Assessment and theoretical interpretation of spoken discourse and cognitive skills in two adolescents with acquired brain injury

Although discourse assessment is recommended, few tools exist for adolescent acquired brain injury (ABI) and few theories describe the contribution of cognition to discourse impairment. This study explored whether a novel discourse protocol can identify difficulties following ABI and whether a discourse processing model provides a useful account of impairment.
Using a case-control design, two adolescent males with moderate ABI (12 and 14 years) were compared to a neurotypical sample on a range of language and cognitive assessments. Patterns in performance were interpreted using a theoretical model. Participants completed a standardised omnibus language assessment, discourse assessment, and battery of cognitive tasks.
Analyses revealed significant differences in discourse and cognition between adolescents with and without ABI. No impairment was detected on a standardised language assessment. Patterns in discourse and cognition aligned with a contemporary model of discourse processing.
Participants with ABI demonstrated discourse deficits relative to the neurotypical reference sample. The findings demonstrate the value of discourse sampling across multiple genres and analysis of microlinguistic to superstructural features. A structure-building framework (SBF) model, originating in schizophrenia, provides a promising theory with which to interpret discourse impairment and has the potential to inform intervention for discourse in ABI.

尽管语篇评估（discourse assessment）已被推荐用于临床实践，但针对青少年获得性脑损伤（adolescent acquired brain injury, ABI）的专用工具仍较为匮乏，且鲜有理论能够阐释认知因素对语篇损伤的作用机制。本研究旨在探索一款新型语篇范式能否识别青少年ABI患者的语篇障碍，以及语篇加工模型能否为这类损伤提供有效解读。
本研究采用病例对照设计（case-control design），选取2名年龄分别为12岁与14岁的中度ABI青少年男性作为病例组，将其与神经典型（neurotypical）对照组的语言与认知评估结果进行对比。研究采用理论模型对参与者的表现模式进行解读，所有受试者均完成了标准化综合语言评估、语篇评估以及一套认知任务组合（battery of cognitive tasks）。
分析结果显示，患与未患ABI的青少年在语篇表现与认知水平上存在显著差异；但标准化语言评估未检测到明显的语言损伤。受试者的语篇表现与认知模式与当前主流的语篇加工模型高度契合。
与神经典型对照组相比，ABI患者表现出显著的语篇缺损。本研究结果证实了多体裁语篇采样以及从微语言特征到超结构特征（microlinguistic to superstructural features）分析的应用价值。源自精神分裂症（schizophrenia）的结构构建框架（structure-building framework, SBF）模型，为阐释语篇损伤机制提供了极具前景的理论框架，同时有望为青少年ABI患者的语篇康复干预提供指导依据。