Strategies to Improve Impaired Social Communication after TBI
Social communication abilities are at the heart of an individual’s
social competence. When a person sustains a
traumatic brain injury (TBI) that impairs social communication abilities, he or she may experience
disruptions in employment, family and romantic relationships, and overall
social integration. In fact, damage to social communication is actually
more predictive of negative life outcomes than is damage to cognitive
and physical abilities.
Simply put, social communication is the ability to send and receive messages (verbal and nonverbal) to and from others. To effectively communicate, one must, for example, be able to register and process others’ emotional expressions, generate multiple appropriate responses to that expression, then perform the chosen response. A TBI can impair one or many of these processes. As a result, TBI patients may display impulsive behavior, poor planning skills, slow processing speed, or egocentricity, all of which may impair their ability to effectively participate in the social and vocational world.
For some individuals with moderate to severe TBI, social isolation is a considerable problem. As social communication abilities deteriorate following TBI, patients may struggle to maintain their relationships and overall capacity to integrate socially. Some may experience difficulties returning to work because their ability to sustain conversation and interpret social cues may be seriously impaired. At home, disruption to social communication abilities – particularly changes to personality – can seriously increase marital stress, and at the same time increase the perceived burden by family members.
Impairment of social communication abilities clearly poses significant problems for those who have sustained TBI. Accordingly, researchers have dedicated substantial attention to intervention strategies for post-TBI communication rehabilitation. Some of these intervention strategies, such as interpersonal process recall (IPR), focus specifically on individual recovery. In IPR trials, participants are asked to recall interpersonal communication dynamics that were previously displayed on a videotape. A counselor then discusses the various aspects of communication with participants, providing them with feedback and guiding their attention and memory toward social orientation. Participants who engaged in IPR treatment showed significant improvement in their interpersonal skills. Furthermore, individual case studies show that feedback and self-monitoring processes can also reinforce positive social communication.
While individual intervention strategies provide patients with one-on-one guidance and feedback, group interventions can provide participants with opportunities for social interaction in a positive environment. In one study, a group intervention program was designed to foster self-awareness, group support, feedback, and problem-solving in a social setting. At a twelve-week follow-up, those who participated in the group intervention showed significantly improved social performance when compared to the no-treatment control group. At six months post-intervention, participants had maintained their social development, and their self-reported life satisfaction was significantly higher. This study gave such strong findings that it is included in the American Congress of Rehabilitation Medicine Brain Injury-Interdisciplinary Special Interest Group’s rehabilitation manual.
Another group study investigated the effects of a social skills training program versus a non-therapeutic social activities program. Researchers found that participation in group activities alone (such as cooking and craft-making) did not lead to improved social performance. On the other hand, participants who completed the skills training program (in which clinicians guided their behavioral and perceptive abilities) did show improved partner-directed behavior. While group activity may be beneficial, active therapeutic intervention does appear necessary for an effective recovery plan.
Some intervention plans are focused less on group structure and more on content. For example, a communication intervention strategy may concentrate specifically on improving receptive communication abilities, which involve an individual’s perception of social interactions.
Programs that coach participants to judge facial, vocal, and bodily expressions have been moderately effective, as participants showed modest development of emotion perception after the treatment course. When participants were given a set of short stories and asked to identify characters’ emotional expressions, they demonstrated increased ability to identify their own potential emotions in a particular social situation. These findings indicate that TBI patients may benefit from both verbal and non-verbal receptive communication intervention.
More recently, however, researchers have designed interventions targeting partnered communication and contextual interaction. These studies showed that when partners are trained to employ communication strategies (such as verbal awareness), interactions become more focused and efficient, and conversation partners with TBI can better focus on the topic at hand rather than stray toward unrelated issues. In sum, intervention strategies which involve contextual coaching and partner-based training appear to benefit both TBI patients and their conversational partners.
These intervention strategies provide a foundation for further study of post-TBI social communication difficulties. Evidence overwhelmingly suggests that understanding of communicative problems and appropriate treatment can significantly improve an individual’s recovery from TBI-related social impairment. After a brain injury, impairments in communication may impair a patient’s ability to function in the social world, to maintain healthy and supportive relationships, and to sustain occupational security. Targeted intervention in the post-injury recovery period may provide these individuals with significantly improved quality of life and the opportunity for a more healthful, stable future.
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