Affect Recognition in Traumatic Brain Injury: Responses to Unimodal and Multimodal Media

Dynamic and/or multimodal assessments for social cognition in neuropsychology: Results from a systematic literature review

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

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.

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

Traumatic brain injury (TBI) can lead to impairments in emotion recognition that can present considerable challenges to social communication and the maintenance of interpersonal relationships. This review aimed to estimate the magnitude of emotion recognition impairments in TBI patients overall, and at the emotion category level, and to determine if the magnitude of observed impairments were moderated by modality (e.g., face, voice, multi-modal) of emotional expression, and severity of injury. Searches of PubMed, Scopus, PsycINFO, and Medline databases identified 17 studies which satisfied strict inclusion and exclusion criteria for the systematic review (comparing TBI patients to matched controls). Of these studies, 15 were included in the meta-analysis (N_TBI = 474; N_Control = 461). Moderate/large average deficits emerged for TBI patients relative to controls (Hedges' g = 0.79, 95% CI: 0.61 - 0.96, p < .001; Q = 22.53, p = .068, τ² = 0.04, I² = 37.84; indicating low heterogeneity). TBI patients were impaired across all emotion categories, with moderate/large effect sizes observed for fear and anger, moderate effect sizes for disgust, neutral and sadness, while effect sizes for happiness and surprise were small. The magnitude of impairment for individuals with TBI severity classified as moderate/severe TBI was moderate, whereas severe TBI was large. Moderate/large effect sizes were observed across the different modalities of presentation. This meta-analysis provides evidence for marked global impairments in emotion recognition, with the magnitude of impairment greatest for negative emotions (i.e., anger and fear). This meta-analysis provided no evidence to suggest that the magnitude of impairment is influenced by injury severity or modality of stimulus presentation. Recommendations for future research are discussed.

The relationship between vocal affect recognition and psychosocial functioning for people with moderate to severe traumatic brain injury: a systematic review

The purpose of this review was to explore how vocal affect recognition deficits impact the psychosocial functioning of people with moderate to severe traumatic brain injury (TBI). A systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was conducted, whereby six databases were searched, with additional hand searching of key journals also completed. The search identified 1847 records after duplicates were removed, and 1749 were excluded through title and abstract screening. After full text screening of 65 peer-reviewed articles published between January 1999 and August 2019, only five met inclusion criteria. The methodological quality of selected studies was assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018 with a fair level of agreement reached. A narrative synthesis of the results was completed, exploring vocal affect recognition and psychosocial functioning of people with moderate to severe TBI, including aspects of social cognition (i.e., empathy; Theory of Mind) and social behaviour. Results of the review were limited by a paucity of research in this area, a lack of high-level evidence, and wide variation in the outcome measures used. More rigorous study designs are required to establish more conclusive evidence regarding the degree and direction of the association between vocal affect recognition and aspects of psychosocial functioning. This review is registered with Prospero.

Cognitive-communication difficulties following traumatic brain injury sustained in older adulthood: a scoping review

BACKGROUND

Older adults are a peak incidence group for traumatic brain injury (TBI). However, empirical evidence on TBI in older adults is often limited to extrapolated findings from studies involving younger adults. While cognitive-communication deficits are an established consequence of TBI with substantial impact on social outcome for younger adults, little is known about the nature of cognitive-communication changes experienced by older adults following a new-onset TBI. In order to inform evidence-based service delivery and support older adults who sustain TBI, it is important to understand how these difficulties manifest in older adults.

AIMS

To review the empirical literature to determine the nature and breadth of research that has addressed the influence of older age on cognitive-communication outcomes following TBI sustained in older adulthood.

METHODS & PROCEDURES

A scoping review framework was used. Five electronic databases (Medline, PsycINFO, Embase, CINAHL and Scopus) were searched to locate peer-reviewed studies addressing cognitive-communication following TBI sustained at ≥ 55 years. Given the absence of dedicated investigations within the search yield, studies were included where at least 30% of participants were aged ≥ 55 years at injury, and age was a stated focus of the investigation.

OUTCOMES & RESULTS

A total of 2468 unique records were identified and reduced to 225 after title and abstract screening. Full-text review revealed only three studies that met the criteria. Collectively these studies included adults aged 55-93 years at injury. Two studies focused on age as a predictor for acute cognitive-communication difficulty, and one on the impact of age on facial emotion recognition in the chronic stages of injury. None of the studies had a dedicated focus on cognitive-communication outcomes for older adults who sustained a TBI within the defined period of older adulthood.

CONCLUSIONS & IMPLICATIONS

This scoping review produced limited results and insufficient evidence to inform rehabilitation for older adults. Indeed, very little is known about cognitive-communication outcomes for older adults who sustain a TBI. This review highlights the need, in the context of an ageing population, for research within this area to be prioritized. What this paper adds What is already known on the subject Empirical evidence to support the management of post-TBI cognitive-communication difficulties in adults predominantly stems from studies with young adults. However, the broader TBI literature suggests that outcome for older adults requires specific consideration due to its distinct nature and occurrence during a stage of life when there is the potential for subtle change to the processes of cognition and communication as part of typical ageing. What this paper adds to existing knowledge This scoping review identifies that research related to cognitive-communication outcomes for older adults who have sustained a TBI is very much in its infancy. Overarching statements about post-TBI cognitive-communication outcomes for older adults cannot be drawn, nor can it be determined if outcomes for older adults differ from younger adults. What are the potential or actual clinical implications of this work? The lack of research in this area means that tangible guidance cannot be provided to clinicians working with older adults following TBI to support evidence-based practice for cognitive-communication. This scoping review strongly supports the need for further research in this area.

The complex audio visual emotion assessment task (CAVEAT): development of a shorter version for clinical use

PURPOSE

The Complex Audio Visual Emotion Assessment Task (CAVEAT) is a measure of emotion recognition using dynamic, naturalistic videos to assess recognition of 22 different emotional states (11 positive, 11 negative). It has established construct validity and demonstrated sensitivity to emotion perception impairments in those with moderate-severe traumatic brain injury (TBI). Despite this, its lengthy administration has limited its use in clinical practice and rehabilitation. The current paper aimed to develop shortened versions of the CAVEAT and examine their psychometric properties.

METHODS

The CAVEAT-S A and CAVEAT-S B (22 items each) and the CAVEAT-S AB (44 items) were developed using the original data. Comparability, reliability, construct and predictive validity were examined in the original sample (Study 1: 32 people with TBI and 32 demographically matched control participants) and a replication sample (Study 2: 18 adults with TBI and 21 demographically matched controls).

RESULTS

All short forms produced comparable accuracy ratings to the full measure, as well as discriminating between people with or without a TBI. Shortened forms all correlated with other measures of emotion perception and social cognition and also predicted psychosocial outcomes in terms of self-reported interpersonal relationships. Internal reliability of the short forms was low relative to the longer forms, especially for the two very short measures.

CONCLUSIONS

The new shortened forms of the CAVEAT are promising tools that are sensitive and valid for assessing emotion perception in people with TBI for clinical purposes. Their application in other clinical disorders is yet to be examined.Implications for rehabilitationEmotion perception deficits are present in many clinical populations and an important target for rehabilitation.CAVEAT Short provides ecologically valid emotional stimuli. Such stimuli are important for assessing real world function and to set rehabilitation targets.By having parallel versions of CAVEAT, there is the opportunity to test pre and post intervention while minimising practice effects.Alternatively, one version of CAVEAT-S can be used for assessment, while the other is used for training purposes during remediation.

Sex Differences in Emotional Insight After Traumatic Brain Injury

OBJECTIVE

To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls.

DESIGN

Cross-sectional study.

SETTING

TBI rehabilitation facility in the United States and a university in Canada.

PARTICIPANTS

Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Toronto Alexithymia Scale-20 (TAS-20).

RESULTS

Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P<.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI.

CONCLUSIONS

Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.

A novel combined visual scanning and verbal cuing intervention improves facial affect recognition after chronic severe traumatic brain injury: A single case design

A single case design (AB with follow up) was used to determine the effect of a combined visual scanning and verbal cuing intervention technique in improving facial affect recognition after traumatic brain injury (TBI). A 35-year-old male (BR) with impaired ability to recognize facial emotions as a result of severe TBI participated in the study over a 3-month duration. BR's mean accuracy across six universal static facial expressions of emotion improved significantly during intervention and was maintained at follow up. BR was most impaired in labelling negative (sad, angry, disgusted, anxious) versus positive facial expressions (surprised, happy). BR's accuracy to negative facial affect significantly improved during intervention. No further improvement was possible for positive expressions because a ceiling effect was observed at baseline. Overall BR's mean response times across emotions was reduced at baseline but increased significantly during intervention. This was also recorded for both positive and negative expressions, respectively. This novel combined intervention has potential to improve facial affect recognition after TBI. Further evaluation using a multiple-baseline design is recommended. Additional research is needed to determine whether improved facial affect recognition following training translates to improvements in social function and communication in people with TBI.

Detection of text-based social cues in adults with traumatic brain injury

OBJECTIVES

Written text contains verbal immediacy cues-word form or grammatical cues that indicate positive attitude or liking towards an object, action, or person. We asked if adults with moderate-severe traumatic brain injury (TBI) would respond to these cues, given evidence of TBI-related social communication impairments.

METHODS

Sixty-nine adults with TBI and 74 healthy comparison (HC) peers read pairs of sentences containing different types of immediacy cues (e.g., speaker A said "these Canadians" vs. B said "those Canadians.") and identified which speaker (A or B) had a more positive attitude towards the underlined entity (Task 1); and pairs of sentences comprised of a context sentence (e.g., Fred is asked, "Did you visit Joan and Sue?") and a statement sentence (Fred says, "I visited Sue and Joan.") and were asked to indicate how much Fred liked or disliked the underlined words (Task 2).

RESULTS

HC group scores were significantly higher on Task 1, indicating more sensitivity to cues. On Task 2, TBI and HC group ratings differed across cue types and immediacy types, and the TBI group appeared to have less sensitivity to these cues.

CONCLUSIONS

Findings suggest that TBI-related impairments may reduce sensitivity to subtle social cues in text.

Facial emotion recognition of older adults with traumatic brain injury

OBJECTIVES

The objective of this study was to examine the effects of traumatic brain injury (TBI) and age on facial emotion recognition abilities in adults. Age and TBI were expected to have negative effects on emotion recognition and a TBI by age interaction was hypothesized such that older adults with TBI would have the lowest emotion recognition scores.

METHODS

A prospective cohort study was conducted. Participants were 26 adults with moderate-severe TBI (13 older and 13 younger) and 26 uninjured peers matched for age, sex, and education. Emotion recognition was measured using the Emotion Recognition Task, which is comprised of dynamically morphed facial expressions of the six basic emotions, presented at different intensity levels.

RESULTS

TBI and older age were associated with poorer recognition of both subtle and intense expressions, but only for expressions of anger and sadness. There was no interaction of age and TBI.

CONCLUSIONS

Results add to the growing evidence of emotion recognition impairments after TBI, particularly for select negative emotions, and extend this finding to adults over the age of 60. Further research is needed to better understand social cognitive effects of TBI across the adult lifespan.

Empathic Responses to Affective Film Clips Following Brain Injury and the Association With Emotion Recognition Accuracy

OBJECTIVE

To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and controls, and examine associations with affect recognition.

DESIGN

Cross sectional study using a quasi-experimental design.

SETTING

Multi-site study conducted at a postacute rehabilitation facility in the United States and a university in Canada.

PARTICIPANTS

Adults (N=120) with moderate to severe TBI (n=60) and those without TBI (n=60), frequency matched for age and sex. Average time postinjury was 14 years (range: .5-37).

MAIN OUTCOME MEASURES

Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling.

RESULTS

Participants with TBI had lower emotion recognition scores (P=.007) and fewer empathic responses than controls (67% vs 79%; P<.001). Participants with TBI accurately identified and empathically responded to characters' emotions less frequently (65%) than controls (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to controls. Affect recognition was associated with empathic responses in both groups (P<.001). When participants with TBI accurately recognized characters' emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions.

CONCLUSIONS

Participants with TBI were less likely to recognize and respond empathically to others' expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.

Sex differences in response to emotion recognition training after traumatic brain injury

OBJECTIVE

To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI).

SETTING

Post-acute rehabilitation facilities.

PARTICIPANTS

203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men).

DESIGN

Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist.

MEASURES

Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST).

RESULTS

A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention.

CONCLUSION

This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.

Prosodic processing post traumatic brain injury - a systematic review

BACKGROUND

Traumatic brain injury (TBI) survivors often report difficulties with understanding and producing paralinguistic cues, as well as understanding and producing basic communication tasks. However, a large range of communicative deficits in this population cannot be adequately explained by linguistic impairment. The review examines prosodic processing performance post-TBI, its relationship with injury severity, brain injury localization, recovery and co-occurring psychiatric or mental health issues post-TBI METHODS: A systematic review using several databases including MEDLINE, EMBASE, Cochrane, LLBA (Linguistics and Language Behaviour Abstract) and Web of Science (January 1980 to May 2015), as well as a manual search of the cited references of the selected articles and the search cited features of PubMed was performed. The search was limited to comparative analyses between individuals who had a TBI and non-injured individuals (control). The review included studies assessing prosodic processing outcomes after TBI has been formally diagnosed. Articles that measured communication disorders, prosodic impairments, aphasia, and recognition of various aspects of prosody were included. Methods of summary included study characteristics, sample characteristics, demographics, auditory processing task, age at injury, brain localization of the injury, time elapsed since TBI, reports between TBI and mental health, socialization and employment difficulties. There were no limitations to the population size, age or gender. Results were reported according to the PRISMA guidelines. Two raters evaluated the quality of the articles in the search, extracted data using data abstraction forms and assessed the external and internal validity of the studies included using STROBE criteria. Agreement between the two raters was very high (Cohen's kappa = .89, P < 0.001). Results are reported according to the PRISMA guidelines.

RESULTS

A systematic review of 5212 records between 1980 and 2015 revealed 206 potentially eligible studies and 8 case-control studies (3 perspective and 5 retrospective) met inclusion and exclusion criteria for content and quality. Performance on prosodic processing tasks was found to be impaired among all participants with a history of TBI (ages ranged from 8 to 70 years old), compared to those with no history of TBI, in all eight studies examined. Compared with controls, individuals with a history of TBI had statistically significantly slower reaction time in identifying emotions from prosody and impaired processing of prosodic information that is muffled, non-sense, competing, or in conflict (prosody versus semantics). Heterogeneous findings on correlations between specific brain locations and prosodic processing impairment were reported. Psychiatric issues, employment status or social integration post-TBI were scarcely reported but, when reported, they co-occurred with a history of TBI and prosodic impairments.

CONCLUSIONS

The current review confirms the relationship between impaired prosodic processing and history of TBI. Future studies should collect and report comprehensive details about severity of TBI, location of brain injury and time elapsed since injury, as they could key influence factors to the extent of prosodic processing impairments and recovery from auditory processing impairments post-TBI. The exploration of prosodic processing tasks as a possible neuropsychological marker of TBI diagnosis and recovery is warranted.

Labelling Facial Affect in Context in Adults with and without TBI

Recognition of facial affect has been studied extensively in adults with and without traumatic brain injury (TBI), mostly by asking examinees to match basic emotion words to isolated faces. This method may not capture affect labelling in everyday life when faces are in context and choices are open-ended. To examine effects of context and response format, we asked 148 undergraduate students to label emotions shown on faces either in isolation or in natural visual scenes. Responses were categorised as representing basic emotions, social emotions, cognitive state terms, or appraisals. We used students' responses to create a scoring system that was applied prospectively to five men with TBI. In both groups, over 50% of responses were neither basic emotion words nor synonyms, and there was no significant difference in response types between faces alone vs. in scenes. Adults with TBI used labels not seen in students' responses, talked more overall, and often gave multiple labels for one photo. Results suggest benefits of moving beyond forced-choice tests of faces in isolation to fully characterise affect recognition in adults with and without TBI.

Sex Differences in Emotion Recognition and Emotional Inferencing Following Severe Traumatic Brain Injury

The primary objective of the current study was to determine if men and women with traumatic brain injury (TBI) differ in their emotion recognition and emotional inferencing abilities. In addition to overall accuracy, we explored whether differences were contingent upon the target emotion for each task, or upon high- and low-intensity facial and vocal emotion expressions. A total of 160 participants (116 men) with severe TBI completed three tasks – a task measuring facial emotion recognition (DANVA-Faces), vocal emotion recognition (DANVA-Voices) and one measuring emotional inferencing (emotional inference from stories test (EIST)). Results showed that women with TBI were significantly more accurate in their recognition of vocal emotion expressions and also for emotional inferencing. Further analyses of task performance showed that women were significantly better than men at recognising fearful facial expressions and also facial emotion expressions high in intensity. Women also displayed increased response accuracy for sad vocal expressions and low-intensity vocal emotion expressions. Analysis of the EIST task showed that women were more accurate than men at emotional inferencing in sad and fearful stories. A similar proportion of women and men with TBI were impaired (≥ 2 SDs when compared to normative means) at facial emotion perception, χ2 = 1.45, p = 0.228, but a larger proportion of men was impaired at vocal emotion recognition, χ2 = 7.13, p = 0.008, and emotional inferencing, χ2 = 7.51, p = 0.006.

Identifying Core Affect in Individuals from fMRI Responses to Dynamic Naturalistic Audiovisual Stimuli

Recent research has demonstrated that affective states elicited by viewing pictures varying in valence and arousal are identifiable from whole brain activation patterns observed with functional magnetic resonance imaging (fMRI). Identification of affective states from more naturalistic stimuli has clinical relevance, but the feasibility of identifying these states on an individual trial basis from fMRI data elicited by dynamic multimodal stimuli is unclear. The goal of this study was to determine whether affective states can be similarly identified when participants view dynamic naturalistic audiovisual stimuli. Eleven participants viewed 5s audiovisual clips in a passive viewing task in the scanner. Valence and arousal for individual trials were identified both within and across participants based on distributed patterns of activity in areas selectively responsive to audiovisual naturalistic stimuli while controlling for lower level features of the stimuli. In addition, the brain regions identified by searchlight analyses to represent valence and arousal were consistent with previously identified regions associated with emotion processing. These findings extend previous results on the distributed representation of affect to multimodal dynamic stimuli.

Exploring the Use of Isolated Expressions and Film Clips to Evaluate Emotion Recognition by People with Traumatic Brain Injury

The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion expressions, and multimodal (i.e., film clips) stimuli that included contextual cues. All stimuli were presented via computer. Participants were required to indicate how the person in each stimulus was feeling using a forced-choice format. Additionally, for the film clips, participants had to indicate how they felt in response to the stimulus, and the level of intensity with which they experienced that emotion.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information

OBJECTIVE

Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings.

PARTICIPANTS

Fifteen adults with and 15 adults without severe TBI.

DESIGN

Repeated-measures between-groups design.

MAIN MEASURES

Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions.

RESULTS

Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group.

CONCLUSIONS

Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.