{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:03:19Z","timestamp":1784768599918,"version":"3.55.0"},"reference-count":56,"publisher":"CSIRO Publishing","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,24]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To examine the clustering and switching behaviours, beyond total word count, as indicators of subtle executive dysfunction in individuals with and without a history of mild traumatic brain injury (mTBI), and to determine whether subcomponent analyses reveal cognitive inefficiencies overlooked by standard assessments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-five university students (mTBI = 9; controls = 26) aged 18\u201324 years completed phonemic (FAS) and semantic (animal naming) verbal fluency tasks. Total correct responses, mean cluster size and number of switches were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with controls, individuals with mTBI produced fewer \u2018S\u2019 words (z = 2.66, P = 0.007, r = 0.45) and semantic switches (z = 2.45, P = 0.015, r = 0.41). Both groups were significantly different in semantic and phonemic clusters (mTBI: z = 2.22, P = 0.026, r = 0.74; controls: z = 3.51; P &amp;lt; 0.001, r = 0.69). No group differences were observed for phonemic switching. Findings indicate subtle reductions in cognitive flexibility and verbal productivity in individuals with chronic mTBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clustering and switching analyses in verbal fluency tasks may detect subtle, executive deficits in individuals with chronic mTBI that are not captured by total word count alone. These findings support the feasibility of subcomponent verbal fluency measures as sensitive tools for long-term mTBI assessment and monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/ib26001","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:51:35Z","timestamp":1784767895000},"source":"Crossref","is-referenced-by-count":0,"title":["Beyond word count: a pilot study of the verbal fluency task in chronic mild traumatic brain injury"],"prefix":"10.1071","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8574-3832","authenticated-orcid":true,"given":"Warren C.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Speech Language Pathology and Audiology A , , , .","place":["Jackson, MS, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony P.","family":"Salvatore","sequence":"additional","affiliation":[{"name":"Independent Researcher B , , , .","place":["Pensacola, FL, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise C.","family":"Keegan","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Sciences Moravian University C , , , .","place":["Bethlehem, PA, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-5410","authenticated-orcid":true,"given":"Jerry K.","family":"Hoepner","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences & Disorders University of Wisconsin D , , , .","place":["Eau Claire, WI, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"1","key":"2026072220513358100_R55","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-65525-9","article-title":"Executive functions predict verbal fluency scores in healthy participants.","volume":"10","author":"Amunts","year":"2020","journal-title":"Scientific Reports"},{"issue":"1","key":"2026072220513358100_R56","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-85981-1","article-title":"Comprehensive verbal fluency features predict executive function performance.","volume":"11","author":"Amunts","year":"2021","journal-title":"Scientific Reports"},{"issue":"3","key":"2026072220513358100_R1","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1111\/1460-6984.12276","article-title":"Semantic fluency in aphasia: clustering and switching in the course of 1 minute.","volume":"52","author":"Bose","year":"2017","journal-title":"International Journal of Language & Communication Disorders"},{"issue":"6","key":"2026072220513358100_R2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1044\/2025_PERSP-24-00315","article-title":"Traumatic brain injuries in diverse populations: a tutorial for applying the intersectionality framework to analyze the societal impacts of injury.","volume":"10","author":"Brown","year":"2025","journal-title":"Perspectives of the ASHA Special Interest Groups"},{"key":"2026072220513358100_R3"},{"key":"2026072220513358100_R4","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1044\/2026_AJSLP-25-00493","article-title":"Challenging the field: moving beyond disparity descriptions to actionable steps in aphasia research.","volume":"35","author":"Brown","year":"2026","journal-title":"American Journal of Speech Language Pathology"},{"issue":"1","key":"2026072220513358100_R5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1055\/s-0043-1778016","article-title":"Intersectionality in aphasia services for ethnosocially diverse adult populations.","volume":"45","author":"Centeno","year":"2024","journal-title":"Seminars in Speech Language"},{"issue":"13","key":"2026072220513358100_R6","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1080\/02699050500110678","article-title":"Microlinguistic deficits in the narrative discourse of adults with traumatic brain injury.","volume":"19","author":"Coelho","year":"2005","journal-title":"Brain Injury"},{"issue":"6","key":"2026072220513358100_R8","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1097\/01.HTR.0000300227.67748.77","article-title":"Initial reliability and validity of the OSU TBI identification method.","volume":"22","author":"Corrigan","year":"2007","journal-title":"Journal of Head Trauma Rehabilitation"},{"issue":"13\u201314","key":"2026072220513358100_R7","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1089\/neu.2024.0590","article-title":"Retrospective identification and characterization of traumatic brain injury-recommendations from the 2024 National institute of neurological disorders and stroke traumatic brain injury classification and nomenclature initiative retrospective classification working group.","volume":"42","author":"Corrigan","year":"2025","journal-title":"Journal of Neurotrauma"},{"issue":"9","key":"2026072220513358100_R9","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1080\/02699050210128870","article-title":"Mild traumatic brain injury (mTBI): assessment and treatment procedures used by speech-language pathologists (SLPs).","volume":"16","author":"Duff","year":"2002","journal-title":"Brain Injury"},{"issue":"1","key":"2026072220513358100_R10","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1159\/000508098","article-title":"Magnetic resonance spectroscopy following mild traumatic brain injury: a systematic review and meta-analysis on the potential to detect posttraumatic neurodegeneration.","volume":"20","author":"Eisele","year":"2020","journal-title":"Neurodegenerative Diseases"},{"key":"2026072220513358100_R11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02687038.2025.2561681","article-title":"Eight ways speech-language pathologists can contribute to health equity: the case of Black stroke survivors with aphasia.","author":"Gadson","year":"2025","journal-title":"Aphasiology"},{"issue":"23","key":"2026072220513358100_R12","doi-asserted-by":"publisher","first-page":"3235","DOI":"10.1089\/neu.2021.0062","article-title":"Epidemiology of chronic effects of traumatic brain injury.","volume":"38","author":"Haarbauer-Krupa","year":"2021","journal-title":"Journal of Neurotrauma"},{"issue":"11","key":"2026072220513358100_R13","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1080\/02699052.2018.1493226","article-title":"Traumatic brain injury education for adult patients and families: a scoping review.","volume":"32","author":"Hart","year":"2018","journal-title":"Brain Injury"},{"issue":"2S","key":"2026072220513358100_R15","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1044\/2022_AJSLP-22-00103","article-title":"\u2018I avoid interactions with medical professionals as much as possible now\u2019: health care experiences of individuals with traumatic brain injuries.","volume":"32","author":"Hoepner","year":"2023","journal-title":"American Journal of Speech-Language Pathology"},{"issue":"5","key":"2026072220513358100_R14","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1080\/02699052.2024.2311332","article-title":"Healthcare perceptions of persons with traumatic brain injuries across providers: shortcomings in the chronic phase of care.","volume":"38","author":"Hoepner","year":"2024","journal-title":"Brain Injury"},{"issue":"1","key":"2026072220513358100_R16","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1080\/13825585.2010.517826","article-title":"Cognitive fatigue defined in the context of attention networks.","volume":"18","author":"Holtzer","year":"2011","journal-title":"Neuropsychology, Development, and Cognition B Aging, Neuropsychology and Cognition"},{"key":"2026072220513358100_R17","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.comppsych.2017.01.007","article-title":"Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence.","volume":"74","author":"Iverson","year":"2017","journal-title":"Comprehensive psychiatry"},{"issue":"3","key":"2026072220513358100_R18","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1080\/13803395.2010.518703","article-title":"Which verbal fluency measure is most useful in demonstrating executive deficits after traumatic brain injury?","volume":"33","author":"Kav\u00e9","year":"2011","journal-title":"Journal of Clinical and Experimental Neuropsychology"},{"key":"2026072220513358100_R19","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jcomdis.2018.08.001","article-title":"Discourse-based treatment in mild traumatic brain injury.","volume":"76","author":"Kintz","year":"2018","journal-title":"Journal of Communication Disorders"},{"issue":"4","key":"2026072220513358100_R20","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1212\/WNL.0b013e31827f07be","article-title":"Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy.","volume":"80","author":"Kluger","year":"2013","journal-title":"Neurology"},{"issue":"1","key":"2026072220513358100_R21","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1044\/nnsld25.1.17","article-title":"Assessment of cognitive-communication disorders in adults with mild traumatic brain injury.","volume":"25","author":"Krug","year":"2015","journal-title":"Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders"},{"issue":"7","key":"2026072220513358100_R22","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1212\/wnl.55.7.934","article-title":"Fatigue and declines in cognitive functioning in multiple sclerosis.","volume":"55","author":"Krupp","year":"2000","journal-title":"Neurology"},{"issue":"5","key":"2026072220513358100_R23","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/j.jemermed.2016.12.017","article-title":"Retrospective chart analysis of concussion discharge instructions in the emergency department.","volume":"52","author":"Lane","year":"2017","journal-title":"Journal of Emergency Medicine"},{"issue":"6","key":"2026072220513358100_R24","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1080\/23279095.2021.1973471","article-title":"Systematic administration and analysis of verbal fluency tasks: preliminary evidence for reliable exploration of processes underlying task performance.","volume":"30","author":"Lehtinen","year":"2021","journal-title":"Applied Neuropsychology. Adult"},{"issue":"5","key":"2026072220513358100_R25","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/S1474-4422(15)00002-2","article-title":"Diagnosis, prognosis, and clinical management of mild traumatic brain injury.","volume":"14","author":"Levin","year":"2015","journal-title":"The Lancet Neurology"},{"key":"2026072220513358100_R26"},{"key":"2026072220513358100_R27","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.neuropsychologia.2018.08.030","article-title":"Changes in discourse structure over time following traumatic brain injury.","volume":"119","author":"Lindsey","year":"2018","journal-title":"Neuropsychologia"},{"issue":"5","key":"2026072220513358100_R28","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3109\/17518420903087251","article-title":"Mild traumatic brain injury and executive functions in school-aged children.","volume":"12","author":"Maillard-Wermelinger","year":"2009","journal-title":"Developmental Neurorehabilitation"},{"issue":"4","key":"2026072220513358100_R29","doi-asserted-by":"publisher","first-page":"323","DOI":"10.4236\/psych.2015.64033","article-title":"Call for an integrative and multi-disciplinary approach to Traumatic Brain Injury (TBI).","volume":"6","author":"Mansour","year":"2015","journal-title":"Psychology"},{"issue":"4","key":"2026072220513358100_R30","doi-asserted-by":"publisher","first-page":"315","DOI":"10.3233\/NRE-2006-21406","article-title":"Cognitive and emotional consequences of TBI: intervention strategies for vocational rehabilitation.","volume":"21","author":"Mateer","year":"2007","journal-title":"NeuroRehabilitation"},{"issue":"8","key":"2026072220513358100_R31","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1080\/13854040903074652","article-title":"An integrated review of recovery after mild traumatic brain injury (mTBI): implications for clinical management.","volume":"23","author":"McCrea","year":"2009","journal-title":"The Clinical Neuropsychologist"},{"issue":"4","key":"2026072220513358100_R32","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3233\/NRE-2002-17407","article-title":"Executive dysfunction following traumatic brain injury: neural substrates and treatment strategies.","volume":"17","author":"McDonald","year":"2002","journal-title":"NeuroRehabilitation"},{"key":"2026072220513358100_R33","unstructured":"Mejia P (2016) Nature of the verbal fluency task in concussed athletes Open Access Theses & Dissertations. 898. Available at https:\/\/scholarworks.utep.edu\/open_etd\/898"},{"issue":"2S","key":"2026072220513358100_R34","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1044\/2022_AJSLP-22-00101","article-title":"Self-perception of cognitive-communication functions after mild traumatic brain injury.","volume":"32","author":"Norman","year":"2023","journal-title":"American Journal of Speech-Language Pathology"},{"key":"2026072220513358100_R35","doi-asserted-by":"publisher","first-page":"100092","DOI":"10.1016\/j.brain.2024.100092","article-title":"Traumatic brain injury or traumatic brain disease: a scientific commentary.","volume":"6","author":"Obasa","year":"2024","journal-title":"Brain Multiphysics"},{"issue":"3S","key":"2026072220513358100_R36","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1044\/2024_AJSLP-24-00116","article-title":"Factors influencing speech-language pathology referral and utilization in mild traumatic brain injury: an exploratory analysis.","volume":"34","author":"O\u2019Brien","year":"2025","journal-title":"American Journal of Speech-Language Pathology"},{"issue":"2","key":"2026072220513358100_R37","doi-asserted-by":"publisher","first-page":"539","DOI":"10.3233\/NRE-162102","article-title":"Verbal fluency tests: developing a new model of administration and scoring for Spanish language.","volume":"41","author":"Olabarrieta-Landa","year":"2017","journal-title":"NeuroRehabilitation"},{"issue":"3","key":"2026072220513358100_R38","doi-asserted-by":"publisher","first-page":"289","DOI":"10.4085\/1062-6050-0181.23","article-title":"Postinjury outcomes after non-sport-related concussion: a CARE consortium study.","volume":"59","author":"Roby","year":"2024","journal-title":"Journal of Athletic Training"},{"issue":"1","key":"2026072220513358100_R39","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0210","article-title":"Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study.","volume":"1","author":"Seabury","year":"2018","journal-title":"JAMA Network Open"},{"key":"2026072220513358100_R40"},{"issue":"1","key":"2026072220513358100_R41","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/TLD.0000000000000241","article-title":"Narrative discourse intervention after traumatic brain injury: a systematic review of the literature.","volume":"41","author":"Steel","year":"2021","journal-title":"Topics in Language Disorders"},{"issue":"2","key":"2026072220513358100_R42","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1111\/1460-6984.12784","article-title":"How do speech\u2013language pathologists assess and treat spoken discourse after TBI? A survey of clinical practice.","volume":"59","author":"Steel","year":"2024","journal-title":"International Journal of Language & Communication Disorders"},{"key":"2026072220513358100_R43"},{"issue":"7","key":"2026072220513358100_R44","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1080\/13803395.2016.1163327","article-title":"New ways to analyze word generation performance in brain injury: a systematic review and meta-analysis of additional performance measures.","volume":"38","author":"Thiele","year":"2016","journal-title":"Journal of Clinical and Experimental Neuropsychology"},{"issue":"11","key":"2026072220513358100_R54","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1016\/j.apmr.2023.04.010","article-title":"Communication and psychosocial outcomes 2-years after severe traumatic brain injury: Development of a prognostic model.","volume":"104","author":"Togher","year":"2023","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"2","key":"2026072220513358100_R45","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1093\/arclin\/14.2.167","article-title":"Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming.","volume":"14","author":"Tombaugh","year":"1999","journal-title":"Archives of Clinical Neuropsychology"},{"issue":"1","key":"2026072220513358100_R46","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/nyas.70064","article-title":"Exploring factors affecting verbal fluency in healthy aging.","volume":"1553","author":"Tremblay","year":"2025","journal-title":"Annals of the New York Academy of Sciences"},{"issue":"1","key":"2026072220513358100_R47","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1037\/\/0894-4105.11.1.138","article-title":"Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults.","volume":"11","author":"Troyer","year":"1997","journal-title":"Neuropsychology"},{"issue":"3","key":"2026072220513358100_R48","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1076\/1380-3395(200006)22:3;1-V;FT370","article-title":"Normative data for clustering and switching on verbal fluency tasks.","volume":"22","author":"Troyer","year":"2000","journal-title":"Journal of Clinical and Experimental Neuropsychology"},{"issue":"11","key":"2026072220513358100_R49","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1089\/neu.2017.5257","article-title":"Divergent classification methods of post-concussion syndrome after mild traumatic brain injury: prevalence rates, risk factors, and functional outcome.","volume":"35","author":"Voormolen","year":"2018","journal-title":"Journal of Neurotrauma"},{"issue":"5","key":"2026072220513358100_R50","doi-asserted-by":"publisher","DOI":"10.3390\/jcm7050095","article-title":"Multimodal assessment of recurrent MTBI across the lifespan.","volume":"7","author":"Wilke","year":"2018","journal-title":"Journal of Clinical Medicine"},{"issue":"12","key":"2026072220513358100_R51","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0166439","article-title":"Computerized analysis of verbal fluency: normative data and the effects of repeated testing, simulated malingering, and traumatic brain injury.","volume":"11","author":"Woods","year":"2016","journal-title":"PLoS One"},{"issue":"3","key":"2026072220513358100_R52","doi-asserted-by":"publisher","first-page":"213","DOI":"10.21849\/cacd.2018.00451","article-title":"Effects of playing positions on memory and auditory comprehension in high school football players with a mild concussion.","volume":"3","author":"Yoo","year":"2018","journal-title":"Clinical Archives of Communication Disorders"},{"issue":"7","key":"2026072220513358100_R53","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1080\/13803395.2011.558496","article-title":"Component analysis of verbal fluency in patients with mild traumatic brain injury.","volume":"33","author":"Zakzanis","year":"2011","journal-title":"Journal of Clinical and Experimental Neuropsychology"}],"container-title":["Brain Impairment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/ib\/article-pdf\/doi\/10.1071\/IB26001\/1947580\/ib26001.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/ib\/article-pdf\/doi\/10.1071\/IB26001\/1947580\/ib26001.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:51:38Z","timestamp":1784767898000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/ib\/article\/doi\/10.1071\/IB26001\/273156\/Beyond-word-count-a-pilot-study-of-the-verbal"}},"subtitle":[],"editor":[{"given":"Nicholas","family":"Behn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":56,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9,24]]}},"URL":"https:\/\/doi.org\/10.1071\/ib26001","relation":{},"ISSN":["1443-9646","1839-5252"],"issn-type":[{"value":"1443-9646","type":"print"},{"value":"1839-5252","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}