Production of main concepts by Mandarin-speakers with traumatic brain injury in China : a pilot study

Abstract

Background According to Zhao and Wang (2001), traumatic brain injury (TBI) is a great public health concern in Mainland China with incidence rates of 55 and 64 per 100,000 as well as mortality rates of 6.3 and 9.7 per 100,000 in urban and rural areas of China, respectively. To provide proper management of communication disorders in TBI cases in China, valid assessment tools are required. Motivated by Nicholas and Brookshire (1995) and considering the cultural and linguistic differences between English and Chinese, Kong (2009, 2011) has developed a clinically oriented assessment of aphasia discourse focusing on main concept analysis (MCA) for Cantonese speakers. Specifically, the MCA evaluates the degree of presence, accuracy, and completeness of concepts produced and a speaker’s efficiency of the production. Aim The aims of this pilot study were to (1) examine how well the MCA can be applied to Mandarin-speaking TBI clients in Mainland China and (2) investigate how MCA performance varied as a function of severity of language impairment and cognitive deficits in TBI. Methods Seventeen TBI clients (12 male + 5 female; mean age of 39.7 years) were recruited and described four sets of sequential pictures (previously designed for MCA by Kong). The main concepts within the language samples were tallied for each speaker and each of them was categorized as (i) Accurate and Complete – AC, (ii) Accurate but Incomplete – AI, (iii) Inaccurate – IN, or (iv) Absent – AB. A composite Main Concept Score (calculated by “3×AC+2×AI+1×IN”) and an efficiency measure of AC per minute were then computed. Each of the subjects was also administered the Mandarin version of the Western Aphasia Battery (MAB; Peking University Health Science Center, 1988) to estimate their language impairment as well as the Mandarin adaptation of the Cognitive Linguistic Quick Test (CLQT; Helm-Estabrooks, 2001) to reflect their deficits across different cognitive domains. Results As shown in Table 1, the severity of language impairment significantly affected our subjects’ performance on the MCA measures of AC, AB, MC Score, and AC per minute. Based on the results of the MAB, five and 12 subjects were diagnosed with fluent and non-fluent aphasia, respectively. An independent-sample t-test for between-group analyses of the MC Score revealed significant differences of the two fluency groups (t=2.655, p<0.05). The significant correlations between MC Score and CLQT subtests also indicated the subjects’ ability to perform a discourse task could potentially be affected by various cognitive domains, including attention (e.g., symbol cancellation), memory (e.g., personal facts and design memory), visuospatial (e.g. design generation), and executive function (e.g., clock drawing). Conclusion and Further Directions The preliminary results suggested that the MCA is sensitive in reflecting the language and cognitive impairments among speakers with TBI. The score distributions indicated that the tool is also culturally suitable for use in native Mandarin speakers in Mainland China. Additional analyses involving comparison between TBI and control groups as well as examination of the effect of age and education level on main concept production are in progress.