JCPSLP Vol 16 no 3 2014_FINAL_WEB

impacted upon her natural running ability because her head hurt whenever she ran. Since the injury she had doubts about her potential to be a personal trainer, saying “ It just wouldn’t work, cos I can’t do half the stuff I used to ”. Her overall school performance had deteriorated post-TBI as she struggled to keep up with her class work. Mandy experienced a change in her personality and the way that she communicated with others following the TBI. She became quieter and showed less emotion than she did pre-morbidly but felt like she had to “ act happy so people don’t think I am all weird ”. In the initial phase of rehabilitation Mandy participated in a battery of standardised language, visual perceptual and cognitive assessments, administered by the treating speech pathologist, occupational therapist and neuropsychologist. Assessment results showed that Mandy had problems with memory, planning, word-finding, using and understanding facial expression, interpreting jokes and sarcasm, attending to a topic, providing an appropriate amount of information to her listeners, and self-evaluating her communication performance. These difficulties were particularly prominent Analysis of participant interviews showed the complex and multi-faceted effects of Mandy’s social communication impairment post-TBI. Three themes emerged from the analysis of the interviews: • Theme 1: “Half the time they don’t even know what I’m on about” relates to people not comprehending Mandy; • Theme 2: “When they say a joke I click to it a couple of days later” focuses on Mandy’s struggle with high level language comprehension (e.g. difficulties understanding figurative language); • Theme 3: “I can just look in her eyes and go ‘All right, should we not talk to you today?’” presents strategies used by Mandy and others to reduce the potential for communication breakdown. Theme 1: “Half the time they don’t even know what I’m on about” Mandy’s TBI had affected her ability to express meaning clearly to others, which led to communication breakdown. Difficulty conveying her message stemmed from a number of cognitive-linguistic deficits such as: planning and word-finding difficulties, becoming tangential, and providing insufficient information. While these difficulties were evident on formal assessments conducted by the rehabilitation team prior to this study, observations during the interviews, and reports from the interview participants throughout the data collection phase confirmed the persistent nature of these communication difficulties. Mandy stated that her friends commented that her unsuccessful communication attempts were similar to her speaking in another language: Interviewer: How do your friends react to that? Mandy: “Can you speak English?” That’s what they say to me! According to Grice’s maxim of relation (Grice, 1975; Kleinke, 2010), all communication partners are responsible for establishing shared meaning; however, Mandy indicated that her listeners did not give timely input when she had difficulty planning what she wanted to say. She indicated that her friends were unable to suggest words that they thought she might be looking for, because “ half the time when Mandy was tired or had a headache. Findings and discussion

they don’t even know what I am on about ”. The fact that Mandy required more time to plan her contributions to conversations meant that the timing of her input sometimes confused her audience: Mandy: They’ll be talking about something and then they’ll be talking about something different and cos I take ages to think of what I have to say, I just say it and they’ll go “That was ages ago”. Vivienne: Mmmmm. We were discussing that ten minutes ago. Mandy’s tendency to become tangential in conversation reflected a common consequence of TBI (Bogart et al., 2012). In contrast with Grice’s (1975) maxims of effective communication, Mandy’s irrelevant contributions hindered the information exchange as her communication partners had difficulty deciphering her meaning. Since cohesion within discourse is expected most of the time in typically developing teenagers (Ciccia & Turkstra, 2002), Mandy’s failure to make clear links within her conversation may have led to perceptions from her communication partners that she was an ineffective communicator (Sim, Power, & Togher, 2013). For example, Vivienne commented that “ She does get distracted on the simplest things – she [will] start telling you something else and you think ‘Hang on…why have you changed? ’”, indicating that Mandy got distracted and was prone to changing the topic without warning. Vivienne stated that Mandy did not always give sufficient detail when talking to someone and that Mandy did not recognise the discrepancy between her own level of background knowledge on the topic and that of her listeners. She described the feeling of waiting for Mandy to provide more detail in order to clarify her meaning: “ She stops [talking] and you go ‘What were you talking about?’ and you’re supposed to know exactly [what she means] and she goes ‘You know! Bla-bla-bla ’.” Consequently, Mandy deviated from Grice’s (1975) conversational maxim of quantity because she did not give all the information required. This potentially led to communication breakdowns and reduced satisfaction for conversation participants. In addition, Vivienne described how Mandy’s facial expression was sometimes incongruous with the tone of the message she was conveying, thus transmitting ambiguous meaning: “ She’s trying to say something upbeat but her face is screwed up […] I’m thinking, ‘What? ’” Mandy confirmed that the contradiction between her facial expression and message could have been due to the effort she had to apply when concentrating on what she was saying. However, she was possibly unaware of how she portrayed herself to others. The mismatch between Mandy’s words and emotion was also a violation of Grice’s maxim of manner (Grice, 1975; Kleinke, 2010), and this could further contribute to communication breakdown. Theme 2: “When they say a joke I click to it a couple of days later” In addition to confusing her communication partners with her expressive impairment, Mandy had difficulty understanding non-literal or affective meaning conveyed by others. For example, Mandy was unsure about the potential meaning of the facial expression of her communication partners: Mandy: You’re death-staring me. Vivienne: No I didn’t. Mandy: She’s looking at me like “You weirdo”.

129

JCPSLP Volume 16, Number 3 2014

www.speechpathologyaustralia.org.au