Transcript Title in 48 point font Authors and Affiliations in 24

The La Trobe Communication Questionnaire and
Vocational Outcome Following Traumatic Brain Injury.
Margaret A. Struchen, Ph.D.1, 2 & Laura Rosas, M.A.2
1
Introduction
Social and behavioral factors play a major role in vocational status
following traumatic brain injury (TBI). Brooks and colleagues identified
conversational deficits as a major predictor of failure to return to work
following severe TBI.1 Interpersonal difficulties have been found to be the
most common cause of job separation following brain injury.2 A metaanalytic study examining predictors and indicators of work status following
TBI found that emotional and behavioral problems, unawareness of deficits,
and loss of initiative were some of the factors that showed a moderate
relationship to work status.3
Most previous research relating interpersonal functioning to vocational
outcome has utilized rating scales of broad aspects of cognitive and
behavioral functioning, with the assessment of social communication
involving only a few items. Douglas and colleagues4 developed the LaTrobe
Communication Questionnaire (LCQ) as a measure of perceived
communication ability for adults with TBI. This questionnaire is based on
Damico’s analysis of discourse categories, a commonly used method of
evaluating conversation.5 Also included in the LCQ are some items related
to cognitive constructs typically affected following TBI.
The purpose of the current study is to investigate the relationship
between ratings on the LCQ and vocational outcome for persons with TBI.
It was hypothesized that having greater communication problems would be
associated with lowered productivity status for individuals with TBI.
Methods
Participants:
Participants were 22 adults with moderate to severe TBI who
participated in a study examining the assessment of social communication
abilities and 17 family members of these individuals. Participants with TBI
were drawn from a sample of individuals participating in follow-up
evaluations as part of the NIDRR TBI Model Systems study, all of whom
had received inpatient rehabilitation and were at least 1-year post-injury. All
participants with TBI were productive (either employed or students) on a
full-time or part-time basis at the time of their injuries.
Table 1. Demographic and injury characteristics.
Individuals with TBI: (N=22)
Age (M, (SD), [range]:
Education:
Gender:
Female:
Male:
Emergency Room GCS (ER-GCS):
Injury Mechanism:
Motor vehicle accident:
Other:
Family Members: (N=17)
Age:
Education:
Relationship:
Spouse:
Parent:
Other:
Contact with person with TBI:
Daily:
Weekly:
37.6 (9.5) [23-55]
13.0 (1.6) [9-16]
9 (41%)
13 (59%)
6.8 (3.7) [3-15]
17 (77%)
5 (23%)
50.8 (13.2) [30-71]
12.6 (1.9) [9-16]
6 (35%)
8 (47%)
3 (18%)
14 (82%)
3 (18%)
Baylor College of Medicine/University of Texas-Houston PM&R Alliance, Houston, Texas
2 Brain Injury Research Center, The Institute for Rehabilitation and Research (TIRR)
Measures:
La Trobe Communication Questionnaire (LCQ)4 The 30-item LCQ is a
questionnaire designed to assess communication skills of individuals with TBI.
Items are rated on a 4-point scale ranging from “Never or rarely” to “Usually or
Always.” An example item would be “When talking to others do you say or do
things others might consider rude or embarrassing?” Two of the 3 LCQ forms
were used: the self-report form and the significant other report form. Total scores
are computed by summing ratings across all 30 items. Good internal consistency
and stability were demonstrated for the measure.4
Community Integration Questionnaire (CIQ).6-7 The CIQ is a 15-item
structured interview assessing three domains of functional outcome from TBI:
Productivity (e.g., school attendance, employment); Home Competency (e.g.,
shopping, meal preparation); and Social Integration (e.g., friendships, visits).
The CIQ measures actual performance of activities, as compared with measuring
potential to perform activities. The stability and validity of the CIQ have been
confirmed in the TBI population.6 Subscales utilized for the current study reflect
the more recent factor analysis by Sander et al. (1999).7
Craig Handicap Assessment and Reporting Technique-Short Form
(CHART-SF). 8 The CHART is a widely used questionnaire that measures
societal participation for persons with disabilities. The CHART-SF is a shortform (17 items) of the instrument that reproduces all CHART subscales with at
least 90% accuracy. The CHART-SF yields subscales on Physical and Cognitive
Independence, Mobility, Social Integration, and Occupation. For purposes of the
current project, the Occupation subscale was utilized.
Procedure:
All individuals with TBI completed the LCQ, CIQ, and CHART-SF as part of
a more extensive assessment of social communication and executive functioning
conducted at the time of their yearly follow-up. Family members completed the
LCQ at or near the time of the follow-up for their loved one with TBI.
Results
Comparison of LCQ Ratings between Individuals with TBI and their
Family Members:
Due to concerns about changes in self-awareness experienced after TBI,
self-report measures have been traditionally viewed as problematic. More recent
studies have found evidence that perceptions of the individual with TBI may be
relatively consistent with those of close others on certain areas of functioning.9
Previous studies using the LCQ with small samples have examined this issue
and found conflicting results. In a sample assessed within 1-year post-injury,
individuals with TBI reported significantly fewer problems than did their family
members.10 However, in a sample assessed at least 2 years post-injury, no such
differences were found.11
To evaluate this issue in the current study, paired t-test comparisons were
conducted to examine differences in the LCQ Total score and in the number of
communication behaviors indicated as more problematic since the time of injury
between the 17 pairs of adults with TBI and their family members. No
significant differences were found between self-report and family report on the
LCQ summary scores. Therefore, the self-report scores were utilized in further
analyses regarding vocational and functional status.
This project was partially supported by funding from the National Institute on Disability and Rehabilitation
Research , United States Department of Education (Grant #H133G010152).
Comparison of LCQ Scores between Persons with TBI and Family
60
50
40
TBI
30
Family
20
10
0
LCQ Total
LCQ Increased Items
Relationship between Self-Report LCQ and Vocational Outcome:
Multiple regression analyses were employed to examine the relationship
between self-report LCQ total scores and functional outcome measures, after
covarying for injury severity, as measured by the ER-GCS score. Separate
analyses were conducted for each of the 4 CIQ scores and the Occupation
subscale of the CHART-SF.
The full model of ER-GCS and total LCQ scores was found to be
significantly related to CIQ Productivity scores (F (2, 19) = 3.48, p = 0.05), with
LCQ scores uniquely accounting for 17% of the variance. After accounting for
injury severity, the relationships between LCQ scores and scores on the Home
Integration and Social Integration subscale scores were not found to be
significant. However, a significant relationship was found between total LCQ
scores and the Total CIQ score (F (2, 19) = 6.08, p < 0.01), with the overall model
(including ER-GCS) accounting for 33% of the variance in Total CIQ score and
LCQ scores uniquely accounting for 14% of the variance.
As with CIQ Productivity scores, the full model of ER-GCS scores and
total LCQ scores was found to be significantly associated with CHART-SF
Occupation subscale scores (F (2, 19) = 3.52, p = 0.05), with LCQ scores
uniquely accounting for 15% of the variance.
Conclusions
•Perceptions of adults with TBI did not differ significantly from those of their
close others regarding overall communication skills and perceptions of
communication skill changes since injury. This is consistent with a previous study
of adults with TBI who were >2 years post-injury. Such findings seems to indicate
that self-awareness of communication abilities is fairly intact for those who are
past the acute stages of recovery following TBI.
•Scores on the LCQ were significantly related to measures of productivity and
functional outcome. This provides some preliminary evidence of the ecological
validity of the LCQ and suggests that the LCQ may be a useful adjunct to
neuropsychological evaluation for individuals with TBI.
References
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Head Trauma Rehabilitation. 1991;6(3):1-11.
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