Confrontation Naming Impairment in Patients with TBI Undergoing Inpatient Rehabilitation

Research Objectives: 1) To identify the incidence of confrontation naming disturbance in persons undergoing inpatient rehabilitation for subacute traumatic brain injury (TBI).
2) To investigate the relationship between TBI-related confrontation naming impairment and inpatient neurorehabilitation length of stay (LOS).
3) To document rates of recovery from TBI-related confrontation naming impairment at discharge from an inpatient rehabilitation setting.

Design: Retrospective analysis of data from an inpatient neurorehabilitation LOS.

Setting: Inpatient neurorehabilitation

Participants: 222 patients with TBI admitted to an inpatient neurorehabilitation unit.

Interventions: No interventions

Main Outcome Measures: Total and rehabilitation LOS, Boston Naming Test (BNT), language (aphasia) profile characterization via portions of the Western Aphasia Battery-R (WAB-R).

Results: Over the 3-year period, 222 of 323 (69%) patients admitted to an inpatient neurorehabilitation unit, and who were Rancho V or higher, demonstrated impaired BNT scores determined by Heaton-based norms at admission. 215 of the 222 patients with at least one impaired BNT and WAB-R language profiling, had data for aphasia typing, of which 88% were fluent. Patients with at least one impaired BNT score experienced a significantly longer rehabilitation LOS than patients who were not impaired. Of the 152 of 222 patients for whom there were impaired BNT scores at admission and discharge; 48% were no longer impaired at discharge, while 52% remained impaired at discharge.

Conclusions: Speech-Language Pathologists report low confidence in assessment of persons with TBI receiving inpatient neurorehabilitation. In this study and setting, BNT and sub-sections of the WAB-R were well tolerated by persons with TBI and provided valuable insight into their cognitive functioning. Naming impairment was common in this cohort. As orientation is routinely assessed verbally, and duration of impaired orientation and memory are used to gauge TBI severity, and to inform prognosis and discharge planning, post-traumatic language disturbance represents an important and often overlooked confound on the assessment of posttraumatic amnesia. Prospective controlled studies are needed to clarify the implications on best practices for this population.

Author(s) Disclosures: Kimberly L. Frey
Natalie Gilmore
David B. Arciniegas
Michael Makley
Elise Elbourn
Joanne Steel
Leanne Togher