Narrative Discourse Treatment for Traumatic Brain Injury

Recruiting in Palo Alto (17 mi)

Overseen by Karen Le, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

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

Trial Summary

What is the purpose of this trial?

This trial tests a new therapy to help Veterans with TBI improve their storytelling skills. The therapy aims to make their stories better organized and more meaningful, which can help them communicate better in daily life. Storytelling interventions are increasingly being proposed as a tool for rehabilitation after Traumatic Brain Injury (TBI).

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 data supports the effectiveness of the treatment Narrative Discourse Treatment for Traumatic Brain Injury?

Research shows that Discourse Processing Treatment (DPT) can improve the way people with traumatic brain injury communicate by making their speech more informative and coherent. Combining DPT with Attention Process Training-2 (APT-2) may help these improvements apply to new situations, suggesting that these treatments can enhance both communication and thinking skills. ^{1 2 3 4 5}

Is Narrative Discourse Treatment safe for humans?

The available research does not provide specific safety data for Narrative Discourse Treatment or its related therapies, but these treatments are generally considered safe as they involve non-invasive speech and language therapy techniques. ^{1 2 4 5 6}

How is Narrative Discourse Treatment different from other treatments for traumatic brain injury?

Narrative Discourse Treatment (DPT) is unique because it specifically targets discourse-level deficits, which are communication issues arising from the interaction of language and cognitive processes, rather than just focusing on language or cognition alone. It has been shown to improve discourse informativeness and coherence more effectively than other treatments, and when combined with Attention Process Training-2 (APT-2), it enhances generalization to untrained tasks. ^{1 2 4 5 7}

Research Team

Karen Le, PhD

Principal Investigator

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

Eligibility Criteria

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.

Trial Timeline

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)

Treatment Details

Interventions

• Narrative discourse treatment (Behavioral Intervention)

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.

Participant Groups

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+

Dr. Grant Huang

VA Office of Research and Development

Acting Chief Research and Development Officer

PhD in Medical Psychology and Master of Public Health from the Uniformed Services University of Health Sciences

Dr. Erica M. Scavella

VA Office of Research and Development

Chief Medical Officer since 2022

MD from University of Massachusetts School of Medicine

Findings from Research

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

A qualitative exploration of speech-language pathologists' approaches in treating spoken discourse post-traumatic brain injury. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

How do speech-language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

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

4. United States pubmed.ncbi.nlm.nih.gov

Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Improving Discourse following Traumatic Brain Injury: A Tale of Two Treatments. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Telehealth administration of narrative and procedural discourse: A UK and US comparison of traumatic brain injury and matched controls. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Correct information unit analysis for determining the characteristics of narrative discourse in individuals with chronic traumatic brain injury. [2022]