Addressing deficits in emotion recognition after severe traumatic brain injury: The role of focused attention and mimicry

Relationships of self-awareness and facial affect recognition to social communication ability in persons with traumatic brain injury

Traumatic brain injury (TBI) can cause changes to the injured person's physical ability, cognitive functioning, and social interactions. Since these attributes largely determine a person's concept of who they are, TBI poses a threat to sense of self. Due to the importance of social communication skills for community integration, impairment of these skills is a particular threat to sense of self. The present investigation sought to explore characteristics that influence social communication abilities. We hypothesized that both ability to interpret facial affect and self-awareness would be associated with communication ability. We also expected that facial affect recognition would influence self-awareness and that the effect of facial affect recognition on social communication would be partially mediated by self-awareness. For this prospective cohort study, participants were 77 individuals with documented TBI. Of these, 65% were male and 83% sustained severe injuries. The hypothesized association of facial affect recognition with social communication was demonstrated with path analysis as was the effect of facial affect recognition on self-awareness. However, the effect of facial affect recognition on social communication was not mediated by self-awareness. In addition, social communication was associated with employment, social integration, and loneliness. Findings highlighted the importance of social communication after TBI.

Facial emotion recognition in adult with traumatic brain injury: A protocol for systematic review and meta-analysis

BACKGROUND

Traumatic brain injury (TBI) refers to head injuries that disrupt normal function of the brain. TBI commonly lead to a wide range of potential psychosocial functional deficits. Although psychosocial function after TBI is influenced by many factors, more and more evidence shows that social cognitive skills are critical contributors. Facial emotion recognition, one of the higher-level skills of social cognition, is the ability to perceive and recognize emotional states of others based on their facial expressions. Numerous studies have assessed facial emotion recognition performance in adult patients with TBI. However, there have been inconsistent findings. The aim of this study is to conduct a meta-analysis to characterize facial emotion recognition in adult patients with TBI.

METHODS

A systematic literature search will be performed for eligible studies published up to March 19, 2020 in three international databases (PubMed, Web of Science and Embase). The work such as article retrieval, screening, quality evaluation, data collection will be conducted by two independent researchers. Meta-analysis will be conducted using Stata 15.0 software.

RESULTS

This meta-analysis will provide a high-quality synthesis from existing evidence for facial emotion recognition in adult patients with TBI, and analyze the facial emotion recognition performance in different aspects (i.e., recognition of negative emotions or positive emotions or any specific basic emotion).

CONCLUSIONS

This meta-analysis will provide evidence of facial emotion recognition performance in adult patients with TBI.

INPLASY REGISTRATION NUMBER

INPLASY202050109.

Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review

INTRODUCTION

Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used.

DEVELOPMENT

We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale.

CONCLUSIONS

The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.

Treatment of social cognition impairments in patients with traumatic brain injury: a critical review

Objective: The aim of this study is to review published research on treatment of social cognition impairments in patients with traumatic brain injury (TBI).Methods: Following the PRISMA guidelines, a PubMed literature search was conducted, followed by a manual search in recently published papers. Main criteria for selection were that patients had sustained a TBI, and that social cognition was the main target of treatment. A total of 16 papers and three reviews were selected and included in the present review.Results: Five studies (including three randomized controlled trials (RCT)) addressed facial affect recognition, one study specifically addressed emotional prosody, two RCTs used a combination of treatment strategies addressing social perception deficits. Six studies, including two RCTs, addressed social communication skills or theory of mind. Finally, two RCTs reported the effectiveness of a more global approach, addressing multiple domains of social cognition, such as emotion perception, social skills training, and theory of mind.Discussion/conclusion: Although there has been much less research on treatment of social cognition in patients with TBI as compared with psychiatric conditions, the findings reported in the present review are encouraging. Further multicenter large-scale RCTs are needed, with special emphasis on the generalization of treatment effects to social skills in everyday life.

Assessment and Rehabilitation of Social Cognition Impairment after Brain Injury: Surveying Practices of Clinicians

Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury.

Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia.

Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation.

Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation.

Two case study evaluations of an arts-based social skills intervention for adolescents with childhood brain disorder

OBJECTIVE

Arts-based programmes have been shown to be useful for individuals with disturbances in cognitive and behavioural functioning. The current case studies examined the feasibility and effectiveness of a theatre skills training programme to facilitate social skills and participation for adolescents with childhood brain disorder.

METHODS

A case study approach was used with two adolescent participants. Focus groups were conducted immediately post-intervention, while a battery of quantitative measures were administered pre- and post-treatment, as well as 8 months post-treatment.

RESULTS

Perceived and documented improvements in social skills and participation were observed from pre- to post-intervention and at follow-up.

CONCLUSION

Results support the use of an arts-based intervention for youth with brain injuries to facilitate social skills and participation. Findings also highlight the need for more sensitive measures of these skills for youth with childhood brain disorder, who may have impaired awareness of their abilities and/or impairments in memory and language comprehension.