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Abstracting meaning from complex information
(gist reasoning) in adult traumatic brain injury
Asha Kuppachi Vas
a
, Jeffrey Spence
a
& Sandra Bond Chapman
a
a
Center for BrainHealth®, The University of Texas at Dallas, Dallas, TX, USA
Published online: 30 Jan 2015.
To cite this article: Asha Kuppachi Vas, Jeffrey Spence & Sandra Bond Chapman (2015): Abstracting meaning
from complex information (gist reasoning) in adult traumatic brain injury, Journal of Clinical and Experimental
Neuropsychology, DOI: 10.1080/13803395.2014.994478
To link to this article: http://dx.doi.org/10.1080/13803395.2014.994478
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Abstracting meaning from complex information
(gist reasoning) in adult traumatic brain injury
Asha Kuppachi Vas, Jeffrey Spence , and Sandra Bond Chapman
Center for BrainHealth®, The University of Texas at Dallas, Dallas, TX, USA
(Received 8 Augu st 2014; accepted 29 November 2014)
Gist reasoning (abstracting meaning from complex information) was compared between adults with moderate-to-
severe traumatic brain injury (TBI, n = 30) at least one year post injury and healthy adults (n = 40). The study also
examined the contribution of executive functions (working memory, inhibition, and switching) and memory
(immediate recall and memory for facts) to gist reasoning. The correspondence between gist reasoning and
daily function was also examined in the TBI group. Results indicated that the TBI group performed significantly
lower than the control group on gist reasoning, even after adjusting for executive functions and memory.
Executive function composite was positively associated with gist reasoning (p < .001). Additionally, performance
on gist reasoning significantly predicted daily function in the TBI group beyond the predictive ability of executive
function alone (p = .011). Synthesizing and abstracting meaning(s) from information (i.e., gist reasoning) could
provide an informative index into higher order cognition and daily functionality.
Keywords: Abstraction; Adults; Cognition; Cognitive processes; Executive function; Functional outcomes; Gist;
Healthy; Reasoning; Traumatic brain injury.
One essential skill that allows an individual to
effectively understand and absorb complex and
lengthy information is the inherent ability to
abstract core meaning(s) (Gabrieli, 2004).
Abstracting meanings is achieved by ignoring less
relevant details, focusing on important informa-
tion, and drawing upon our experiences and
knowledge to construct generalized ideas
(Chapman, 1995; Ulatowska & Chapman, 1994).
Abstracting meanings represents a complex inte-
grative function that is ubi quitous in everyday
life. Healthy adults typical ly are able to engage in
abstracting meaning with relative ease. In contrast,
little is known about the degree to which a trau-
matic brain injury (TBI) in adulthood affects the
critical everyday life skill of abstracting meaning(s)
from massive information to whic h one is exposed.
A TBI affects one’s ability to effectively manip-
ulate and organize information. Specifically, mod-
erate-to-severe TBI can affect recall of details from
paragraph-level information and/or word-lists, and
organization of information (Coelho, Youse, Le, &
Feinn, 2003; Ferstl, Walther, Guthke, & von
Cramon, 2005; Hartley & Jensen, 1991; Holliday,
Hamilton, Luthra, Oddy, & Weekes, 2005; Hough
& Barrow, 2003; Nicholas & Brookshire, 1995).
Whereas paradigms that examine recall and orga-
nization of information are informative, such
methodologies fall short in examining the level to
which one is able to derive and convey deeper level
meanings (e.g., abstracted meanings) from a wide
variety of information sources including talks,
newspaper articles, works of art, movies, and
legal documents, to mention a few (Chapman,
1998). Perhaps abstract thinking impairments,
amongst other factors, could exp lain the dichot-
omy documented in standard TBI assessments of
near normal performance on traditional cognitive
testing, yet reporting significant difficulties in com-
plex daily life tasks. Therefore, Chapman and col-
leagues proposed a cognitive construct that
examines how one extracts and conveys meanings
from information, an ability referred to as gist
reasoning. Gist reasoning is defined as the ability
Address correspondence to: Asha K. Vas, Center for BrainHealth®, The University of Texas at Dallas, 2200 W Mockingbird Lane,
Dallas, TX-75235, USA (E‑mail: asha.vas@utdallas.edu).
Journal of Clinical and Experimental Neuropsychology, 2015
http://dx.doi.org/10.1080/13803395.2014.994478
© 2015 Taylor & Francis
Downloaded by [The University of Texas at Dallas] at 10:40 09 February 2015
to synthesize complex information, whether writ-
ten, auditorily presented, or visually depicted, into
abstracted meanings that are not explicitly stated
(Chapman, 1995). The gist reasoning construct has
been employed to characterize abstraction abilities
in both healthy adults and clinical populations
including adults with strok e, right-hemisphere
brain damage, and mild cognitiv e impairment,
adolescents with attention deficit hyperactivity dis-
order, and youth with TBI (Ulatowska, Allard, &
Chapman, 1990; Ulatowska, Chapman, Highley,
& Prince, 1998; Chapman et al., 2002; Gamino &
Chapman, 2009; Gamino, Chapman, & Cook,
2009; Glosser & Deser, 1991). Evidence also sug-
gests that adults with TBI who sustain their inju-
ries in adolescence have gist reasoning deficits that
persist years post injury despite recovery to rela-
tively normal levels of performance on daily living
activities (Vas & Chapman, 2012).
No known study to date has examined the
impact of moderate-to-severe TBI on gist reason-
ing in adults who sustained a brain injury in adult-
hood, one year or longer prior to assessment. The
current study examined three questions to advance
our empirical knowledge regarding the effects of
TBI on gist reasoning. First, the study compared
gist reasoning performance betwee n adults with
TBI and healthy adults (control group). Second,
the study examined the contribution of executive
functions and memory to gist reasoning. Third, the
relation between gist reasoning and performance
on daily-life tasks was examined in the TBI group.
We hypothesized lower performance on gist rea-
soning in the TBI group than in the control group.
We predicted significant c ontribution of executive
functions over and above that of memory to gist
reasoning. We also hypothes ized that gist reason-
ing would predict daily function in the TBI group.
METHOD
Participants
Participants included seventy adults: 30 adults (out
of 32 recruited) with TBI and 40 healthy adults
(control group); all between 25–55 years of age at
testing. The TBI group included participants in
chronic stages of recovery (at least one year post
injury), who sustained a moderate-to-severe TBI
(Glasgow Coma Scale, GCS, <12 at the time of
injury) at or after the age of 18 (Teasdale, Jennett,
Murray, & Murray, 1983). All participants were
native English speakers with (a) minimum high-
school education, at least 8th-grade equivalency
on vocabulary and read ing comprehension as gist
reasoning measure involves reading lengthy infor-
mation, (b) IQ of 85 or above, as lower intellectual
abilities could contribute to variance in processing
information in gist reasoning task (Table 1).
Exclusion criteria for both groups (TBI and con-
trol) included previous history of stroke, learning
disability, substance abuse, and major psychiatric
disorders as determined by phone screening with
the participant. Participants with significant vision
and hearing problems were not included in the
study as the experimental procedures involved
reading and processing auditorily presented
TABLE 1
Demographic and clinical characteristics of TBI and control group
Variables TBI (n = 30) Control (n = 40) ES t(68)
Age at testing (years) 38.53 ± 9.91 37.67 ± 10.58 0.18 0.34 ns
Premorbid estimate verbal IQ (WTAR) 113.4 ± 8.72 116.2 ± 7.94 0.34 –1.43 ns
Current IQ (WASI) 109 ± 13.62 112.9 ± 11.39 –0.25 –1.46 ns
Education 15.43 ± 1.75 15.52 ± 1.79 –0.05 –0.21 ns
SES (BSMSS) 43.39 ± 5.66 45.4 ± 8.26 –0.28 –0.92 ns
Reading grade (WRAT) 12.28 ± 1.17 12.51 ± 1.05 –0.2 –0.86 ns
Processing speed
CW-1,2 SS (D-KEFS) 9.61 ± 2.22 10.51 ± 1.82 –0.44 –1.85 ns
Trails-A 28.83 ± 11.30 25.62 ± 6.5 0.34 1.49 ns
Hayling-A 5.86 ± .57 6.00 ± .59 –0.24 –0.94 ns
Additional characteristics of TBI group
GCS 5.3 ± 3.08 __ __ __
Age at TBI 28.8 ± 9.43 __ __ __
Years since TBI 9.8 ± 8.83 __ __ __
Note. TBI = traumatic brain injury; ES = effect size; ns = group differences were not significant; WTAR = Wechsler Test of Adult
Reading; WASI = Wechsler Abbreviated Scale of Intelligence; SES = socioeconomic status; BSMSS = Barratt Simplified Measure of
Social Status; WRAT = Wide Range Achievement Test; CW-1,2 = Color–Word Interference Test, Tasks 1 and 2; SS = scaled score;
D-KEFS = Delis–Kaplan Executive Function System; GCS = Glasgow Coma Scale. The TBI group consisted of 18 males and 12
females. The control group consisted of 20 males and 20 females.
2 VAS, SPENCE, CHAPMAN
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information. Participants with significantly
impaired processing speed (two standard devia-
tions below the respective group average) exam-
ined on measures of the Delis–Kaplan Executive
Function System (D-KEFS) Color–Word
Interference Tasks 1 and 2 (Delis, 2001), Trails-
A, (Reitan & Wolfson, 1995), and Hayling
Sentence Completion Task–1 (Burgess & Shallice,
1997) were not included in th e study as processing
speed could confound gist reasoning performance
(Felmingham, Baguley, & Green, 2004).
Information on education and socioeconomic sta-
tus was also collected as these factors could influ-
ence complex cognition including reading skills
during gist reasoning (Coelho, 2002).
Socioeconomic status was evaluated on the
Barratt Simplified Measure of Social Status
(Barratt, 2005). Both the TBI and control group
were recruited from the Dallas metroplex area.
Recruitment of both TBI and the control group
were done with flyers posted at the center and by
contacting participants who had previously
expressed interest in the center’s research studies.
Two TBI participants were not included in the
study as their reading grade and IQ did not meet
the inclusion criteria. Informed consent obtained
from all participants was in approval and acco r-
dance with the guidelines of the Ins titutional
Review Board of The University of Texas at
Dallas and The University of Texas Southwestern
Medical Center.
Measures
Gist reasoning was examined using the Test of
Strategic Learning (TOSL; Chapman, Gamino, &
Cook, under review). The TOSL measure consists
of three texts designed to examine two compo-
nents: (a) how one constructs generalized/gist
meanings from lengthy information (i.e., gist rea-
soning) and (b) number of details recalled (i.e.,
memory for details). The three texts vary in length
(from 291–575 words) and complexity. For the gist
reasoning component of each text, the participant
is asked to construct a gist-based overview/synopsis
of ideas that are not explicitly stated in the text. An
example of a gist-based overv iew/synopsis is first
illustrated to clarify that the task entails combining
and synthesizi ng the explicit details in the text to
construct generalized ideas. The participant is pro-
vided with a copy of the text to follow along as the
examiner reads each text aloud. After the examiner
finishes reading the text, the par ticipant’s copy is
taken away so that the participant does not have
the option to refer to the original text while
providing his or her abstracted ideas in the form
of a written overview/synopsis. Prior work has
demonstrated that individuals are less likely to
abstract meaning when the literal information
remains in front of them (Chapman, Ulatowska,
King, Johnso n, & McIntire, 1 995). The TOSL has
demonstrated test–retest reliability and is validated
as a measure of ability to abstract meaning from
complex information in typically developing youth
(Gamino et al., 2009), in healthy adults (Anand
et al., 2010), in children with TBI (Cook,
Chapman, & Gamino, 2007), and in adults with
TBI (Vas, Chapman, Cook, Elli ott, & Keebler,
2011). The TOSL measure has a manualized objec-
tive scoring system wherein each abstracted gist-
idea receives one point. A total composite of 38
points is possible for the three overviews/synopses
of the three texts. Two trained examiners blinded
to the participants’ group status scored the over-
views/synopses for gist-based meanings. Interrater
reliability of scores assessed on intraclass correla-
tion coefficients in both groups for gist reasoning
performance was over 90% (Cronbach’s α range
.86–.99; confidence interval, CI .76–.98). For the
memory for details component, each participant is
asked a set of questions that elicit memory for
factual details of the texts.
Executive functions were measured using tests of
working memory, inhibition, and switching.
Memory function was examined on measures of
immediate recall and memory for facts. Two reli-
able and valid measures were chosen to examine
performance for each of the functions of working
memory, inhibitio n, switching, immediate recall,
and memory for facts (see Table 2 for description
of measures). Daily-life function in the TBI group
was examined on three self-r eported functional
measures, including Glasgow Outco me Scale–
Extended (GOS–E, Wilson, Pettigrew, &
Teasdale, 1998), Functional Status Examination
(FSE, Dikme n, Machamer, Miller, Doctor, &
Temkin, 2001),
and Community Integration
Questionnaire (CIQ, Willer, Ott enbacher, &
Coad, 1994; see Tabl e 2 for description of mea-
sures, and Table 3 for daily function status). Each
of these functional measures has been validated
and used extensively in characterizing daily-life
functioning in adults with TBI (Hudak et al.,
2005; Shukla, Devi, & Agrawal, 2011).
Overview of statistical analyses
Descriptive analyses examined distribution pat-
terns of participant characterization variables of
age at testing, IQ, education , socioeconomic status,
GIST REASONING IN ADULT TBI 3
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reading proficiency, and speed of processing as
these variables could influence gist reasoning per-
formance. A standardized z score was derived for
all the individual measures including gist reason-
ing, working memory, inhibiti on, switching,
immediate recall, memory for facts, and daily func-
tion (TBI group) as the current measures involved
a combination of standardized and experimental
measures with varied scales of performance. An
executive function composite score was derived
by averaging the z scores of each of the individual
measures of working memory, inhibition, and
switching. Similarly, memo ry composite score was
the z score average of immediate recall and
TABLE 2
Description of cognitive process measures
Variable Measure Description Scoring
Working memory WAIS–III Digit Backward Orally recall number strings read aloud in backward
order
14 total points possible
Listening Span (Daneman
& Carpenter, 1980)
Participant recalls the last word of sentences followed
by answering questions related to the sentence.
1–7
Inhibition D-KEFS, CW inhibition
task–3
Name the color of ink a word is printed in versus
reading the word (word color spellings are always
incongruent with color of ink)
Total time to complete the
task + the number of
errors.
Hayling sentence
completion test
Orally complete a set of sentences in which the last
word is missing. Specifically, complete the
sentences with an unrelated word that does not fit
within the context of the sentence.
Total time to complete the
sentences + number of
errors (completing the
sentence with a word
that fits within the
context of the sentence).
Switching Trails B Alternately connect a set of numbers and alphabets in
a certain sequence.
Total time to successfully
complete the task.
D-KEFS Category
Switching
Verbally produce as many names of fruits and
furniture by alternating between the categories.
Number of successful
switches between the
categories in 60 seconds.
Immediate recall WAIS–III Digit Forward Oral recall of number strings 0–16
WMS–IV Logical
Memory
Oral recall of two short stories read aloud one at a
time.
0–50
Memory for details
(2 subtests)
TOSL Question probes of specific details and explanations
of key information in the texts.
0–48
Probe example (specific detail): What happened to
John’s career as a teacher?
Probe example (explanation): Why did John feel like
a failure?
Daily function GOS–E Gross outcome measure that tracks degree of
functional recovery with broad functional
categories
2–8
FSE Tests 10 functional categories including personal care,
mobility/ambulation, travel, work and/or school,
leisure and recreation, home management, social
integration, cognitive and behavioral competency,
standard of living, and financial independence.
10–40
CIQ Provides a general overview of an individual’s
functioning based on responses to 15 questions
related to participation in activities at home, social,
and education or vocation settings.
0–29
Note. WAIS = Wechsler Adult Intelligence Scale (Wechsler, 1981); D-KEFS = Delis–Kaplan
Executive Function System; CW =
Color–Word Interference Test; WMS = Wechsler Memory Scale (Wechsler, 2002); TOSL = Test of Strategic Learning; GOS–E=
Glasgow Outcome Scale–Extended; FSE = Functional Status Examination; CIQ = Community Integration Questionnaire.
TABLE 3
Daily function status in the TBI group
Measures Mean SD Range 95% CI
GOS–E 5.9 0.95 4–8 [5.54, 6.25]
FSE 19.7 5.26 8–31 [17.73, 21.66]
CIQ-composite 17.7 6.12 7–29 [15.47, 20.05]
CIQ-H 6.26 2.57 2–10 [5.30, 7.22]
CIQ-S 7.73 2.82 3–12 [6.67, 8.78]
CIQ-P 3.76 2.19 0–7 [2.94, 4.58]
Note. TBI = traumatic brain injury; CI = confidence inter-
val; CIQ = Community Integration Questionnaire; CIQ-H =
CIQ home integration ; CIQ-S = CIQ social integration; CIQ-P
= CIQ productivity; GOS–E = Glasgow Outcome Scale–
Extended; FSE = Functional Status Examination.
4 VAS, SPENCE, CHAPMAN
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memory for facts. The daily function composite
(TBI group) was the average z score of the three
functional measures. A z score composite allows
scores across individual measures that have differ-
ent scales to be combined for analyses and to
improve statistical power for analyses that have
small sample size (Curtiss, Vanderploegg,
Spencer, & Salazar, 2001; Hart, Whyte, Kim, &
Vaccaro, 2005; Kim et al., 2005).
Gist reasoning performance was assessed by a
standard general linear model (GLM) in SPSS
(Stern, 2009). The GLM included group ind icators
(TBI and the control group), the executive function
composite, the memory function composite, and
the interaction between each of the executive and
memory function composites with group.
Additionally, a reduced GLM assessed the relative
contribution of each of the executive and memory
function composites (including their respective
interactions) on gist reasoning and difference in
gist reasoning between the TBI and control groups.
Full and reduced GLMs were hierarchical so that
each covariate in the model could be tested by the
principle of conditional sums of squares.
A separate GLM assessed the relative impor-
tance of gist reasoning, executive function, and
memory on predicting daily function scores in the
TBI group. As above, these GLMs were hierarch-
ical to test each separately and to test each in the
presence of the others. Thus, the best predictor
(gist reasoning, executive function, or memory) of
daily function was derived.
RESULTS
Independent-sample t tests demonstrated no signif-
icant differences between the TBI group and con-
trol group on participant characterization variables
of age, education, socioeconom ic status, IQ, and
reading comprehension (Table 1). Performance on
gist reasoning, executive functions, memory, and
daily function (TBI group) was normally distribu-
ted in both TBI and control groups.
Gist reasoning: Group differences and
contributive factors
The TBI group had significantly lower gist reason-
ing performance than the control group (Tabl e 4)
despite comparable education, IQ, reading com-
prehension, and speed of processing (Table 1).
With regard to the contributive factors to gist rea-
soning, executive function explained a significant
proportion (36%) of the variance in gist reasoning
z scores, F(2, 64) = 10.03, p < .001 (see Table 5).
In contrast, the memory composite did not signifi-
cantly contribute to any of the variance in the gist
reasoning z scores, F (2, 64) = 0.853, p = .431.
Therefore, group differences in gist reasoning was
assessed using the reduced GLM that contained
only the executive function composite and its inter-
action with group.
The reduced GLM determined that only the
linear term, rather than the interaction coefficient,
of the executive function composite significantly
predicted gist reasoning. That is, there was a sig-
nificant positive association between executive
function and gist reasoning, t(66) = 4.73, p <
.001, and this association did not differ between
the TBI and control groups, t(66) = 0.04, p = .963.
However, even after account ing for the positive
association between exec utive function and gist
reasoning, the TBI group maintained a signifi-
cantly lower gist reasoning score than the control
group, t(66) = –2.40, p = .019.
TABLE 4
Performance on gist reasoning, executive functions, and memory
Variables Measures TBI (n = 30) Control (n = 40) ES F(1, 68)
Gist reasoning TOSL 11.43 ± 7.65 21.10 ± 7.04 –1.3 30.00***
Working memory Digit Backward 6.26 ± 2.13 7.47 ± 2.48 –0.52 4.57*
Listening Span 2.8 ± 1.22 4.08 ± 1.14 –1.08 20.50***
Inhibition Color–Word–3 8.03 ± 3.46 10.78 ± 1.87 –0.98 18.14***
Hayling 4.81 ± 1.73 6.1 ± 0.89 –0.93 16.15***
Switching Trails-B 86.1 ± 49.16 55.57 ± 23.42 0.79 11.87**
Category Switching 10.93 ± 2.83 13.95 ± 3.37 –0.97 15.62***
Immediate recall Digit Forward 10.13 ± 1.99 11.3 ± 2.37 –0.54 4.74*
Logical Memory 9.16 ± 3.83 11.82 ± 3.6 –0.71 8.83**
Memory for facts
a
TOSL 36.33 ± 7.34 41.65 ± 3.69 –0.91 15.73***
Note. TBI = traumatic brain injury; TOSL = Test of Strategic Learning; ES = Cohen’s d effect size; ns = group differences were not
significant.
a
Sum of two subtests.
*p < .05. **p < 01. ***p < .001.
GIST REASONING IN ADULT TBI 5
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Association of gist reasoning, execut ive
function, and memory with daily function in
the TBI group
Significant positive relations were found between
gist reasoning and each of the self-reported func-
tional measures of CIQ (r = .54, p < .01), FSE (r =
.66, p < .001), and GOS–E(r = .48, p < .01) in the
TBI group. As hypothesized, positive relation was
found between gist reasoning and composite of the
three functional measures(r = .67, p < .01).
Stepwise variable selection, through hierarchical
GLM, revealed that the memory composite did
not significantly predict daily function in the pre-
sence of the executive function composite and gist
reasoning scores, t(26) = 1.70, p = .101. However,
both executive function and gist reasoning were
important predictors of daily function in the TBI
group. Alone, the executive function composite
was significantly positively associated with daily
function, F(1, 28) = 22.671, p < .001, and
explained 34% of the variance in daily function.
Gist reasoning contributed an additional 16% of
the predictive value of daily function beyond that
explained by executive function, F(1, 27) = 7.45,
p = .011. In fact, the predictive value of gist rea-
soning was even higher (p < .001) when an outlier
participant was excluded from the analyses. The
outlier participant had exp erienced a significant
life event a few weeks prior to the assessment that
temporarily affected his ability to participate in
significant number of daily life functions. The out-
lier participant’s performance on other measures,
including gist reasoning, executive function, and
memory, was within range of the TBI group
performance.
DISCUSSION
The discussion focuses on three significant findings
in the study . First, the study provided new evi-
dence that gist reasoning was lower in adults with
moderate to severe TBI than in healthy controls,
even after accounting for the influence of executive
function on gist reasoning. Second, the study
extended prior evidence of a significant positive
relation between gist reasoning and executive
function as compared to memory for both healthy
controls and TBI. Third, the study demonstrated a
significant contribution of gist reasoning, beyond
that of executive function, to the prediction of
scores obtained from widely used self-reported
measures of daily function.
Gist reasoning: Complex cognitive function
In the curren t study, the majority of the TBI group
had considerable difficulty in transforming the
details into abstracted meanings. For example,
one of the three texts explains the journey of a
noble man who valued societal welfare over his
own, which led to several job losses and limited
monetary gains. One of the ideas commonly
expressed by a majority of the TBI group partici-
pants was that the character “held various jobs as
he was not satisfied with any job.” This type of
response conveys important details (i.e., moving
from one job to another), but fails to integrate
explicit ideas to form abstracted/generalized mean-
ings. In contrast, a majority of the control group
conveyed abstracted themes of compassion and
service dedicated to a higher cause of equality
and justice (see Appendix).
The finding of lower gist reasoning extends prior
evidence in adolescents with moderate-to-severe
TBI and adults with TBI injured in adolescence
who nonetheless showed return of normal to
near-normal cognition on standardized IQ mea-
sures, vocabulary, and reading levels (Gamino
et al., 2009; Vas & Chapman, 2012). Gist reason-
ing impairments in individuals who sustained a
TBI during adolescence is postulated to correlate
with the disruption of the frontal myelination that
could affect development of higher order cognitive
skills including gist reasoning (Chapman et al.,
2006; Chapman & Mckinnon, 2000). All the TBI
participants in the current study sustained their
injuries at or later than the age of 18, yet a major-
ity of them had significant gist reasoning difficul-
ties as compared to the control group.
The combined evidence of gist reasoning impair-
ments in (a) adolescents with TBI, (b) adults who
sustained a TBI in preteen and teenage years, and
(c) adulthood TBI (current study) suggests that a
TBI can have a lasting detrimental impact on the
ability to abstract meanings (as compared to the
control group), despite no measureable difficulty in
comprehending the literal content at word and
sentence levels. In the curren t study, the TBI parti-
cipants’ word and sentence comprehension was
comparable to that of the control group as mea-
sured on the Wide Range Achievement Test
TABLE 5
Gist reasoning: Contributive factors
Variables F(2, 64) p
Executive functions 10.03 <.001
Memory 0.853 .431
6 VAS, SPENCE, CHAPMAN
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(Wilkinson & Robertson, 2006). Additionally, esti-
mates of premorbid verbal intellectual abilities
(Wechsler Test of Adult Reading; Wechsler,
2001) and current IQ (Wechsler Abbreviated
Scale of Intelligence; Wechsler, 1999) of the TBI
group were comparable to those of the control
group (Table 1). Thus, gist reasoning performance
may provide a window into complex cognitive
ability that is often not detected on standard TBI
clinical care assessments. Furthermore, examining
an individual’s ability to integrate details into gen-
eralized/abstract meanings could not be more apt
and timely. In this age of information overload,
adults are continually bombarded with informa-
tion from multiple sources (e.g., news stories, lec-
tures, conversations) and modalities (e.g., written,
verbal, visual). Successful navigation through this
data deluge is difficult for many healthy adults, but
perhaps even more challenging for adults with TBI
with persiste nt cognitive deficits. As a result, indi-
viduals with a history of TBI may be particularly
vulnerable to becoming quickly fatigued by infor-
mation overload despite understanding all the indi-
vidual information elements.
Gist reasoning and executive funct ions
The second major finding was a significant relation
between performance on gist reasoning and execu-
tive function. The positive relation between gist rea-
soning and executive function supports prior
imaging evidence implicating the supportive role of
frontal lobe mediated executive functions in com-
plex cognitive task performance in healthy and TBI
populations (Chambers et al., 2006; Elliott, 2003;
Smith & Jonides, 1999; Stuss & Levine, 2002). In
healthy adults, researchers found significant contri-
butions of working memory, inhibition, and switch-
ing in performing complex tasks such as the
Random Number Generation and Tower of Hanoi
(Miyake et al., 2000). In adults with TBI, researchers
reported correspondence between executive func-
tions (e.g., working memory and inhibition) and
organization of details and recognition of implied
meanings from segments of paragraphs (Coelho,
2002; Ferstl et al., 2005; Hough & Barrow, 2003).
That is, executive functions assist in regulating and
coordinating goal-directed behavior by enabling
appropriate selection and updating to complex task
performance. Therefore, it is vital to characterize
higher order cognition that draws upon integrative
abilities versus specific cognitive processes in com-
prehensive TBI assessment. Chapman and collea-
gues propose gist reasoning as a top-down
functionally relevant cognitive construct that entails
strategically inhibiting less relevant information,
integrating relevant information with past knowl-
edge and experience to form generalized ideas, and
flexibly examining the information and/or problem
from different perspectives (Anand et al., 2010;
Gamino et al., 2009; Vas et al., 2011).
Gist reasoning and daily function
Perhaps one of the most important findings of the
study is the positive relationship between gist rea-
soning and a wide range of self-reported functional
measures. The predictive value of gist reasoning
highlights the ecological relevance of characterizing
the ability to abstract meanings from complex infor-
mation. That is, the gist reaso ning (amongst other
metrics) could serve as a performance index to pre-
dict and capture a broad range of daily life skills
following a TBI. Gist reasoning impairments could
reflect impairments in flexible and innovative think-
ing and may hinder optimal daily life functioning,
including job performance and social fu nctioning.
Limitations and future directions
The current findings, while promising, require
further validation to address at least five limita-
tions. First, although initial severity of the injury
per GCS records was obtained in the current TBI
sample, history of radiological findings to establish
degree and location of neural damage was not
collected due to limited access to medical records.
Secondly, the contribution of participants’ current
medication (if any) to cognitive performance was
not examined. Information on radiological history
and current medication use could improve partici-
pation characterization and inform the relation
between degree of neural damage and cognitive
performance. Third, participants had no access to
texts while writing the gist-based summaries. It is
plausible that individuals with TBI may have diffi-
culty in abstracting meanings from texts with lim-
ited memory of details. Therefore, future studies
should consider providing the texts while writing
gist-based summaries. The fourth limitation is the
use of self-rated questionnaires to examine func-
tional status. Information from family, caregivers,
and employers (if possible) would corroborate the
accuracy of the responses on the functional ques-
tionnaires. Comparing gist reasoning performance
with naturalistic or real-world tasks (tasks done in
real tim e versus self-reports) could help strengthen
the ecological validity of gist reasoning. Imaging
methodologies could also improve our understand-
ing of neural processes, which may guide
GIST REASONING IN ADULT TBI 7
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development of brain biomarkers of frontal lobe
integrity. Fifth, we realize that the sample size is
relatively small to confirm relation between gist
and executive functions. Future studies with large
sample size could further our understanding of the
mechanism of gist reasoning. Additionally, investi-
gating the relation between gist reasoning and
commonly used abstraction measures could inform
us of the unique and common abstraction skills
that may underl ie gist reasoning.
Clinical implications and conclusions
Clinicians are increasingly cognizant of the limita-
tions of traditional cognitive testing to predict long-
term functional outcomes, especially in complex
daily responsibilities. There is a growing demand
to identify and/or develop functionally relevant
measures that (a) are sensitive to higher order cog-
nitive performance, (b) have the attri butes of being
reliably measured, (c) are time efficient in charac-
terizing performance patterns, and (d) are predictive
of daily-life functionality (Burgess et al., 2006; Chen
&D’Esposito, 2010). With further validation, gist
reasoning may fulfill the requirements as an eco lo-
gically salient task that reflects the complexities and
unstructured nature of everyday life.
The findings from the study propose gist reason-
ing as a promising and sensitive way to character-
ize functionall y relevant complex integrative
function in adults with TBI. Specifically, gist rea-
soning performance could inform of cognitive
impairments that stymie learning and adaptation
during rehabilitation and long-term recovery in
adults with TBI. In closing, translating the break-
throughs of characterizing higher order cognition
into clinical practice has never been more vital,
particularly considering the increasing number of
individuals who suffer “invisible” but life-altering
injuries. A paradigmatic shift away from focusing
predominately on specific cognitive processes in
TBI towards adopting complex integrated cogni-
tive abilities is critical. Therefore, efforts to
improve awareness and access to functionally rele-
vant cognitive constructs, including gist reasoning,
to practicing neurologists, physiatrists, neuropsy-
chologists, and rehabilitation professionals is criti-
cal to guide accurate assessment and subsequent
training of higher order cognitive abilities.
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APPENDIX
GIST REASONING PERFORMANCE
TBI participant
John started his career as a schoolteacher and went on to
becoming a professor. He was considered a failure at
these professions, as he was too easy on his students.
He then decided to focus his attention on the legal world.
He failed as a lawyer as he did not take on big cases that
brought in more money. He then became a storeowner,
but failed at it as he gave too much credit to his custo-
mers and did not make a profit. He also worked as a file
clerk in his seventies, but did not enjoy his job. Many
years after his death, it was realized that he helped the
society.
Control participant
One may think of John as a failure. He was a kind and
generous man who thought of others’ welfare rather than
bringing in more money at all his careers such as
teaching, practicing law and so on. He wanted to
improve the system at every job. But, those ideas did
not go well with the bosses and John could not keep
any job for long. Therefore, he was thought of as a
failure both by himself and by the society. However,
when we look back, John is considered very successful
as his ideas that are used even today helped the society
over the years.
The TBI and control group participant are compar-
able on age, IQ, and education. The two overviews of
a 575-word t ext share commonalities and yet reveal
stark contrasts as to how mea ning is extracted from
complex information. On the one hand , both show
comparable levels of syntax and similar levels of infor-
mation reduction. The TBI participant’soverview
illustrates a capacity to recall some key information,
but fails to convey meaning beyond t he literal/concrete
facts in the original text. The overview has one
abstra cted idea (in italics). On the other hand, the
control group participant’s overview reflects abstracted
gist-based ideas (in italics) of values, kindness, and
societal contributions that were not explicitly stated
in the original text.
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