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41236119.Pdf 'C , ~!q.l -~ . • • • -• INTERPERSONAL COMMUNICATION SIGLLS IN THE TRAUMATIC BRAIN INJURY POPULATION: AN ANALYSIS ACROSS SITUATIONS LEANNE TOGHER A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Communication Sciences and Disorders The Faculty of Health Sciences The University of Sydney © FEBRUARY, 1998 I certify that this Leanne Togher's thesis is ready for submission Chris Code Thesis Supervisor School of Communication Sciences and Disorders January 1998 RARE BOOKS Ull The University of Sydney Copyright in relation to this thesis· Under the CopyrightAct 1968 (several provision of which ace referred to below). this thesis must be used only under the normal conditions of scholarly fair dealing for the purposes of research. criticism or review. In particular no results or conclusions should be extracted from it. nor should it be copied or closely paraphrased in whole or in part without the written consent of the author: Proper written acknowtedgement should be made for any assistance obtained from this thesis. Under Section 35(2) of the Copyright Act 1968'the author of a literary. dramatic. musical or artistic work is the owner of any copyright subsisting in the work'. Byvirtue of Section 32( I) copyright 'subsists in an original literary, dramatic, musical or artistic work that is unpublished' and of which the author was an Australian citizen,anAustralian protected person or a person resident inAustralia. The Act, by Section 36( I) provides: 'Subject to this Act, the copyright in a literary, dramatic, musical or artistic work is infringedby a person who, not being the owner of the copyright and without the licence of the owner of the copyright, does in Australia, or authorises the doing in Australia of, any act comprised in the copyright'. Section 31(I)(a)(i)provides that copyright includesthe exclusive right to 'reproduce the work in a material form'.Thus, copyright is infringed by a person who, not being the owner of the copyright,reproduces or authorises the reproduction of a work. or of more than a reasonable part of the work, in a material form, unless the reproduction is a 'fair dealing' with the work 'for the purpose of research or study' as further defined in Sections 40 and 41 of the Act. Section 51(2) provides that 'Where a manuscript, or a copy,of a thesis or other similar literary work that has not been published is kept in a library of a university or other similar institution or in an archives,the copyright in the thesis or other work is not infringed by the making of a copy of the thesis or other work by or on behalf of the officer in charge of the library or archives if the copy is supplied to a person who satisfies an authorized officer of the library or archives that he requires the copy for the purpose of research or study'. "Thesis' includes 'treatise', dissertation' and other similar productions. ABSTRACT This thesis investigates a range of everyday interactions of traumatic brain injury (TBI) subjects when compared with control subjects to examine whether there are differences in the overall structure of interactions, in the way information is exchanged and in the wording which is used. Analyses from systemic functional linguistics including generic structure potential analysis, exchange structure analysis and analysis of politeness markers were used to examine the interactional impairments reported to followTBI. Results indicated that TBI subjects differed from controls in their use of interpersonal language resources. These differences were exaggerated when subjects were interacting with someone in authority. When placed in a more powerful role, TBI subjects were able to utilise language resources to a similar extent to controls across the three levels of analysis. This thesis has important implications for the assessment and management of interactional communication impairments which may follow TBI, including suggestions for therapy with the person with TBI and for communication partners of people with TBI including therapists, family members and the community. II ACKNOWLEDGMENTS This thesis was originally developed from the clinical dilemma of working with TBI clients in a clinic room and translating this into the "real world". I would therefore firstly like to thank my patients with TBI and their families whom I met at the former Lidcombe Hospital Brain Injury Rehabilitation Unit for their inspiration. I would like to particularly thank Professor Chris Code and Linda Hand for their encouragement, inspiration, support and sense of humour throughout the long journey this thesis represents. Many thanks also to Dr Beth Armstrong, Dr Alison Ferguson, for their moral support, friendship and encouragement and especially to Dr Ann Packman for her detailed proofreading, guidance and friendship. This thesis would not have been possible without the assistance of a number of speech pathologists and others who have contributed to this project- These include Dr. Roger Adams, Dr Rhonda Buskell, Stacey Carter, Anne Deane, Denise Drane, Susan Grant, Sally Ieffriess, Elisabeth Harrison, Dr Adeline Hodgkinson, Belinda Kenny, Dr Skye McfIonald, Lynne Mortensen, Anne Moseley,Anne Pfaff, Kerry Plumer, Chris Sheard, joyce Smith, Amanda Wales and Robert West. I would like to thank participants of the Aphasia Study Group in Sydney who commented on earlier versions of this work. I would like to thank the following people for their insightful comments, discussions and reviews: Dr Mary Boyle,Dr jack Damico, Professor Audrey Holland, Professor Leonard (Chick) Lal'ointe, Dr Don Robin, Nina Simmons-Mackie, Dr Kathryn Yorkston and Dr Mark Y1visaker. I would like to express my gratitude to the Motor Accidents Authority of NSW particularly Anne Deanes and Kathy Hayes. Without their generous financial assistance through the Motor Accidents Rehabilitation Research Scholarship, this thesis would not have been completed in such a timely fashion. I would also like to thank the South Western Sydney Area Health Service in Sydney for the contribution of time and resources to this project, particularly from the Brain Injury Rehabilitation Unit at Liverpool Hospital and the Speech Pathology Department at Bankstown-Lidcombe Hospital. I am also grateful for financial resources from the Applied Linguistics Association of Australia who awarded me the M.A.K. Halliday Scholarship in 1993, the Graduates Association of Cumberland College of Health Sciences and the Herbert johnson Travel Grant administered through The University of Sydney. Thanks to Brenda and Kim Coffey from the Adult Development Program, Sydney for their assistance with subject recruitment, the Volunteer Centre of NSW, the Spinesafe organisation, the NSW Police Service, the State Transit Sydney Buses Info Line, the students and staff of Benilde Catholic College, Bankstown and the parents and therapists who generously allowed themselves to be taped. I would like to thank my mum, Aileen Gapes, dad, john Gapes and sister, Michelle Gapes for their tireless support and encouragement. Thanks also to my friends Kathy Begg, Fiona Cumiskey, Glenda Woodley and Lauren Pearce for their warm interest and support. Finally, I would especially like to thank my husband, Bill Togher, whose wonderful encouragement, enthusiasm, energy and celebration of all the milestones of this thesis made its completion a relatively stress free and exciting process right to the end. This thesis is dedicated to my friend, Warwick Love, who has always been a great inspiration. iii None ofthe work contained within this thesis has been submitted to any other university or institution. The conduct of this research was approved by The University of Sydney Ethics Committee (Reference numbers: 92/11/3 and 95/12/23). od~;zre-/ Leanne Togher IV Publications, conference proceedings and conference presentations arising from this thesis Publications Togher, L., Hand, L. & Code, C. (1996). A new perspective on the relationship between communication impairment and disempowennent followinghead injury in information exchanges. Disability and Rehabilitation, 18 (11), 559-566. Togher, L. (1997). Operationalizing Discourse Therapy. Aphasiology, 11(6), 621 - 625. Togher, L., Hand, L. & Code, C. (1997). Analysing discourse in the traumatic brain injury population: Telephone interactions with different communication partners. Brain Injury. 11 (3), 169-189. Togher, L., Hand, L. & Code, C. (1997). Measuring service encounters with the traumatic brain injury population. Aphasiology. 11 (4-5),491-504. Togher, L. & Hand, L. (in press) Use of politeness markers with different communication partners: An investigation of five subjects with traumatic brain injury. Aphasiology. McDonald, S., Togher, L. & Code, C. (Eds.) (in press).Communication skills after traumatic brain injury. Hove: Psychology Press. Togher, L., Hand, L. & Code, C. (in press). Exchanges of information in the talk of people with traumatic brain injury, In Communication skills following traumatic brain injury. McDonald, S., Togher, L. and Code, C. (Eds.), Hove: Psychology Press. Togher, L., McDonald, S. & Code, C. (in press). Language Impairment Following Traumatic Brain Injury. In Communication skills following traumatic brain injury. McDonald, S., Togher, L. and Code, C. (Eds.), Hove: Psychology Press. Conference proceedings Togher, L. & Hand. L. (1993). The use of exchange structure analysis with the head injury population. Proceedings of the First National Aphasiology Symposium, Sydney, Australia. Togher, L., Hand,
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