Systematic Review of Discourse and Social Communication Interventions in Traumatic Brain Injury

Abstract

Purpose: This study reviewed the current state of discourse and social communication interventions in traumatic brain injury (TBI) to provide clinically focused guidance about treatment efficacy, treatment approaches by TBI severity, treatment components, and treatment outcome measures. Method: Searches were conducted in five electronic databases and reference lists of topical articles for discourse or social communication interventions in TBI published between 2012 and 2021. Search terms reflected three concepts: TBI, treatment, and cognitive-communication. Studies were evaluated for methodological quality using rating scales specific to study design. Results: Seven hundred sixty-seven records were identified, culminating in 21 studies for qualitative synthesis. All approaches resulted in improvement posttreatment, but durability and strength of evidence varied. Five treatment components were identified as “essential” for fostering change. Discourse approaches were generally more effective in mild-to-moderate TBI, whereas social communication approaches were more effective in moderate-to-severe TBI. Communication outcome measures were generally more sensitive to change than measures of other domains of functioning. Conclusions: The evidence suggests that discourse and social communication treatments are promising for improving communication in TBI. Selection of treatment components and tailoring treatment to the individual are important clinical considerations. Use of at least two proximal outcome measures that evaluate the target behavior and extent of functional generalization may be advantageous. The field would benefit from additional, more rigorous treatment studies to provide a greater understanding of how best to treat cognitive-communicative impairments in people with TBI. Supplemental Material: https://doi.org/10.23641/asha.19233516