Duncan R. Babbage

Meta-Analysis of Facial Affect Recognition Difficulties After Traumatic Brain Injury

OBJECTIVE Difficulties in communication and social relationships present a formidable challenge for many people after traumatic brain injury (TBI). These difficulties are likely to be partially attributable to problems with emotion perception. Mounting evidence shows facial affect recognition to be particularly difficult after TBI. However, no attempt has been made to systematically estimate the magnitude of this problem or the frequency with which it occurs. METHOD A meta-analysis is presented examining the magnitude of facial affect recognition difficulties after TBI. From this, the frequency of these impairments in the TBI population is estimated. Effect sizes were calculated from 13 studies that compared adults with moderate to severe TBI to matched healthy controls on static measures of facial affect recognition. RESULTS The studies collectively presented data from 296 adults with TBI and 296 matched controls. The overall weighted mean effect size for the 13 studies was -1.11, indicating people with TBI on average perform about 1.1 SD below healthy peers on measures of facial affect recognition. Based on estimation of the TBI population standard deviation and modeling of likely distribution shape, it is estimated that between 13% and 39% of people with moderate to severe TBI may have significant difficulties with facial affect recognition, depending on the cut-off criterion used. CONCLUSION This is clearly an area that warrants attention, particularly examining techniques for the rehabilitation of these deficits.

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 ones 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.

Affect Recognition, Empathy, and Dysosmia After Traumatic Brain Injury

OBJECTIVE To investigate if olfaction is associated with affect recognition and empathy deficits after traumatic brain injury (TBI). Prior research has shown that TBI often leads to loss of smell. We hypothesized a relationship with emotion perception, because the neural substrates of the olfactory system overlap with the ventral circuitry of the orbital frontal cortex, which play a critical role in affective responses, such as empathy. DESIGN Comparative study investigating differences between participants with TBI who had impaired olfaction (dysosmia) with those with normal olfaction (normosmia). SETTING Postacute rehabilitation facilities in the United States, Canada, and New Zealand. PARTICIPANTS Participants (N=106) in the current study were a convenience sample of adults with moderate to severe TBI who were tested for olfactory function as part of a larger, related study on affect recognition. On average, participants were 11.5 years postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Olfaction (Brief Smell Identification Test), facial affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Faces [DANVA2-AF]), vocal affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Paralanguage [DANVA2-AP]), emotional inference (Emotional Inference from Stories Test [EIST]), and empathy (Interpersonal Reactivity Index [IRI]). RESULTS Fifty-six percent of participants were dysosmic and only 36% of these participants were aware of their deficit. Participants with dysosmia performed significantly poorer on the DANVA2-AF (P=.003), DANVA2-AP (P=.007), EIST (P=.016), and IRI (P=.013). Medium effect sizes were found for all measures. Dysosmia had a sensitivity value of 86.4% for detecting facial affect recognition impairments and 67.8% for vocal affect recognition impairments. CONCLUSIONS This study shows that olfactory deficits may be indicative of affect recognition impairments and reduced empathy. Early knowledge of affect recognition and empathy deficits would be valuable so that treatment could be implemented predischarge.

Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a persons ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a persons executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

The importance of vocal affect to bimodal processing of emotion: Implications for individuals with traumatic brain injury

UNLABELLED Persons with traumatic brain injury (TBI) often have difficulty recognizing emotion in others. This is likely due to difficulties in interpreting non-verbal cues of affect. Although deficits in interpreting facial cues of affect are being widely explored, interpretation of vocal cues of affect has received much less attention. Accurate interpretation of vocal affect cues is important, particularly when facial cues are absent or ambiguous. These cues also contribute to more accurate identification of emotion. The neural substrates of facial and vocal affect recognition appear to be shared, further contributing to improved bimodal processing. This article discusses the importance of vocal affect cues in interpreting emotion. Expression of vocal affect in persons with TBI is also briefly discussed since difficulty in controlling and manipulating vocal cues of emotion when speaking may also contribute to poor social outcomes. A review of the literature in acoustic parameters that contribute to identification and expression of emotions is followed by a discussion on the integration of visual and auditory cues in bimodal processing and the relationship between facial and vocal affect in persons with TBI. LEARNING OUTCOMES Readers will be able to: 1) Identify the parameters primarily used to describe the acoustic characteristics of vocal affect; 2) Describe the acoustic parameters typically associated with Anger, Fear, Happiness and Sadness; 3) Describe the difficulties experienced by persons with TBI in the perception and integration of facial and vocal cues of affect.

A randomized controlled trial of emotion recognition training after traumatic brain injury.

Objective:To examine the effectiveness of 2 affect recognition interventions (Faces and Stories) in people with a traumatic brain injury. Setting:Postacute rehabilitation facilities. Participants:A total of 203 participants with moderate to severe traumatic brain injury were screened; 71 were eligible and randomized to the Faces (n = 24), Stories (n = 23), and Control interventions (n = 24). Participants were an average of 39.8 years of age and 10.3 years postinjury; 74% of participants were male. Design:Randomized controlled trial with immediate, 3-month, and 6-month follow-up posttests. Interventions were 9 hours of computer-based training with a therapist. Measures:Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces; Emotional Inference From Stories Test; Empathy (Interpersonal Reactivity Index); and Irritability and Aggression (Neuropsychiatric Inventory). Results:The Faces Intervention did significantly better than the Control Intervention on the Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces (P = .031) posttreatment; no time effect or group interaction was observed. No other significant differences were noted for the Faces Intervention. No significant differences were observed between the Stories and the Control Interventions; however, a significant time effect was found for the Emotional Inference From Stories Test. Conclusion:The Faces Intervention effectively improved facial affect recognition in participants with chronic post–traumatic brain injury, and changes were maintained for 6 months. Future work should focus on generalizing this skill to functional behaviors.

The relationship between facial affect recognition and cognitive functioning after traumatic brain injury

Abstract Primary objective: There is considerable evidence suggesting facial affect recognition and cognitive functions are impaired in many people with moderate-to-severe traumatic brain injury (TBI). However, little is known about the relationship between these two domains in the TBI population. Research design: This study investigated the relationship between facial affect recognition and cognitive functioning in 75 adults with moderate-to-severe TBI. Methods and procedures: Participants were administered three facial affect recognition tests and a computerized cognitive test battery that assessed seven cognitive domains. Main outcomes and results: Deficits in facial affect recognition were significantly correlated with impairments in non-verbal memory, working memory, speed of processing, verbal memory and verbal delayed memory. No significant relationship was found between executive dysfunction and facial affect recognition impairments. Non-verbal memory, working memory and speed of processing significantly predicted overall facial affect recognition performance. Conclusions: It is concluded that impairment in several cognitive processes may contribute to facial affect recognition deficits in TBI, in particular non-verbal memory, working memory and speed of processing. Furthermore, executive functioning may not be a critical factor in facial affect recognition, but would most likely be important in deciding what to do once facial affect is perceived. Trial registration: ClinicalTrials.gov identifier: NCT00283153.

Philosophical worldview and personality factors in traditional and social scientists: studying the world in our own image

Abstract The relationship between organismic vs mechanistic worldviews, scientific predilections, and personality in a sample of academics in the social and traditional sciences was investigated. The current study examined these relationships in light of recent personality theory—the Big Five trait taxonomy. Social scientists were found to be more organismically-oriented, while traditional scientists were more mechanistically-oriented. Females were more organismically-oriented; males, mechanistically-oriented. Worldview was significantly related to coherent sets of personality features. This is the first research evidence that has found a demonstrated link between personality and philosophical worldview factors and one’s broader scientific pursuit (traditional vs social science). The extension of this research to examine the development of philosophical worldview and personality, and some practical implications of differences in philosophical worldview in scientific life, are discussed.

Affective disorders after traumatic brain injury : cautions in the use of the symptom checklist-90-R

Design: The current study compared the Symptom Checklist 90—Revised (SCL-90-R) results from a population of 88 individuals with traumatic brain injury (TBI) to those of a normative group. Setting: Individuals with traumatic brain injury referred to a university-based psychology clinic. Results: Results corroborated those from a smaller study, 1 where a considerable proportion of the elevations found on the subscales was attributed to endorsement of items identified as having a neurological basis. Conclusion: This reinforces the view that the results of neurological groups on clinical measures of emotional distress that have been standardized on physically healthy populations can be distorted because many of the items can be answered from physical and emotional perspectives.

Recognition of facial and vocal affect following traumatic brain injury

Abstract Objective: Studies of facial affect recognition by people with traumatic brain injury (TBI) have shown this to be a significant problem. Vocal affect recognition also appears to be challenging for this population, but little is known about the degree to which one modality is impaired compared to the other. This study compared facial and vocal affect recognition of high and low intensity emotion expressions in people with moderate-to-severe TBI. Methods: The Diagnostic Analysis of Nonverbal Accuracy-2 (Adult Faces; Voices) was administered to 203 participants with TBI. Results: Adults with TBI identified vocal emotion expressions with greater accuracy than facial emotion expressions. Facial affect recognition impairment was identified in 34% of participants, 22% were classified as having vocal affect recognition impairment and 15% showed impairment in both modalities. Participants were significantly less accurate at identifying low vs high intensity emotion expressions in both modalities. Happy facial expressions were significantly better identified than all other emotions. Errors were distributed across the emotion categories for vocal expressions. Conclusions: The degree of facial affect impairment was significantly greater than vocal affect impairment in this sample of people with moderate-to-severe TBI. Low intensity emotion expressions were particularly problematic and an advantage for positively valenced facial emotion expressions was indicated.