling therapy appears safe for people with TBI. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about narrative discourse treatment for traumatic brain injury (TBI) because it targets communication skills in a unique way. Unlike traditional therapies that often focus on cognitive rehabilitation through medication or standard speech therapy, this treatment involves biweekly sessions that specifically improve storytelling and conversation abilities. By concentrating on narrative skills, this approach aims to enhance social interaction and overall communication, which are often areas of struggle for those with TBI. This targeted method could provide a more personalized and effective intervention for improving the quality of life for TBI patients.

What evidence suggests that this narrative discourse treatment might be effective for traumatic brain injury?

Research has shown that narrative discourse treatment, which participants in this trial may receive, can help people with traumatic brain injury (TBI) improve their communication skills. This treatment focuses on storytelling and organizing stories, enhancing social interactions—an area often challenging for those with TBI. One study found that participants told clearer stories after this type of treatment. Another review highlighted the potential benefits but also noted the difficulty in measuring results. Although this research remains in the early stages, it suggests that narrative discourse treatment could help Veterans with TBI communicate better in their daily lives. ^{1 2 6 7 8}

Who Is on the Research Team?

Karen Le, PhD

Principal Investigator

VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Are You a Good Fit for This Trial?

This trial is for Veterans with mild to moderate TBI who experience communication difficulties. They must have a significant other to report on their discourse ability, be able to engage in telehealth sessions, and have stable housing. Excluded are those with penetrating head injuries, developmental disabilities, psychotic disorders, neurological illnesses other than TBI, aphasia or APD, or recent substance abuse.

Inclusion Criteria

I have trouble communicating after a brain injury, affecting my daily activities.

I am a veteran with a brain injury affecting my thinking or memory.

I have a private and quiet space at home for telehealth sessions.

Exclusion Criteria

You have been diagnosed with alcohol or drug abuse in the past 30 days.

Veterans using marijuana occasionally for medical reasons, like pain or PTSD, may be allowed to participate as long as it doesn't affect their daily activities and is not used regularly.

You have had a serious head injury where an object has gone into your head.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive biweekly discourse treatment sessions to address narrative discourse impairments

8 weeks

Biweekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Narrative discourse treatment

Trial Overview

The study tests a new narrative discourse treatment aimed at improving story content and organization for better daily communication in Veterans with TBI. It's evaluated based on tolerability and acceptability through telehealth sessions.

How Is the Trial Designed?

Group I: Discourse Treatment Experimental Treatment 1 Intervention

Biweekly discourse treatment sessions.

Group II: Treatment as Usual Active Control 1 Intervention

No treatment. Participants will engage in their usual care.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A survey of 70 speech-language pathologists (SLPs) revealed that their practices for assessing and treating discourse in individuals with traumatic brain injury (TBI) generally align with research recommendations, focusing on individualized and goal-based approaches.

Barriers to effective discourse management included client-specific factors, SLPs' knowledge and confidence, and time constraints for transcription and analysis, indicating a need for further training and resources in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How do speech-language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice. Steel, J., Coluccio, I., Elbourn, E., et al.[2023]

Using narrative structure as a framework in therapy can help improve language abilities in individuals with chronic aphasia, facilitating the transfer of skills from clinical tasks to everyday communication.

The study highlights the importance of systematic planning in therapy for chronic aphasia, demonstrating effective interventions tailored to individuals with varying language profiles and stages of recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using narrative as a bridge: linking language processing models with real-life communication. Whitworth, A.[2022]

The study demonstrated that telehealth can be effectively used to assess narrative and procedural discourse in individuals with traumatic brain injury (TBI), with no reported technical difficulties during the 10-minute assessments for both TBI participants and healthy controls.

Results showed that individuals with TBI performed significantly worse on narrative discourse tasks compared to controls, indicating that narrative tasks may be more challenging, while no significant differences were found in procedural discourse performance, suggesting the need for more complex assessments in that area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls. Cruse, N., Piotto, V., Coelho, C., et al.[2022]

Discourse Processing Treatment (DPT) significantly improves discourse informativeness and coherence in adults with traumatic brain injury (TBI), indicating its effectiveness in addressing communication deficits.

Combining DPT with Attention Process Training-2 (APT-2) enhances the generalization of improvements to untrained tasks, suggesting that a multi-faceted approach may be beneficial for cognitive rehabilitation in TBI patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Discourse following Traumatic Brain Injury: A Tale of Two Treatments. Henderson, A., Roeschlein, MA., Wright, HH.[2021]

Individuals with traumatic brain injury (TBI) showed significantly decreased time efficiency in narrative discourse compared to a control group, indicating challenges in how quickly they can convey information.

Despite similar total numbers of information units, the TBI group demonstrated a strong correlation between their narrative discourse efficiency and cognitive functions like working memory and executive function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correct information unit analysis for determining the characteristics of narrative discourse in individuals with chronic traumatic brain injury. Matsuoka, K., Kotani, I., Yamasato, M.[2022]

Cognitive Pragmatic Treatment (CPT) significantly improved communicative-pragmatic abilities in 15 adults with severe traumatic brain injury, as shown by enhanced performance in comprehension and production across various communication modalities after 24 group sessions.

The benefits of the CPT program were not only immediate but also persisted for at least 3 months post-training, indicating its long-term efficacy in aiding communication skills in individuals with chronic TBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals. Gabbatore, I., Sacco, K., Angeleri, R., et al.[2022]

This study explored how speech-language pathologists (SLPs) treat spoken discourse impairments in adults after traumatic brain injury (TBI), revealing a variety of individualized treatment activities that focus on social communication skills and strategy development.

SLPs reported that their practices align with best practices and guidelines, emphasizing the importance of context-sensitive and goal-directed interventions, while also identifying a need for better training, resources, and outcome measures in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A qualitative exploration of speech-language pathologists' approaches in treating spoken discourse post-traumatic brain injury. Hoffman, R., Spencer, E., Steel, J.[2023]

Citations

1.

alliedhealth.ceconnection.com

alliedhealth.ceconnection.com/ovidfiles/00011363-202101000-00005.pdf

Narrative Discourse Intervention After Traumatic Brain Injury

Purpose: Narrative discourse (e.g., telling anecdotes or relating personal events) comprises a key part of social interaction and is commonly affected after ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11307254/

Systematic Review of Discourse and Social ...

This study reviewed the current state of discourse and social communication interventions in traumatic brain injury (TBI) to provide clinically focused ...

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8903041/

Patterns of narrative discourse in early recovery following ...

To investigate the nature and patterns of narrative discourse impairment in people with severe Traumatic Brain Injury (TBI) during early recovery.

4.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0021992417302654

Discourse-based treatment in mild traumatic brain injury

The purpose of the study was to determine if discourse processing treatment improved the discourse production in individual with TBI.

5.

pubs.asha.org

pubs.asha.org/doi/10.1044/nnsld12.3.14

Treatment of Discourse Deficits Following TBI

These studies also highlight many of the difficulties in discourse assessment and intervention, which may limit the treatment outcomes of individuals with ...

6.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/39052432/

Narrative Discourse Performance in Traumatic Brain Injury

This study examined to what extent narrative discourse comprehension accounts for narrative discourse production outcomes (story grammar, story completeness).

7.

pubs.asha.org

pubs.asha.org/doi/10.1044/2023_PERSP-22-00115

The Effects of Cognitive Rehabilitation on Pragmatic ...

This meta-analysis provides evidence that cognitive rehabilitative protocols created in collaboration with speech-language pathologists (SLPs) ...

8.

researchgate.net

researchgate.net/publication/358932284_Systematic_Review_of_Discourse_and_Social_Communication_Interventions_in_Traumatic_Brain_Injury

(PDF) Systematic Review of Discourse and Social ...

This study reviewed the current state of discourse and social communication interventions in traumatic brain injury (TBI) to provide clinically focused ...