Emotion Recognition and Traumatic Brain Injury: a Systematic Review and Meta-Analysis

The Emotion Authenticity Recognition (EAR) test: normative data of an innovative test using dynamic emotional stimuli to evaluate the ability to recognize the authenticity of emotions expressed by faces

Despite research has massively focused on how emotions conveyed by faces are perceived, the perception of emotions' authenticity is a topic that has been surprisingly overlooked. Here, we present the Emotion Authenticity Recognition (EAR) test, a test specifically developed using dynamic stimuli depicting authentic and posed emotions to evaluate the ability of individuals to correctly identify an emotion (emotion recognition index, ER Index) and classify its authenticity (authenticity recognition index (EA Index). The EAR test has been validated on 522 healthy participants and normative values are provided. Correlations with demographic characteristics, empathy and general cognitive status have been obtained revealing that both indices are negatively correlated with age, and positively with education, cognitive status and different facets of empathy. The EAR test offers a new ecological test to assess the ability to detect emotion authenticity that allow to explore the eventual social cognitive deficit even in patients otherwise cognitively intact.

ZL006 mitigates anxiety-like behaviors induced by closed head injury through modulation of the neural circuit from the medial prefrontal cortex to amygdala

Closed head injury is a prevalent form of traumatic brain injury with poorly understood effects on cortical neural circuits. Given the emotional and behavioral impairments linked to closed head injury, it is vital to uncover brain functional deficits and their driving mechanisms. In this study, we employed a robust viral tracing technique to identify the alteration of the neural pathway connecting the medial prefrontal cortex to the basolateral amygdala, and we observed the disruptions in neuronal projections between the medial prefrontal cortex and the basolateral amygdala following closed head injury. Remarkably, our results highlight that ZL006, an inhibitor targeting PSD-95/nNOS interaction, stands out for its ability to selectively reverse these aberrations. Specifically, ZL006 effectively mitigates the disruptions in neuronal projections from the medial prefrontal cortex to basolateral amygdala induced by closed head injury. Furthermore, using chemogenetic approaches, we elucidate that activating the medial prefrontal cortex projections to the basolateral amygdala circuit produces anxiolytic effects, aligning with the therapeutic potential of ZL006. Additionally, ZL006 administration effectively mitigates astrocyte activation, leading to the restoration of medial prefrontal cortex glutamatergic neuron activity. Moreover, in the context of attenuating anxiety-like behaviors through ZL006 treatment, we observe a reduction in closed head injury-induced astrocyte engulfment, which may correlate with the observed decrease in dendritic spine density of medial prefrontal cortex glutamatergic neurons.

Dynamic Emotion Recognition and Social Inference Ability in Traumatic Brain Injury: An Eye-Tracking Comparison Study

Emotion recognition and social inference impairments are well-documented features of post-traumatic brain injury (TBI), yet the mechanisms underpinning these are not fully understood. We examined dynamic emotion recognition, social inference abilities, and eye fixation patterns between adults with and without TBI. Eighteen individuals with TBI and 18 matched non-TBI participants were recruited and underwent all three components of The Assessment of Social Inference Test (TASIT). The TBI group were less accurate in identifying emotions compared to the non-TBI group. Individuals with TBI also scored lower when distinguishing sincere and sarcastic conversations, but scored similarly to those without TBI during lie vignettes. Finally, those with TBI also had difficulty understanding the actor's intentions, feelings, and beliefs compared to participants without TBI. No group differences were found for eye fixation patterns, and there were no associations between fixations and behavioural accuracy scores. This conflicts with previous studies, and might be related to an important distinction between static and dynamic stimuli. Visual strategies appeared goal- and stimulus-driven, with attention being distributed to the most diagnostic area of the face for each emotion. These findings suggest that low-level visual deficits may not be modulating emotion recognition and social inference disturbances post-TBI.

Facial affect recognition in context in adults with and without TBI

Introduction

Several studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab.

Methods

Participants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person's real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels.

Results

Over 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups.

Discussion

Results revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI.

Effectiveness of training in expressing positive emotions, reacting to change and greeting peers after childhood traumatic brain injury: a single-case experimental study

Background

Social cognitive deficits are common after traumatic brain injury (TBI). The participant in this single-case experimental design (SCED) was 7 years old when he sustained a severe TBI. After 2 years in rehabilitation, he continues to show deficits in social cognition.

Objective

To determine the effectiveness of three interventions, each aimed at improving a behavior altered by social cognition deficits. These behaviors were: (1) expression of positive emotions, (2) reacting to changes in plans, and (3) greeting classmates.

Method

An A-B-A' design was used for each behavior. In addition, each behavior was targeted with a rehabilitation program applied over 10 sessions.

Results

For the first behavior, changes between phases B-A' (NAP = 0.712) and A-A' (NAP = 0.864) indicated improvements in the child's ability to express positive emotions. In the second behavior, changes in the intensity of reactions between phases B and A' (NAP = 0.815) and A vs. A' (NAP = 0.834) indicated that the child adapted to changes in a plan and to unexpected situations in a more adaptive way. For the third behavior, changes in the number of greetings between phases A and B (NAP = 0.883) and A vs. A' (NAP = 0.844) suggested that during the third phase of the study, the participant fully acquired the habit of greeting peers and increased his interactions with others.

Conclusion

While the participant showed improvements in all three targeted behaviors, due to the complexity of the third behavior, it is recommended that in future research, the intervention targeting social interactions should be applied over a longer timeframe to ensure that improvements are more stable in the long term.

Emotion recognition of faces and emoji in individuals with moderate-severe traumatic brain injury

BACKGROUND

Facial emotion recognition deficits are common after moderate-severe traumatic brain injury (TBI) and linked to poor social outcomes. We examine whether emotion recognition deficits extend to facial expressions depicted by emoji.

METHODS

Fifty-one individuals with moderate-severe TBI (25 female) and fifty-one neurotypical peers (26 female) viewed photos of human faces and emoji. Participants selected the best-fitting label from a set of basic emotions (anger, disgust, fear, sadness, neutral, surprise, happy) or social emotions (embarrassed, remorseful, anxious, neutral, flirting, confident, proud).

RESULTS

We analyzed the likelihood of correctly labeling an emotion by group (neurotypical, TBI), stimulus condition (basic faces, basic emoji, social emoji), sex (female, male), and their interactions. Participants with TBI did not significantly differ from neurotypical peers in overall emotion labeling accuracy. Both groups had poorer labeling accuracy for emoji compared to faces. Participants with TBI (but not neurotypical peers) had poorer accuracy for labeling social emotions depicted by emoji compared to basic emotions depicted by emoji. There were no effects of participant sex.

DISCUSSION

Because emotion representation is more ambiguous in emoji than human faces, studying emoji use and perception in TBI is an important consideration for understanding functional communication and social participation after brain injury.

Reference Values of the Quality of Life after Brain Injury (QOLIBRI) from a General Population Sample in Italy

Traumatic brain injury (TBI) may affect the lives of the individuals concerned and their relatives negatively in many dimensions. Health-related quality of life (HRQoL) is a comprehensive and complex concept that can assess one's satisfaction with a broad range of areas of life and health. The Quality of Life after Traumatic Brain Injury (QOLIBRI) questionnaire is a TBI-specific measure for HRQoL which is used in research and health services worldwide. When evaluating self-reported HRQoL after TBI, reference values from a general population are helpful to perform clinically relevant evaluations and decisions about the condition of an affected person by comparing the patient scores with reference values. Despite the widespread use of the QOLIBRI, reference values have until now only been available for the Netherlands and the United Kingdom. The aim of this study was to validate the QOLIBRI for the general population in Italy and to provide reference values. An adapted form of the QOLIBRI was administered to 3298 Italians from a healthy general population using an online survey. Their scores were compared with those of 298 individuals post-TBI recruited within the international longitudinal observational cohort CENTER-TBI study in Italian hospitals, who completed the original questionnaire. The psychometric characteristics and the measurement invariance of the QOLIBRI were assessed. A regression analysis was performed to identify predictors relevant for HRQoL in the general population. Reference values were provided using percentiles. Measurement invariance analysis showed that the QOLIBRI captures the same HRQoL constructs in an Italian general population and Italian TBI sample from the observational Center-TBI study. Higher age, higher education and the absence of a chronic health condition were associated with higher QOLIBRI scores, suggesting better HRQoL. Reference values were provided for a general Italian population adjusted for age, sex, education and presence of chronic health conditions. We recommend using these for a better interpretation of the QOLIBRI score in clinical practice and research in Italy.

Emotion recognition and eye tracking of static and dynamic facial affect: Acomparison of individuals with and without traumatic brain injury

Diminished social functioning is often seen after traumatic brain injury (TBI). Mechanisms contributing to these deficits are poorly understood but thought to relate to impaired ability to recognize facial expressions. Static stimuli are often used to investigate ability post-TBI, and there is less evidence using more real-life dynamic stimuli. In addition, most studies rely on behavioral responses alone. The present study investigated the performance of a TBI group and matched non-TBI group on static and dynamic tasks using eye-tracking technology alongside behavioral measures. This is the first study to use eye tracking methodology alongside behavioral measures in emotion recognition tasks in people with brain injury. Eighteen individuals with heterogeneous TBI and 18 matched non-TBI participants were recruited. Stimuli representing six core emotions (Anger, Disgust, Fear, Happy, Sad, and Surprise faces) were selected from the Amsterdam Dynamic Facial Expression Set (ADFES). Participants were instructed to identify the emotion displayed correctly whilst eye movement metrics were recorded.

RESULTS

Results of analyses showed that TBI patients had First Fixation to nose for all emotion stimuli, shorter Fixation Duration and lower Fixation Count to eyes, were generally slower to classify stimuli, and less accurate than non-TBI group for the static task. Those with TBI were also less accurate at identifying Angry, Disgust, and Fear stimulus faces compared to the non-TBI group during the dynamic unfolding of an emotion.

CONCLUSION

In the present study, those with TBI had atypical eye scan patterns during emotion identification in the static emotion recognition task compared to the non-TBI group and were associated with lower identification accuracy on behavioral measures in both static and dynamic tasks. Findings suggest potential disruption to oculomotor systems vital for first stage perceptual processing. Arguably, these impairments may contribute to diminished social functioning.

The Effects of Separate Facial Areas on Emotion Recognition in Different Adult Age Groups: A Laboratory and a Naturalistic Study

The identification of facial expressions is critical for social interaction. The ability to recognize facial emotional expressions declines with age. These age effects have been associated with differential age-related looking patterns. The present research project set out to systematically test the role of specific facial areas for emotion recognition across the adult lifespan. Study 1 investigated the impact of displaying only separate facial areas versus the full face on emotion recognition in 62 younger (20–24 years) and 65 middle-aged adults (40–65 years). Study 2 examined if wearing face masks differentially compromises younger (18–33 years, N = 71) versus middle-aged to older adults’ (51–83 years, N = 73) ability to identify different emotional expressions. Results of Study 1 suggested no general decrease in emotion recognition across the lifespan; instead, age-related performance seems to depend on the specific emotion and presented face area. Similarly, Study 2 observed only deficits in the identification of angry, fearful, and neutral expressions in older adults, but no age-related differences with regards to happy, sad, and disgusted expressions. Overall, face masks reduced participants’ emotion recognition; however, there were no differential age effects. Results are discussed in light of current models of age-related changes in emotion recognition.