Academic journal article New Zealand Journal of Psychology

Psychometric Evaluation of the Profile of Functional Impairment in Communication with Traumatically Brain-Injured Children

Academic journal article New Zealand Journal of Psychology

Psychometric Evaluation of the Profile of Functional Impairment in Communication with Traumatically Brain-Injured Children

Article excerpt

The Profile of Functional Impairment of Communication (PFIC) was employed to examine communication by children with a traumatic brain-injury (TBI) during a family problem-solving discussion. Communication by 11 children with a TBI was compared with that of 11 children with orthopaedic injuries. Children with a TBI evidenced impaired communication on five of the 10 subscales of the PFIC. Injury severity was significantly correlated with scores on nine of the 10 PFIC subscales. Adequate inter-rater reliability was found for eight of the PFIC subscales. These results provide encouraging preliminary evidence for the use of the PFIC in assessing children with a TBI.

Although gross aphasia is thought to be rare in children with a Traumatic brain injury (TBI), subtle problems with language use are common (Ewing-Cobbs, Levin, Eisenberg, & Fletcher, 1987; Jordan & Murdock, 1993; Ylvisaker, 1986). Despite the subtle nature of language impairments following TBI, these impairments are thought to undermine social adjustment (Godfrey & Shum, 1999; Godfrey, Knight & Partridge, 1996). One mechanism through which language impairment is thought to affect psychosocial adjustment is by compromising the injured child's ability to communicate effectively with family and peers. Consistent with this notion, analyses of narrative discourse by children with a TBI has documented impaired functional language use during social interaction (e.g., Chapman et al., 1992).

Assessing functional language use can be a difficult task. For example, discourse analysis of the type undertaken by Chapman et al. (1982) involves the transcription and qualitative analysis of speech samples derived from naturalistic speech contexts. This method provides a powerful means of identifying subtle deficits in communication, and of comprehensively describing these deficits. However, this method is of less use for clinical assessment. The main limitations of discourse analysis include the large amount of time involved in undertaking such analyses, the lack of standardisation of this method, and the difficulty in deriving indices of severity of impairment.

This article reports on the application of the Profile of Functional Impairment of Communication (PFIC; Linscott, Knight, & Godfrey, 1996) with children. The PFIC was designed to provide a more practical means for assessing communication impairment. The scale provides a comprehensive qualitative description of communication difficulties as well as a clinical index of the severity of communication impairment.

Method

Subjects

Medical records at the Neurological Unit at Dunedin Hospital were reviewed to identify children aged between 6 and 15 years who had suffered a moderate or severe TBI between one and five years previously, and who were discharged from hospital in a conscious state. A moderate or severe TBI was defined as a brain injury resulting from a blunt trauma associated with any of the following criteria:

a. Post-traumatic amnesia (PTA; Russell, 1961) of more than one day.

b. Glasgow Coma Scale (GCS; Jennett & Teasdale, 1974) score of 3-12.

c. GCS score of 13-15 when complicated by mass lesion or evidence of brain injury in the computed tomography (CT) or magnetic resonance imagery.

Subjects with a premorbid history of psychiatric disorder, neurological disease or previous TBI were excluded from the study.

Twenty-four families were sent a written invitation to participate in the study, of whom 11 agreed to take part. Of those who declined to participate, 9 did so by written communication. Two subjects did not respond to the invitation, one subject was untestable due to a psychiatric disturbance, and another because of a severe hearing disability. The final sample comprised 8 males and 3 females.

The mean age of the participating subjects at testing was 13.8 years (S.D. = 4.3), and their average duration of PTA was 9. …

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