Discourse Process Training and Attention Process Training 2 in Adults with Traumatic Brain Injury
Persons with traumatic brain injury (TBI) often present with relatively preserved lexical and grammatical skills but exhibit discourse level deficits which negatively affect functional communication. Discourse following TBI has been characterized as disorganized, tangential and uninformative. Cognitive deficits experienced by individuals with TBI may underlie these discourse deficits. A context sensitive approach to rehabilitation holds that linguistic and cognitive deficits should be targeted through functional tasks. By contrast, in a process specific approach to rehabilitation, discrete cognitive skills are trained through decontextualized tasks with the assumption that improvements in discrete cognitive skills will cause generalized improvements in functional tasks which rely on these cognitive skills. The purpose of the present study was to compare the effectiveness of a context sensitive approach, Discourse Processing Treatment (DPT) with a process specific approach, Attention Process Training 2 (APT-2) in improving discourse and cognition. DPT targeted discourse deficits with structured cues (comprehension questions and a visual story guide which depicted story grammar elements), metacognitive and metalinguistic strategies, and functional training in the form of narrative practice. APT-2 is a hierarchical, multilevel treatment program which targets five levels of attention (sustained, selective, alternating and divided attention) through decontextualized laboratory tasks. The research questions addressed by the present study were as follows: 1. Will the individual and combined effects of DPT and APT-2 improve performance on measures of discourse informativeness and coherence? 2. Do the individual and combined effects of DPT and APT-2 generalize to improvements on standardized measures of attention and memory? 3. Are the individual and combined treatment effects of DPT and APT-2 maintained for informativeness, coherence and cognitive measures following the entire treatment cycle (both DPT and APT-2) for a one month period? The results of this study suggest that DPT by itself had a greater effect on discourse informativeness and coherence than APT-2 by itself. However, DPT and APT-2 in combination resulted in greater gains in discourse informativeness for untreated picture stimuli. Additionally, all participants showed improvements in attention, as measured by raw completion times on the Comprehensive Trail Making Test (CTMT) following treatment but there was inter subject variability in terms of which treatment yielded the best effect; Participant 1 improved following APT-2, Participant 4 improved following DPT, and Participant 2 improved from both. Overall, our results suggest that DPT may improve discourse informativeness and coherence in adults with TBI but focused cognitive training in addition to DPT may maximize generalization. Our results also suggest that both APT-2 and DPT may result in improvements in attention.
Henderson, Amy. (May 2019). Discourse Process Training and Attention Process Training 2 in Adults with Traumatic Brain Injury (Doctoral Dissertation, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/7237.)
Henderson, Amy. Discourse Process Training and Attention Process Training 2 in Adults with Traumatic Brain Injury. Doctoral Dissertation. East Carolina University, May 2019. The Scholarship. http://hdl.handle.net/10342/7237. March 29, 2020.
Henderson, Amy, “Discourse Process Training and Attention Process Training 2 in Adults with Traumatic Brain Injury” (Doctoral Dissertation., East Carolina University, May 2019).
Henderson, Amy. Discourse Process Training and Attention Process Training 2 in Adults with Traumatic Brain Injury [Doctoral Dissertation]. Greenville, NC: East Carolina University; May 2019.
East Carolina University