Highlights
- •Remediation of social communication skills in people with traumatic brain injury can be beneficial.
- •Evidence is greatest for context-sensitive approaches delivered predominantly in group settings.
- •There is a need for further high-quality studies in this area.
Abstract
Objective
To determine whether behavioral interventions are beneficial for adults with social
communication difficulties after traumatic brain injury (TBI).
Data Sources
Electronic databases were searched through October 2013 to find behavioral intervention
trials. Keywords used in our search were intervention, therapy, treatment, and program
combined with pragmatic disorder, pragmatic impairment, social communication disorder/impairment,
conversation disorder/impairment, social disorder/impairment, cognitive-linguistic
and cognitive-communication deficit; adult; and traumatic brain injury, head injury,
and brain injury. Hand searches of the reference lists of relevant articles were also
conducted.
Study Selection
To be selected for detailed review, articles found in the initial search were assessed
by 2 reviewers and had to meet the following criteria: (1) population (adults with
TBI); (2) intervention (behavioral intervention); and (3) outcomes (changes in social
communication). Articles needed to describe interventions that were delivered directly
to adults with TBI with or without other people (such as significant others) involved.
Of the 2181 articles initially identified, 15 were selected for detailed review.
Data Extraction
Data were independently extracted by members of the research team, then collated and
reviewed by the team.
Data Synthesis
Of the 15 publications that met the study criteria, 7 were single-case design studies,
3 were randomized controlled trials, 1 was a nonrandomized controlled trial, and 4
were cohort studies. The methodological qualities of eligible articles were examined
using the Physiotherapy Evidence Database and Single-Case Experimental Design rating
scales. The interventions described in the studies fell into 2 broad categories: those
addressing a specific impairment in social communication, and context-specific interventions
with a holistic focus on social communication skills. Studies using context-sensitive
approaches had been published more recently and were generally group studies with
higher methodological quality.
Conclusions
Overall, interventions addressing social communication skills for people with TBI
were found to be beneficial irrespective of treatment approach used. While the evidence
base is small and with varying levels of scientific rigor, there is a body of quality
evidence that supports the use of context-sensitive approaches. Further research is
still required to determine the role of impairment-specific versus context-specific
interventions when treating individuals with social communication difficulties after
TBI to inform clinical decision-making.
Keywords
List of abbreviations:
GAS (Goal Attainment Scaling), nRCT (nonrandomized control trial), PEDro (Physiotherapy Evidence Database), RCT (randomized control trial), SCD (single-case design), SCED (single-case experimental design), SCSQ-A (Social Communication Skills Questionnaire–Adapted), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 08, 2015
Footnotes
PROSPERO Registration No.: CRD42013006484.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
