Lyn S. Turkstra

Facial-affect recognition deficit as a predictor of different aspects of social-communication impairment in traumatic brain injury.

Objective: To examine the relationship between facial-affect recognition and different aspects of self- and proxy-reported social-communication impairment following moderate−severe traumatic brain injury (TBI). Method: Forty-six adults with chronic TBI (>6 months postinjury) and 42 healthy comparison (HC) adults were administered the La Trobe Communication Questionnaire (LCQ) Self and Other forms to assess different aspects of communication competence and the Emotion Recognition Test (ERT) to measure their ability to recognize facial affects. Results: Individuals with TBI underperformed HC adults in the ERT and self-reported, as well as were reported by close others, as having more communication problems than did HC adults. TBI group ERT scores were significantly and negatively correlated with LCQ-Other (but not LCQ-Self) scores (i.e., participants with lower emotion-recognition scores were rated by close others as having more communication problems). Multivariate regression analysis revealed that adults with higher ERT scores self-reported more problems with disinhibition–impulsivity and partner sensitivity and had fewer other-reported problems with disinhibition–impulsivity and conversational effectiveness. Conclusions: Our findings support growing evidence that emotion-recognition deficits play a role in specific aspects of social-communication outcomes after TBI and should be considered in treatment planning.

Different aspects of facial affect recognition impairment following traumatic brain injury: The role of perceptual and interpretative abilities

ABSTRACT It is well established that many individuals with traumatic brain injury (TBI) are impaired at facial affect recognition, yet little is known about the mechanisms underlying such deficits. In particular, little work has examined whether the breakdown of facial affect recognition abilities occurs at the perceptual level (e.g., recognizing a smile) or at the verbal categorization stage (e.g., assigning the label “happy” to a smiling face). The aim of the current study was to investigate the integrity of these two distinct facial affect recognition subskills in a sample of 38 individuals with moderate-to-severe TBI and 24 demographically matched healthy individuals. Participants were administered an affect matching (perceptual skills) and an affect labeling (verbal categorization skills) task. Statistical analyses revealed that, while individuals with TBI showed significantly higher levels of impairment in the verbal categorization task than in the perceptual task, they performed less well than healthy comparison participants on both tasks. These findings indicate that facial affect recognition impairment can occur at different cognitive stages following TBI, suggesting the necessity of careful screening to offer targeted treatment. Moreover, they provide further neuropsychological evidence supporting the notion that distinct types of subskills are necessary to achieve successful recognition of facial affects.

Protocol for a prospective, school-based standardisation study of a digital social skills assessment tool for children: The Paediatric Evaluation of Emotions, Relationships, and Socialisation (PEERS) study

Background Humans are by nature a social species, with much of human experience spent in social interaction. Unsurprisingly, social functioning is crucial to well-being and quality of life across the lifespan. While early intervention for social problems appears promising, our ability to identify the specific impairments underlying their social problems (eg, social communication) is restricted by a dearth of accurate, ecologically valid and comprehensive child-direct assessment tools. Current tools are largely limited to parent and teacher ratings scales, which may identify social dysfunction, but not its underlying cause, or adult-based experimental tools, which lack age-appropriate norms. The present study describes the development and standardisation of Paediatric Evaluation of Emotions, Relationships, and Socialisation (PEERS®), an iPad-based social skills assessment tool. Methods The PEERS project is a cross-sectional study involving two groups: (1) a normative group, recruited from early childhood, primary and secondary schools across metropolitan and regional Victoria, Australia; and (2) a clinical group, ascertained from outpatient services at The Royal Children’s Hospital Melbourne (RCH). The project aims to establish normative data for PEERS®, a novel and comprehensive app-delivered child-direct measure of social skills for children and youth. The project involves recruiting and assessing 1000 children aged 4.0–17.11 years. Assessments consist of an intellectual screen, PEERS® subtests, and PEERS-Q, a self-report questionnaire of social skills. Parents and teachers also complete questionnaires relating to participants’ social skills. Main analyses will comprise regression-based continuous norming, factor analysis and psychometric analysis of PEERS® and PEERS-Q. Ethics and dissemination Ethics approval has been obtained through the RCH Human Research Ethics Committee (34046), the Victorian Government Department of Education and Early Childhood Development (002318), and Catholic Education Melbourne (2166). Findings will be disseminated through international conferences and peer-reviewed journals. Following standardisation of PEERS®, the tool will be made commercially available.

White matter correlates of different aspects of facial affect recognition impairment following traumatic brain injury

ABSTRACT Although facial affect recognition deficits are well documented in individuals with moderate-to-severe traumatic brain injury (TBI), little research has examined the neural mechanisms underlying these impairments. Here, we use diffusion tensor imaging (DTI), specifically the scalars fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD), to examine relationships between regional white-matter integrity and two facial affect sub-skills: perceptual affect recognition abilities (measured by an affect matching task) and verbal categorization of facial affect (measured by an affect labeling task). Our results showed that, within the TBI group, higher levels of white-matter integrity in tracts involved in affect recognition (inferior fronto-occipital, inferior longitudinal, and uncinate fasciculi) were associated with better performance on both tasks. Verbal categorization skills were specifically and positively correlated with integrity of the left uncinate fasciculus. Moreover, we observed a striking lateralization effect, with perceptual abilities having an almost exclusive relationship with integrity of right hemisphere tracts, while verbal abilities were associated with both left and right hemisphere integrity. The findings advance our understanding of the neurobiological mechanisms that underlie subcomponents of facial affect recognition and lead to different patterns of facial affect recognition impairment in adults with TBI.

Friendship Quality, Friendship Quantity, and Social Participation in Adults with Traumatic Brain Injury

&NA; Adults with traumatic brain injury (TBI) often report reduced social participation and loss of friends, but little is known about quality of friendship after TBI. Our objective was to characterize social participation, friendship quantity, and friendship quality of adults with TBI and a comparison group of uninjured adults. Participants included 18 adults with moderate to severe TBI and 16 of their informant friends; and 18 uninjured adults and 11 of their informant friends. The main measures used were the Participation Assessment with Recombined Tools‐Objective, the Social Network Questionnaire, and the McGill Friendship Questionnaire. Participants with TBI reported significantly less social participation and had fewer total friends, although this difference was not statistically significant. Adults with TBI differed from their friends on one measure of friendship quality, but reports for friendship quality were high in both groups. Adults with TBI reported overall high levels of friendship quality despite having lower levels of social participation compared with uninjured adults. Future research should investigate how the balance of quantity and quality of friendships relates to satisfaction with social participation and overall quality of life.

Nurses’ concerns about caring for patients with acute and chronic traumatic brain injury

AIMS AND OBJECTIVESnAs a first step in developing traumatic brain injury-specific nursing education, the purpose of this study was to investigate nurses concerns about caring for patients with moderate-to-severe traumatic brain injury.nnnBACKGROUNDnPatients with moderate-to-severe traumatic brain injury typically have significant immediate and chronic cognitive impairments. These cognitive impairments can negatively affect their inpatient stay after an acute traumatic brain injury and affect their health care later in life when seeking care for other acute health conditions during the chronic phase of traumatic brain injury. Nurses must be knowledgeable about modifying care to accommodate the cognitive impairments of these patients throughout the continuum of care. Yet, current guidelines focus exclusively on acute care and do not address nurses central role in dealing with residual cognitive impairments of these patients. Thus, educational and training interventions are needed to ensure nurses have adequate knowledge to care for these patients.nnnDESIGNnWe conducted a cross-sectional, exploratory survey of 692 nurses across hospital departments at three hospitals between October 2014-August 2015. Nurses answered the following qualitative open-ended question: What are your primary concerns about providing care to patients with moderate-to-severe traumatic brain injury?nnnMETHODSnConventional qualitative content analysis was used to analyse nurses responses.nnnRESULTSnFindings showed nurses reported multiple concerns about caring for patients in the acute phase after traumatic brain injury, but few concerns about caring for patients in the chronic phase. Some of the concerns nurses reported included: (i) preventing physical injury; (ii) missing changes in condition; (iii) providing adequate education; (iv) providing support; and (v) promoting recovery. Barriers to providing adequate care were as follows: (i) lack of knowledge; (ii) limited staffing; and (iii) inadequate resources.nnnCONCLUSIONSnFindings have implications for education of nurses and development of nursing guidelines for management of patients with traumatic brain injury, including providing direction for nurses on development of care plans for patients in the chronic phase after a moderate-to-severe traumatic brain injury.

Social-cue perception and mentalizing ability following traumatic brain injury: A human-robot interaction study

ABSTRACT Primary Objective: Research studies and clinical observations of individuals with traumatic brain injury (TBI) indicate marked deficits in mentalizing—perceiving social information and integrating it into judgements about the affective and mental states of others. The current study investigates social-cognitive mechanisms that underlie mentalizing ability to advance our understanding of social consequences of TBI and inform the development of more effective clinical interventions. Research Design: The study followed a mixed-design experiment, manipulating the presence of a mentalizing gaze cue across trials and participant population (TBI vs. healthy comparisons). Methods and Procedures: Participants, 153 adults, 74 with moderate-severe TBI and 79 demographically matched healthy comparison peers, were asked to judge a humanoid robot’s mental state based on precisely controlled gaze cues presented by the robot and apply those judgements to respond accurately on the experimental task. Main Outcomes and Results: Results showed that, contrary to our hypothesis, the social cues improved task performance in the TBI group but not the healthy comparison group. Conclusions: Results provide evidence that, in specific contexts, individuals with TBI can perceive, correctly recognize, and integrate dynamic gaze cues and motivate further research to understand why this ability may not translate to day-to-day social interactions.

Response to text-based social cues in the formation of causal attributions in adults with traumatic brain injury

ABSTRACT Background: Adults with traumatic brain injury (TBI) may have deficits recognizing spoken social cues, with major negative social consequences. We do not know if these deficits extend to written social cues. Written cues, such as letterhead, provide information we use to make critical inferences about an author’s perspective, and interpret subsequent text considering that perspective, and thus are critical for social communication. This study examined response to written social cues in adults with and without TBI. Methods and procedures: We asked adults with TBI (n = 38) and uninjured adults (n = 20) to read an article describing actions of a mass murderer and give reasons for the those actions. Materials were presented on letterhead from either a social or a personality institute, to bias responses to either situational or dispositional factors. We hypothesized persons with TBI would be less likely to show bias consistent with the letterhead. Main outcomes and results: Significantly more comparison-group responses (72%) than TBI-group responses (52%) were biased (p = 0.01) to match the institute in the letterhead. Conclusions: Results indicated reduced sensitivity to written social cues in adults with TBI. Our findings add to evidence of impaired social cue response after TBI, and extend this to written text.

Functional neural correlates of facial affect recognition impairment following TBI

Facial affect recognition deficits following traumatic brain injury (TBI) have been well documented, as has their relationship with impairment in several other cognitive domains. However, little is known about the neurobiological mechanisms underlying affect recognition deficits, in particular mechanisms underlying different aspects of facial affect recognition (e.g., perceptual and interpretive processes). In the current study, 33 adults with moderate-to-severe TBI and 24 demographically matched healthy comparison (HC) participants completed an fMRI facial affect recognition study. While in the scanner, participants were asked to match the affect of a target face to either (a) one of two faces differing in affect (perceptual condition) or (b) one of two written affect labels (interpretative condition). In both groups we found activations in regions typically involved in affect recognition. Our results revealed that in the perceptual condition individuals with TBI tended to activate the left dorsolateral prefrontal cortex less than HCs, and within the HC group individuals with higher perceptual affect recognition scores showed higher levels of activation in the same brain region. Individuals with TBI who were specifically impaired at interpretative affect recognition showed less activation than HCs in the right fusiform gyrus. Moreover, in the labeling condition individuals with TBI tended to de-activate medial prefrontal regions less than HCs. A region of interest analysis revealed that individuals with TBI showed significantly less activation than HCs in the FFA for all the contrasts of interest. Our results suggest involvement of several brain regions in facial affect recognition impairment post TBI, and provide neurobiological support for the notion that distinct aspects of facial affect recognition can be differentially impaired following TBI.

A Theory-Driven System for the Specification of Rehabilitation Treatments

The field of rehabilitation remains captive to the black-box problem: our inability to characterize treatments in a systematic fashion across diagnoses, settings, and disciplines, so as to identify and disseminate the active ingredients of those treatments. In this article, we describe the Rehabilitation Treatment Specification System (RTSS), by which any treatment employed in rehabilitation may be characterized, and ultimately classified according to shared properties, via the 3 elements of treatment theory: targets, ingredients, and (hypothesized) mechanisms of action. We discuss important concepts in the RTSS such as the distinction between treatments and treatment components, which consist of 1 target and its associated ingredients; and the distinction between targets, which are the direct effects of treatment, and aims, which are downstream or distal effects. The RTSS includes 3 groups of mutually exclusive treatment components: Organ Functions, Skills and Habits, and Representations. The last of these comprises not only thoughts and feelings, but also internal representations underlying volitional action; the RTSS addresses the concept of volition (effort) as a critical element for many rehabilitation treatments. We have developed an algorithm for treatment specification which is illustrated and described in brief. The RTSS stands to benefit the field in numerous ways by supplying a coherent, theory-based framework encompassing all rehabilitation treatments. Using a common framework, researchers will be able to test systematically the effects of specific ingredients on specific targets; and their work will be more readily replicated and translated into clinical practice.