The impact of head injury neurobehavioural sequelae on personal relationships: Preliminary findings

Understanding deficits in empathy after traumatic brain injury: The role of affective responsivity

People with traumatic brain injury (TBI) often find social situations challenging because they can no longer respond to the emotional state of the people they are with. Many also lack emotional empathy in their social interactions. But are these problems related? The present study addressed this question by examining psychophysiological indices of emotional responding, including facial electromyography (EMG) and skin conductance during exposure to happy and angry facial expressions, in addition to self-rated emotional empathy in 21 adults with severe TBI and 22 control participants. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally, and showed reduced physiological responding to the emotional expression of anger. By contrast, the control group spontaneously mimicked the emotional expressions they were exposed to, regardless of affective valence, and also demonstrated higher skin conductance responsivity to angry faces. The data further suggested that a loss of emotional empathy plays a role in the emotional response deficits to angry facial expressions following TBI. The results have implications for understanding the impaired social functioning and poor quality of interpersonal relationships commonly seen as a consequence of TBI.

Overview of impaired facial affect recognition in persons with traumatic brain injury

PRIMARY OBJECTIVE

To review the literature of affect recognition for persons with traumatic brain injury (TBI). It is suggested that impairment of affect recognition could be a significant problem for the TBI population and treatment strategies are recommended based on research for persons with autism.

MAIN OUTCOMES AND RESULTS

Research demonstrates that persons with TBI often have difficulty determining emotion from facial expressions. Studies show that poor interpersonal skills, which are associated with impaired affect recognition, are linked to a variety of negative outcomes. Theories suggest that facial affect recognition is achieved by interpreting important facial features and processing one's own emotions. These skills are often affected by TBI, depending on the areas damaged. Affect recognition impairments have also been identified in persons with autism. Successful interventions have already been developed for the autism population. Comparable neuroanatomical and behavioural findings between TBI and autism suggest that treatment approaches for autism may also benefit those with TBI.

CONCLUSIONS

Impaired facial affect recognition appears to be a significant problem for persons with TBI. Theories of affect recognition, strategies used in autism and teaching techniques commonly used in TBI need to be considered when developing treatments to improve affect recognition in persons with brain injury.

Predictors of marital stability 2 years following traumatic brain injury

OBJECTIVE

The purpose of the present study was to determine the predictors of continuous marital stability over 2 years post-injury and examine the moderating effects of ethnicity.

DESIGN

Retrospective study.

SETTING

Longitudinal dataset of the TBI Model Systems National Database.

PARTICIPANTS

Nine hundred and seventy-seven individuals with primarily moderate-to-severe TBI (751 Caucasians and 226 minorities) hospitalized between 1989-2005.

MAIN OUTCOMES

Marital stability was defined as 'stably married' (married at admission and married at follow-up years 1 and 2) and 'unstably married' (being single, divorced or separated at any of the two follow-up years).

RESULTS

Across the 2 years post-injury, 85% of study participants who reported being married upon admission for TBI had stable marital status, while 15% indicated being separated or divorced. Younger age, being a male with a TBI, suffering a TBI as a result of a violent injury and having moderate injury severity predicted marital instability. Furthermore, within minorities, increases in disability resulted in a higher likelihood of being stably married.

CONCLUSIONS

These research findings are clinically relevant and assist marital/couples/family intervention therapists and/or rehabilitation professionals to design programmes early after injury to target these at risk couples. Further research on the modifiable factors contributing to marital instability after TBI and potential moderators is needed.

Inability to empathize following traumatic brain injury

This study examines: (a) the impact of traumatic brain injury (TBI) on emotional empathy, (b) the relationship between emotional empathy and neuropsychological ability, and (c) the influence of low emotional empathy on measures of affect. Eighty-nine patients completed the Balanced Emotional Empathy Scale (BEES), a number of neuropsychological tests, some of which were ecologically valid tests of executive ability, plus two measures of affect, the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The TBI cohort showed a high frequency (60.7%) of low emotional empathy scores compared to the control group (31%). There was no relationship between injury severity and the ability to empathize, or between emotional empathy and neuropsychological performance. There was no evidence to suggest that low scores on affective measures influenced emotional empathy scores. A high proportion of TBI patients lack the ability to empathize, but the deficit does not appear related to any specific cognitive impairment and cannot be predicted by measures of affect.

Lebenszufriedenheit von PartnerInnen chronisch hirngeschädigter Menschen unter besonderer Berücksichtigung von Persönlichkeitsveränderung

Bezugnehmend auf das Prozessmodell der Pflegebelastung von Pearlin et al. (1990) wurde die Lebenszufriedenheit von 67 LebenspartnerInnen chronisch hirngeschädigter Menschen im Zusammenhang mit diversen Belastungsparametern, im Speziellen der wahrgenommenen Persönlichkeitsveränderung der hirngeschädigten Menschen, untersucht. Nahezu alle befragten ProbandInnen (95 %) nahmen eine stark negative Veränderung der Persönlichkeit ihrer hirngeschädigten PartnerInnen wahr. Die gesunden PartnerInnen lagen bezüglich ihrer Lebenszufriedenheit leicht unter dem Normbereich, wobei höhere Lebenszufriedenheit mit einer höheren Zufriedenheit in Bezug auf die soziale Unterstützung einherging. Der Großteil der Varianz von Lebenszufriedenheit wurde durch die Selbstständigkeit der hirngeschädigten Personen erklärt. Die Implikationen dieser Ergebnisse werden diskutiert.