Rodger Ll. Wood

Change in relationship status following traumatic brain injury

Previous studies have highlighted the burden placed on family members and close partners of individuals who have sustained traumatic brain injury. This burden of stress has been attributed to the neurobehavioural sequelae of such injuries. However, the extent to which brain injury affects marriages and close relationships has never been statistically evaluated. This study looked at 131 adults with traumatic brain injury in order to determine the incidence of divorce/separation; 49 per cent of our sample reported that they had divorced or separated from their partners during a 5-8-year period following brain injury. Factors which may predict the outcome of relationships include severity of injury (as determined by length of post-traumatic amnesia), length of relationship, and time since injury. The influence of these factors in determining the risk of relationship breakdown is discussed.

Demographic and cognitive predictors of long-term psychosocial outcome following traumatic brain injury

Demographic factors and cognitive impairment have been found previously to have associations with outcome after brain injury. Kendall and Terry (1996) suggest that preinjury psychosocial functioning, neurological factors, and cognitive impairment have a direct relationship with multidimensional psychosocial adjustment, but that cognitive impairment also has an indirect relationship by means of the mediation of appraisal and coping variables. The aim of this study was to explore these theoretical relationships at very late stages of recovery after brain injury. A total of 131 participants who were more than 10 years after injury (mean = 15.31 yr) completed a neuropsychological assessment, plus outcome measures that included employment status, community integration, life satisfaction, quality of life (QoL), and emotion. Results indicated that injury severity was predictive of life satisfaction; gender and relationship status predicted community integration; and age at injury predicted employment status. Impairment in working memory directly predicted all outcomes except QoL and anxiety. An indirect relationship was also evident between working memory, life satisfaction, and depression. Results partially support Kendall and Terrys model but the variables that significantly influence outcome seem to be determined by the outcome dimensions selected.

Alexithymia and emotional empathy following traumatic brain injury

The frequency of alexithymia and the proportion of cases reporting low emotional empathy after traumatic brain injury (TBI) were compared with a control group. The study also examined the relationship between alexithymia and emotional empathy, controlling for the influence of cognitive ability, severity of head injury, and time since injury. A total of 64 TBI patients and matched controls completed the 20-Item Toronto Alexithymia Scale (TAS-20) and Balanced Emotional Empathy Scale (BEES). The TBI group exhibited a significantly higher frequency of alexithymia (60.9%) and low emotional empathy (64.4%) than did the control group (10.9% and 34.4%). Significant moderate negative correlations were found between TAS-20 and BEES scores, with TAS-20 total scores accounting for a significant amount of variance in BEES scores. However, no significant correlation was obtained between Subscale 1 of the TAS-20 (difficulty identifying feelings) and BEES scores in the TBI group. Additionally, there were no significant relationships between alexithymia, emotional empathy, injury severity, and time since injury. The results suggest an inverse relationship between alexithymia and emotional empathy.

Inability to empathize following traumatic brain injury.

This study examines: (a) the impact of traumatic brain injury (TBI) on emotional empathy, (b) the relationship between emotional empathy and neuropsychological ability, and (c) the influence of low emotional empathy on measures of affect. Eighty-nine patients completed the Balanced Emotional Empathy Scale (BEES), a number of neuropsychological tests, some of which were ecologically valid tests of executive ability, plus two measures of affect, the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The TBI cohort showed a high frequency (60.7%) of low emotional empathy scores compared to the control group (31%). There was no relationship between injury severity and the ability to empathize, or between emotional empathy and neuropsychological performance. There was no evidence to suggest that low scores on affective measures influenced emotional empathy scores. A high proportion of TBI patients lack the ability to empathize, but the deficit does not appear related to any specific cognitive impairment and cannot be predicted by measures of affect.

Neuropsychological correlates of organic alexithymia.

Deficits in emotional recognition and perception following traumatic brain injury (TBI) have been associated with alexithymia (Henry et al., 2006; Williams et al., 2001). This study examined the prevalence of alexithymia in a TBI population, and its relationship to injury severity, neuropsychological ability and affective disorder. A total of 121 patients completed the Toronto Alexithymia Scale-20 (TAS-20), a measure that addresses 3 distinct characteristics of the alexithymia concept; difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. Patients also completed a neuropsychological assessment and measures of depression and anxiety. Results confirm a high prevalence of alexithymia after TBI, relative to the general population and an orthopedic control group. There was no relationship between injury severity and the presence of alexithymia. A negative relationship was found between alexithymia and verbal and sequencing abilities, but there was no relationship with executive dysfunction or any other cognitive domain. Moderate correlations were obtained between alexithymia and affective disorder; regression analyses indicated that alexithymia, depression, and anxiety should be considered distinct, but overlapping constructs. The results of this study suggest that increased neuropsychological attention should be directed towards emotional change after head injury and its relationship with cognition and psychosocial outcome.

Using a temporal discounting paradigm to measure decision-making and impulsivity following traumatic brain injury: A pilot study

Primary objective: This study reports on a pilot study using a temporal discounting paradigm and a standardized impulsivity questionnaire to examine decision-making in a group of brain injured patients and age matched controls. Methods and procedures: Participants were asked to choose between a larger reward available at a specified time in the future and smaller reward available immediately. Outcome and results: Each of the two groups demonstrated temporal discounting; that is, the subjective value of the reward decreased with increasing delay. However, the TBI group discounted more than the controls, suggesting that their decision-making was more impulsive. Conclusion: The results suggest that a temporal discounting paradigm might be a useful method of assessing decision-making after head trauma, especially in cases where capacity to make decisions about financial awards is an issue or in respect of money management generally.

Evaluating A Theory of Stress and Adjustment When Predicting Long Term Psychosocial Outcome After Brain Injury

Kendall and Terry (1996) include many psychosocial predictors in their theoretical model that explains individual differences in psychosocial adjustment (Lazarus & Folkman, 1984). The model depicts appraisal and coping variables as mediating relationships between situation factors, environmental and personal resources, and multidimensional outcome. The aim of this study was to explore these theoretical relationships at very late stages of recovery from traumatic brain injury. A total of 131 participants who were more than 10 years post-injury (mean = 15.31 years) completed several psychosocial measures relating to outcome dimensions comprising employment, community integration, life satisfaction, quality of life (QoL), and emotion. There was no evidence that appraisal and coping variables mediated relationships between psychosocial and any of the outcome variables. However, when appraisal and coping variables were combined with psychosocial variables as direct predictors of outcome, every outcome except employment status was reliably predicted, accounting for between 31 and 46% of the variance. Personality significantly influenced all predicted outcomes. Self-efficacy contributed to the prediction of all outcomes except QoL. Data did not support for the theory of stress and adjustment as a framework for explaining the nature of predictive relationships between psychosocial variables and very long-term, multidimensional outcome after brain injury.

Long-term effect of head trauma on intellectual abilities: a 16-year outcome study

Background: Intelligence was assessed in a group of 74 people with head injury, 16 years after injury (mean 16.77 years; range 10–32 years), and compared with their performance when assessed at an early stage in recovery (mean 1.05 years). Aims: To confirm the presence of long-term impairment relative to estimates of pre-accident ability, to confirm signs of deterioration between early (T1) and late (T2) measures, and to examine relationships between severity of injury, time since injury, length of education, sex and age, and performance on intelligence tests at T2. Expected outcomes: On the basis of evidence from other studies, a significant difference was expected between estimates of pre-accident intelligence and abilities measured at T1 and T2. Deterioration in performance between T1 and T2, and relationships between demographic variables, severity of injury and intellectual performance were also expected. Results and conclusion: The data supported long-term intellectual impairment, but there was no deterioration in abilities between T1 and T2. Performance on intelligence tests was associated with years of education but not with other factors.

The relationship between general intellectual ability and performance on ecologically valid executive tests in a severe brain injury sample

Recent studies of brain injured and healthy individuals have provided empirical support for the theoretical proposition that executive function and general intelligence are closely associated by demonstrating that performance on tests of executive function is correlated with general intellectual ability (g). In the present investigation, the relationship between performance on the Wechsler Adult Intelligence Scale-III (WAIS-III), as a measure of g, and performance on recently developed ecological tests of executive function [i.e., Hayling and Brixton, Zoo Map and Key Search sub-tests from the Behavioral Assessment of the Dysexecutive Syndrome (BADS) battery], was examined in a sample of 118 severely brain injured individuals. The results indicated that (a) performance on tests of executive function share significant variance, and (b) a proportion of that shared variance is associated with performance on the WAIS-III. Correlations between conventional measures of executive function (i.e. Trails B and Controlled Oral Word Association) and WAIS-III were of comparable magnitude to the correlations between new, ecologically valid executive tests and WAIS-III. The results provide some support to the notion that tests of executive function measure non-specific intellectual functions, reminiscent of g.

Impairment in the recognition of emotion across different media following traumatic brain injury

The current study examined emotion recognition following traumatic brain injury (TBI) and examined whether performance differed according to the affective valence and type of media presentation of the stimuli. A total of 64 patients with TBI and matched controls completed the Emotion Evaluation Test (EET) and Ekman 60 Faces Test (E-60-FT). Patients with TBI also completed measures of information processing and verbal ability. Results revealed that the TBI group were significantly impaired compared to controls when recognizing emotion on the EET and E-60-FT. A significant main effect of valence was found in both groups, with poor recognition of negative emotions. However, the difference between the recognition of positive and negative emotions was larger in the TBI group. The TBI group were also more accurate recognizing emotion displayed in audiovisual media (EET) than that displayed in still media (E-60-FT). No significant relationship was obtained between emotion recognition tasks and information-processing speed. A significant positive relationship was found between the E-60-FT and one measure of verbal ability. These findings support models of emotion that specify separate neurological pathways for certain emotions and different media and confirm that patients with TBI are vulnerable to experiencing emotion recognition difficulties.