Collaborative referencing in traumatic brain injury

Traumatic brain injury (TBI) is a global health epidemic that has deleterious consequences for the individuals with the brain injury, their families, and society. The development and validation of effective treatments is imperative. The current study was inspired by Ylvisaker's collaborative intervention approach with individuals with TBI and draws on a line of work by Duff and colleagues (e.g., Duff et al., 2006; Gupta et al., 2011) documenting patterns of spared and impaired learning abilities in individuals with various types focal brain damage (e.g., hippocampus) and selective neuropsychological impairment (e.g., declarative memory) using a collaborative referencing paradigm. This study extends this line of work by examining the ability of individuals with mild to moderate traumatic brain injury to develop and use referential labels for novel picture cards across repeated interactions with a familiar partner as they complete a collaborative referencing task. Five TBI participant pairs (an individuals with TBI and their partner) and five healthy comparison pairs completed 24 trials (6 trials in each of 4 sessions) of the collaborative referencing task across two days. As a group, the performance of four of the five TBI pairs did not differ from healthy comparison pairs on the primary dependent variables of card placement accuracy, time to complete each trial, and reduction in communicative resources across trials. That is, despite having TBI, these individuals were able to develop and use unique and concise labels to reference the novel cards in collaboration with a familiar partner. The fifth TBI participant pair (3591) differed from the other TBI and healthy comparison pair on both quantitative and qualitative measures. Speculating that 3591's husband may have contributed to their poor performance, a follow-up study was conducted whereby 3591 was brought back to lab several months later and she complete one session of the collaborative referencing task with a new partner. The results of the follow-up study were striking. 3591 and her new partner were as successful as other pairs on all measures of learning in the study.

Given the complex nature of cognitive, neurological, behavioral, personality, and communicative impairments associated with TBI, the findings here, that all participants with TBI were successful in the task, are surprising and provides further evidence that these interactive sessions are potent learning environments. The results of the study support the idea that use of a social and collaborative interaction paradigm facilitates learning in adults at least one year time post injury with mild to moderate brain injuries. Aspects of the collaborative referencing task that exemplify Ylvisaker's contextualized invention approach are completion of a goal-directed task, working with a partner who was relevant to the participant's everyday life, supports were provided by the partner as needed, the task was repeated many times in order to increase chances of the pair's success, and skills were taught through collaboration rather than explicit instruction. Although this was not an intervention study, these findings provide further evidence supporting the use of Ylvisaker's social, interactive, and collaborative approach for individuals with TBI. This study is the first to our knowledge to investigate learning during a collaborative referencing task with individuals with TBI and the positive results obtained here suggest that this may be a fruitful way to deploy Ylvisaker's contextualized intervention approach in more controlled research settings.