# Remediating narrative discourse impairments in veterans with TBI: Initial treatment development

> **NIH VA IK2** · VA CONNECTICUT HEALTHCARE SYSTEM · 2022 · —

## Abstract

Cognitive-communication disorders are pervasive following TBI, disrupting communication at the level of
discourse (meaningful language beyond sentence level) and social interaction. Discourse impairments impact
functioning across major life domains. Research consistently shows that people with discourse impairments
following TBI have difficulty securing and maintaining work, struggle with social relationships, experience social
isolation, and report a decline in quality of life. Moreover, discourse impairments affect all severity levels of TBI
and persist over time. The functional impact and chronicity of discourse impairments following TBI underscore
the importance of treating these impairments.
 The overarching goal of this CDA-2 application is to prepare the candidate for a career in cognitive-
communicative interventions research to address discourse impairments in TBI. The aims of the proposed
project are to develop and trial a discourse treatment for veterans with TBI. Training goals for the project are
to: 1) develop expertise in treatment development, 2) strengthen background in TBI-related comorbidities, 3)
expand knowledge of telerehabilitation and computer-aided delivery, 4) develop expertise in conducting
randomized clinical trials (RCTs) of behavioral interventions, including statistical and methodological
approaches, and 5) further scientific writing, presentation skills, and grantsmanship.
 Narratives are a fundamental discourse genre embedded in daily conversation. Breakdowns at global
levels of narrative discourse are a consistent finding in people with TBI and are apparent at the level of story
content and story organization. Impairments in story content include deficiencies in completeness and
accuracy of information, global coherence, and summarization. Impairments in story organization include
reductions in story grammar elements, sequences of events (episodes) and proportion of the narrative
organized by episodes.
 Discourse intervention in TBI is a nascent area of research, and, to date, there have been only a few
studies that have attempted to improve discourse ability in TBI. These prior attempts have been small case
studies, produced no change or limited gains, and did not include veterans with TBI. The proposed project is
an early stage discourse treatment development study that will evaluate the feasibility of a novel narrative
discourse treatment protocol that builds upon these prior attempts with an all-veteran participant sample.
 The first phase of the study will consist of initial manual development for the discourse treatment protocol
and refinement with a small participant sample (5-10 participants). The protocol will incorporate elements from
prior treatment studies that showed some promise: 1) hierarchical training, 2) variety of discourse stimuli, 3)
development of skills and strategies for discourse processing, 4) structured training prompts, 5) meta-cognitive
and meta-linguistic strategies, and 6) integrati...

## Key facts

- **NIH application ID:** 10311590
- **Project number:** 1IK2RX003494-01A2
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Karen Le
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10311590

## Citation

> US National Institutes of Health, RePORTER application 10311590, Remediating narrative discourse impairments in veterans with TBI: Initial treatment development (1IK2RX003494-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10311590. Licensed CC0.

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