Systematic review of behavioral interventions targeting social communication difficulties after traumatic brain injury

Objective To determine whether behavioral interventions are beneficial for adults with social communication difficulties after traumatic brain injury (TBI). Data Sources Electronic databases were searched through October 2013 to find behavioral intervention trials. Keywords used in our search were intervention, therapy, treatment, and program combined with pragmatic disorder, pragmatic impairment, social communication disorder/impairment, conversation disorder/impairment, social disorder/impairment, cognitive-linguistic and cognitive-communication deficit; adult; and traumatic brain injury, head injury, and brain injury. Hand searches of the reference lists of relevant articles were also conducted. Study Selection To be selected for detailed review, articles found in the initial search were assessed by 2 reviewers and had to meet the following criteria: (1) population (adults with TBI); (2) intervention (behavioral intervention); and (3) outcomes (changes in social communication). Articles needed to describe interventions that were delivered directly to adults with TBI with or without other people (such as significant others) involved. Of the 2181 articles initially identified, 15 were selected for detailed review. Data Extraction Data were independently extracted by members of the research team, then collated and reviewed by the team. Data Synthesis Of the 15 publications that met the study criteria, 7 were single-case design studies, 3 were randomized controlled trials, 1 was a nonrandomized controlled trial, and 4 were cohort studies. The methodological qualities of eligible articles were examined using the Physiotherapy Evidence Database and Single-Case Experimental Design rating scales. The interventions described in the studies fell into 2 broad categories: those addressing a specific impairment in social communication, and context-specific interventions with a holistic focus on social communication skills. Studies using context-sensitive approaches had been published more recently and were generally group studies with higher methodological quality. Conclusions Overall, interventions addressing social communication skills for people with TBI were found to be beneficial irrespective of treatment approach used. While the evidence base is small and with varying levels of scientific rigor, there is a body of quality evidence that supports the use of context-sensitive approaches. Further research is still required to determine the role of impairment-specific versus context-specific interventions when treating individuals with social communication difficulties after TBI to inform clinical decision-making