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Treatment of Metaphor Interpretation Deficits Subsequent to Traumatic Brain Injury

Brownell, Hiram PhD; Lundgren, Kristine ScD; Cayer-Meade, Carol MS; Milione, Janet MEd; Katz, Douglas I. MD; Kearns, Kevin PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: November/December 2013 - Volume 28 - Issue 6 - p 446–452
doi: 10.1097/HTR.0b013e31825b5e85
Original Articles

Objective: To improve oral interpretation of metaphors by patients with traumatic brain injury (TBI).

Design: Both single subject experimental design and group analysis.

Setting: Patients’ homes.

Participants: Eight adult patients with moderate to severe traumatic brain injury sustained 3 to 20 years before testing.

Intervention: The Metaphor Training Program consisted typically of 10 baseline sessions, 3 to 9 1-hour sessions of structured intervention, and 10 posttraining baseline sessions. Training used extensive practice with simple graphic displays to illustrate semantic associations.

Main Outcome Measures: Quality of orally produced metaphor interpretation and accuracy of line orientation judgments served as dependent measures obtained during baseline, training, posttraining, and at a 3- to 4-month follow-up. Untrained line orientation judgments provided a control measure.

Results: Group data showed significant improvement in metaphor interpretation but not in line orientation. Six of 8 patients individually demonstrated significant improvement in metaphor interpretation. Gains persisted for 3 of the 6 patients at the 3- to 4-month follow-up.

Conclusion: The Metaphor Training Program can improve cognitive-communication performance for individuals with moderate to severe traumatic brain injury. Results support the potential for treating patients’ residual cognitive-linguistic deficits.

Boston College, Chestnut Hill, Massachusetts (Dr Brownell); Boston University School of Medicine, Boston, Massachusetts (Drs Brownell, Lundgren, and Katz and Mss Cayer-Meade and Milione); VA Boston Healthcare System, West Roxbury, Massachusetts (Drs Brownell and Lundgren and Mss Cayer-Meade and Milione); The University of North Carolina at Greensboro, Greensboro (Dr Lundgren); Braintree Rehabilitation Hospital, Braintree, Massachusetts (Dr Katz); and State University of New York at Fredonia, Fredonia, NY (Dr Kearns).

Corresponding Author: Hiram Brownell, PhD, Department of Psychology, Boston College, Chestnut Hill, MA 02467 (

Portions of this work were presented at the Clinical Aphasiology Conference, Isle of Palms, South Carolina, May 2010.

The study was supported by the National Institute of Deafness and Other Communication Disorders grants R21 DC007165, P30 DC05432, and RO1 DC0520702 as well as the Research Service of the Boston VA Healthcare System.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins