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Written Expression and Workload Perceptions among Adults with and without Traumatic Brain Injury: A Mixed Methods Study

Carly R Dinnes, University of Nebraska - Lincoln


Cognitive-communication deficits are common after traumatic brain injury (TBI) and can disrupt effective communication across all language modalities. Although researchers have investigated the effect these deficits have on spoken communication, sparse literature is available about changes in written expression after injury. Thus, the purpose of this study was to compare the writing quality, behaviors, and experiences of people with TBI to those of people without TBI. Five adults with moderate or severe TBI were matched on age, gender, and education to control participants. Both quantitative and qualitative methods of data collection and analysis were implemented. Quantitative procedures tasked participants with composing essays about a memorable event and rating the workload associated with this writing; Mann Whitney U statistics and Common Language effect sizes were computed for multiple measures of writing quality and productivity. Qualitative data were collected via participant interviews about perceptions and experiences with the writing task; analysis of interview transcripts revealed salient themes and subthemes. Results revealed that participants with TBI differed quantitatively and qualitatively from participants without TBI regarding writing. Quantitative findings indicated that participants with TBI generated essays that were shorter, less complex, less cohesive, and contained more errors than those of participants without TBI. Furthermore, participants with TBI required more attempts to correct errors and more time to generate essays of comparable length to those of participants without TBI. Group comparison across the four themes and fourteen subthemes that emerged from the qualitative data revealed that participants with TBI described more substantial challenges with writing than participants without TBI. However, participants with TBI tended to fixate on only a few causes of challenge rather than recognize multiple contributing factors. Overall, findings suggest that cognitive-communication deficits caused by TBI disrupt effective and efficient written expression. These disruptions make post-injury writing an inefficient, time-consuming, and error-prone means of communication. However, people with TBI are not always cognizant of these changes and may overestimate their ability to communicate effectively through written messages. Thus, clinicians need to evaluate thoroughly and address post-injury writing challenges when treating people with TBI.

Subject Area

Speech therapy

Recommended Citation

Dinnes, Carly R, "Written Expression and Workload Perceptions among Adults with and without Traumatic Brain Injury: A Mixed Methods Study" (2019). ETD collection for University of Nebraska - Lincoln. AAI13903650.