title: Communication disorders and executive function impairment after severe traumatic brain injury: an exploratory study using the GALI (a grid for linguistic analysis of free conversational interchange).
abstract: Following severe traumatic brain injury (TBI), failure to adjust language to communication abilities has been described and attributed by many authors to executive function impairment. Interactional dysfunctions may damage family-based, social and vocational equilibrium, and they are of key importance in prognosis of rehabilitation outcome. In conversation, frequently occurring inappropriate formulations connote difficulties in discursive organization and are likely to include numerous digressions, if not confabulations.
  
  
  OBJECTIVE
  The main objective of this study was to improve assessment of the non-verbal as well as the verbal aspects of the communication disorders observed in TBI subjects. We have developed and are proposing the grid for linguistic analysis (GALI) of free conversational interchange that constitutes an original French-language tool. We wish to demonstrate its validity as a means of measuring interactive skills in a given population.
  
  
  METHODS
  We assessed 17 severely brain injured patients presenting executive dysfunction, who were compared with 34 matched and healthy individuals. Fifty-one 10-minute sequences of free conversation between study participants and therapists were filmed and analyzed by applying the GALI. Three independent raters coded the conversations. Inter-rater reproducibility was considered statistically satisfactory.
  
  
  RESULTS
  The results successfully distinguished TBI patients from healthy subjects and thereby underscored the discriminatory value of the tool. A significant correlation was found between the patients' performances in executive tests and in the GALI.
  
  
  CONCLUSIONS
  In severe TBI a social handicap results from several associated cognitive disorders. Interactive discourse analysis combining non-verbal with verbal aspects confirms the existence of difficulties in communication that are usually underestimated in classic formal language testing methods. The GALI is likely to meet speech therapists' need for reliable assessment of their patients' interactional difficulties and their consequences in social life.
authors.affiliation: 60, rue de l'Ormelet, 14790 Mouen, France.
authors.forename: C
authors.initials: C
authors.lastname: Sainson
authors.affiliation: EA 4136 handicap et système nerveux, université de Bordeaux, 33076 Bordeaux cedex, France. Electronic address: michel33160.barat@orange.fr.
authors.forename: M
authors.initials: M
authors.lastname: Barat
authors.affiliation: Psychologie des actions langagières et motrices (PALM, EA 4649), université de Caen Basse-Normandie, 14032 Caen cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Aguert
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology*; D003147:Communication Disorders / Q000175:diagnosis* / Q000209:etiology; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D055815:Young Adult
keywords: Communication; Conversation; Executive function impairment; Gestualité; Gesture; Interlocutor; Pragmatique; Syndrome dysexécutif; Traumatic brain injury; Traumatisme crânien