Emotion perception deficits following traumatic brain injury: A review of the evidence and rationale for intervention

School of Psychology, University of New South Wales, Sydney, Australia.
Journal of the International Neuropsychological Society (Impact Factor: 2.96). 08/2008; 14(4):511-25. DOI: 10.1017/S1355617708080703
Source: PubMed


While the cognitive disturbances that frequently follow severe traumatic brain injury (TBI) are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that a significant proportion of individuals with TBI demonstrate an inability to recognize affective information from the face, voice, bodily movement, and posture. Because accurate interpretation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area. The present review examines the literature on emotion perception deficits in TBI and presents a theoretical rationale for targeted intervention. Several lines of research relevant to the remediation of emotion perception in people with TBI are considered. These include work on emotion perception remediation with other cognitively impaired populations, current neuropsychological models of emotion perception and underlying neural systems, and recent conceptualizations of remediation processes. The article concludes with a discussion of the importance of carrying out efforts to improve emotion perception within a contextualized framework in which the day-to-day relevance of training is clear to all recipients.

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    • "TBI commonly involves pathology to anterior brain regions implicated in social cognition (Tasker et al., 2005; Wilde et al., 2005), as well as diffuse axonal injury (DAI) which may disrupt formation of white matter connections between regions that contribute to the distributed 'social brain' network, including the superior temporal sulcus, fusiform gyrus, temporal pole, medial prefrontal cortex, orbitofrontal cortex, amygdala, temporoparietal junction and inferior parietal cortex (Beauchamp and Anderson, 2010; Johnson et al., 2005; Yeates et al., 2007). While the sociocognitive and communication impairments documented in adults with TBI suggest that regions of the 'social brain' may be susceptible to the effects of TBI (Bornhofen and McDonald, 2008; Dimoska et al., 2010; Ieetswart et al., 2008; Williams and Wood, 2009), it has been TBI suggest that reduced social (pragmatic) communication may be the mechanism that links impaired emotion perception to more frequent externalizing behaviors among individuals with TBI. That is, in keeping the premises of the Heuristic Model of Social Competence (HMSC; Yeates et al., 2007; Fig. 1), it may be that poor emotion perception contributes to reduced interpersonal effectiveness , which in turn elicits psychological distress, reflected in externalizing behaviors that include aggression, intrusive conduct and rule breaking. "
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    ABSTRACT: Traumatic brain injury (TBI) is a common cause of disability in childhood, and is associated with elevated risk for long-term social impairment. Though social (pragmatic) communication deficits may be among the most debilitating consequences of childhood TBI, few studies have examined very long-term communication outcomes as children with TBI make the transition to young adulthood. In addition, the extent to which reduced social function contributes to externalizing behaviors in survivors of childhood TBI remains poorly understood. The present study aimed to evaluate the extent of social communication difficulty among young adult survivors of childhood TBI (n=34, injury age: 1.0-7.0 years; M time since injury: 16.55 years) and examine relations among aspects of social function including emotion perception, social communication and externalizing behaviors rated by close-other proxies. Compared to controls the TBI group had significantly greater social communication difficulty, which was associated with more frequent externalizing behaviors and poorer emotion perception. Analyses demonstrated that reduced social communication mediated the association between poorer emotion perception and more frequent externalizing behaviors. Our findings indicate that socio-cognitive impairments may indirectly increase the risk for externalizing behaviors among young adult survivors of childhood TBI, and underscore the need for targeted social skills interventions delivered soon after injury, and into the very long-term.
    International Journal of Developmental Neuroscience 10/2013; DOI:10.1016/j.ijdevneu.2013.10.002 · 2.58 Impact Factor
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    • "A central component of SC is the recognition of the facial expression of emotion. The ability to interpret facial affective cues is an important prerequisite for understanding others' thoughts and feelings (Blair, 2003; Bornhofen & McDonald, 2008). Several brain areas are involved in the processing of emotional faces but it is assumed that their output converges in orbitofrontal "
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    ABSTRACT: Deficits in emotion recognition, a crucial aspect of social cognition, are common after serious brain injury, as are executive deficits. Since social cognition and executive function are considered to be separate constructs, our first aim was to examine the presence of emotion recognition problems in brain injury patients with dysexecutive problems. We studied 65 brain injury patients of mixed aetiology participating in a randomised controlled trial evaluating the effects of a multifaceted treatment for executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010) and 84 matched controls with a test for emotion recognition. Results showed that, in patients with acquired brain injury exhibiting executive deficits, emotion recognition deficits are also present. Male patients are more impaired than female patients, irrespective of aetiology. Our second aim was to investigate whether emotion recognition problems negatively predict the results of the treatment programme. Pre-treatment emotion recognition performance significantly predicted resumption of roles in daily life (Role Resumption List; RRL) and performance on an ecologically valid test for everyday executive functioning (Executive Secretarial Task; EST) post-treatment and, in addition, interfered negatively with treatment condition. Moreover, worse pre-treatment emotion recognition skills affect the learning of compensatory strategies for executive dysfunction negatively, whereas pre-treatment dysexecutive deficits do not.
    Neuropsychological Rehabilitation 08/2013; 23(6). DOI:10.1080/09602011.2013.826138 · 1.96 Impact Factor
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    • "Another important issue in the discussion about the relation between frontal cortex and emotion processing is that there will be a more specific region within the frontal lobe dedicated to this process. In this context, orbitofrontal lesions compared to other frontal brain lesions have been associated with poorer emotion recognition (Bornhofen & McDonald, 2008; Hornak et al., 1996). In line with the evidence, our results showed a lower performance of the orbitofrontal TBI subgroup in emotion recognition: these participants presented longer reaction times when compared to other lesions of the TBI subgroups. "
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    ABSTRACT: Adequate emotion recognition is relevant to individuals’ interpersonal communication. Patients with frontal traumatic brain injury (TBI) exhibit a lower response to facial emotional stimuli, influencing social interactions. In this sense, the main goal of the current study was to assess the ability of TBI patients in recognizing basic emotions. Photographs of facial expressions of five basic emotions (happiness, sadness, fear, anger, and surprise) were presented to 32 TBI patients and 41 healthy controls. Emotion recognition was measured by accuracy and reaction time. Overall performance of the TBI group was poorer than control group for emotion recognition, both in terms of accuracy and reaction time. It is suggested that TBI patients show impairment on emotion recognition, and this relation seems to be moderated by the lesion localization.
    Psychology and Neuroscience 12/2011; 4(3):377-384. DOI:10.3922/j.psns.2011.3.011
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