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}

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.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

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

Who Is Running the Clinical Trial?

VA Office of Research and Development Lead Sponsor

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] Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice.

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] Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI.

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

Using narrative as a bridge: linking language processing models with real-life communication. [2022] In chronic aphasia, maximizing generalization of improved language abilities from clinical tasks to everyday communication can require the same systematic planning process as the early stages of therapy, often drawing on additional areas of knowledge and successes from other clinical populations. The use of narrative structure is shown here to be a useful framework for building on the developments within sentence processing impairments in aphasia and creating a bridge to more real-life language tasks. An intervention based on narrative structure is described with two people with different language profiles and at different stages of the chronic aphasia spectrum. The insights gained in assessing language ability, underpinning intervention, and capturing therapeutic changes are demonstrated.

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

Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals. [2022] To verify the efficacy of Cognitive Pragmatic Treatment (CPT), a new rehabilitation training program for improving communicative-pragmatic abilities.

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

Improving Discourse following Traumatic Brain Injury: A Tale of Two Treatments. [2021] Persons with traumatic brain injury (TBI) often present with discourse-level deficits that affect functional communication. These deficits are not thought to be primarily linguistic in nature but instead are thought to arise from the interaction of linguistic and cognitive processes. Discourse processing treatment (DPT) is a discourse-based treatment protocol which targets discourse deficits frequently seen in TBI. Attention Process Training-2 (APT-2) is a published treatment protocol which targets four levels of attention. The purpose of this article is to investigate the effectiveness of DPT and APT-2 in improving discourse production and cognition in adults with TBI. Our results suggest that DPT results in greater improvement in discourse informativeness and coherence, but the combination of DPT and APT-2 resulted in greater generalization to untrained stimuli. Both DPT and APT-2 appear to have some potential to improve cognition, but there was intersubject variability with regard to which treatment is more effective.

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] Impaired discourse production is commonly reported for individuals with traumatic brain injury (TBI). Discourse deficits can negatively impact community integration, return to employment and quality of life. COVID-19 restrictions have reduced in-person assessment services for people with communication impairments. Advances in telehealth may help speech and language therapists (SLTs) to assess monologic discourse more systematically and improve access to services for patients who may find it difficult to attend in-person.

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] To investigate differences between individuals with traumatic brain injury (TBI) and a control group regarding quantitative characteristics of narrative discourse including correct information units (CIUs). The secondary objective was to explore cognitive correlations with narrative discourse measurements.