Tracey McLellan

Public knowledge of 'concussion' and the different terminology used to communicate about mild traumatic brain injury (MTBI).

Primary objective: The primary objective was to investigate the publics general knowledge about concussion (mild traumatic brain injury) and to examine whether terminology influenced attributions made about individuals who experience concussion. Design: A random selection of the community was polled to identify public understanding of concussion. To encourage candid responses, a self-report survey method was used. Methods and procedures: One hundred and three members of the general public were asked to indicate if they associated specific attributes with brain injury or head injury, depending on the randomly assigned questionnaire they completed. Participants also completed a questionnaire about their knowledge of concussion and were asked to indicate whether they or someone they knew had experienced an injury to the head. Main outcomes and results: Participants incorrectly evaluated 20% (2/10) of statements regarding concussion knowledge and were relatively uncertain about another 20% (2/10) of statements. Negative attributes were associated more with brain than head injury, although those with prior experience made more positive attributions than those without. Fifty-nine per cent of participants who had experienced a concussion stated they had no brain/head injury. Conclusions: Overall, public knowledge about concussion and different terminology associated with this injury type is substantially inaccurate. More accurate information is required to increase understanding.

Sensitivity to genuine versus posed emotion specified in facial displays

Two experiments were performed to investigate whether social perceivers were sensitive to the veracity of sad and fear facial displays as well as happiness. In Experiment 1, participants were asked to consider in blocks whether targets were happy or not, sad or not, fearful or not. Triads of photographs (neutral, posed, genuine) were displayed and results showed participants were sensitive to whether each emotion was present and distinguished posed from genuine displays. This sensitivity was emotion specific. In Experiment 2, participants completed a priming task to eliminate instructions to judge target displays. Neutral, posed and genuine displays from a single target were used as primes in a word valance identification task. The results revealed faster responding to positive words following genuine than posed happiness and faster responding to negative words following genuine than posed fear. Together the two experiments demonstrated perceiver sensitivity to negative emotion in an explicit and implicit context.

A comparison of adult outcomes for males compared to females following pediatric traumatic brain injury

OBJECTIVE To identify the association between traumatic brain injury (TBI) and internalizing and externalizing problem behaviors and determine if these apply equally to males and females. METHOD The association between adult psychosocial functioning and childhood TBI for males and females was examined using groups with a history of childhood TBI (mild or moderate/severe) or orthopedic injury (injury age, 1-17, assessed 18-31 at >5 years postinjury), including rates of depression and anxiety disorders, substance abuse/dependence and offending behavior. Repeated-measures logistic regression was used to determine if the rates of internalizing and externalizing problem behaviors varied by group and sex. RESULTS Overall rates of problem behaviors were significantly greater for both moderate/severe TBI (OR = 4.00) and mild TBI (OR = 3.60) groups compared with orthopedic controls. Females were significantly more likely than males to report a history of internalizing problems (OR = 2.22), whereas males were more likely than females to report externalizing problems (OR = 2.10). The sex difference in internalizing/externalizing problems was found consistently across TBI groups and controls. CONCLUSIONS Childhood TBI is associated with psychosocial problems in adulthood, regardless of injury severity. How deficits are expressed differs between the sexes, with important implications for interventions strategies.

Sensitivity to posed and genuine displays of happiness and sadness: A fMRI study

The ability to distinguish posed from genuine facial displays of emotion and to act accordingly is a fundamental social skill. To investigate the neural correlates underpinning this sensitivity, we compared changes in brain activity associated with judging posed and genuine facial displays of happiness and sadness using fMRI. Photographs of displays were presented to 7 right-handed females who judged whether the person was feeling the target emotion and made yes/no responses. Results showed activity increases during the observation of genuine compared to posed happy displays in the left medial superior frontal gyrus (BA 9) and the middle cingulate cortex bilaterally (BAs 24 and 31). The same comparison for sad displays showed increased activity in the left medial superior frontal gyrus (BA 8), and in the right middle and triangular inferior frontal gyri (both BA 46). Participants who exhibited higher sensitivity to sad displays showed larger activity difference in the left medial superior frontal gyrus (BA 8). The present study provides evidence of differential neural activity when judging posed versus genuine facial displays of emotions. Further research is required to elucidate how this might impact social affective neuroscience and in what ways genuine facial displays can enhance our understanding of emotion perception.

Sensitivity to emotion, empathy and theory of mind: Adult performance following childhood TBI

Abstract Primary objective: To examine deficits in emotion perception for adults who had experienced a traumatic brain injury (TBI) during childhood and investigate relationships between emotion perception skills, empathy and Theory of Mind (ToM). Design: Participants consisted of a random selection of individuals (n = 52) who had previously been recruited for a larger study. All participants had experienced an injury event as a child (0–17 years) (mild TBI, moderate/severe TBI or fractured limb) and were now aged between 18–30 years, with a minimum of 5 years post-injury. Methods and procedure: Each participant completed an emotion-sensitivity task, facial expression recognition task, the faux pas test (ToM) and the Interpersonal Reactivity Inventory (IRI: Empathy). Main outcomes: Individuals with moderate/severe TBI were less sensitivite to emotion and less accurate at facial expression recognition than those with mild TBI and orthopaedic controls. Difficulty with affective ToM but not empathy was also found. The emotion-sensitivity and the facial expression recognition tasks were unrelated, with only emotion sensitivity but not expression recognition related to ToM and IRI empathy. Conclusions: The current findings indicated that deficits in social skills are long lasting and raises the issue of whether intervention to improve sensitivity to genuine emotion can influence more complex social skills and improve quality of social interactions for individuals following TBI.

Does the way concussion is portrayed affect public awareness of appropriate concussion management: the case of rugby league

It is important to identify factors that might adversely affect appropriate medical consultation and management of concussion. One factor that might present a barrier to timely intervention is media portrayal of concussion in sporting events, such as professional rugby league. Accordingly, the current study employed a surveillance method of publicly available broadcast information to establish the incidence rate of probable concussion in the National Rugby Leagues Telstra Premiership 2010 season and examined how these injury events were shown to be managed with respect to return-to-play procedures. The incident rate for probable concussion was higher than previously reported: 11.10\1000 player hours (95% CI 5.78 to 16.40) and was likely underestimated. Importantly, most injured players were shown to continue playing or return to play despite being visibly concussed and described as such by the commentary team. Although ‘return-to-play decisions’ for professional players are guided by medical assessment, the authors discuss whether the way concussion is portrayed might affect public awareness of appropriate concussion management.

Predicting adult offending behavior for individuals who experienced a traumatic brain injury during childhood

Objectives:To examine whether individuals who experienced a childhood traumatic brain injury (TBI) are at increased risk for subsequent offending behavior, to identify the emotional characteristics of adults who experienced childhood TBI, and to examine whether these predict offending behavior. Participants:Individuals from the Canterbury region who had experienced a childhood (<18 years of age) injury event and were now 18 years or older and more than 5 years postinjury (between 18 and 30 years of age). Three groups were formed: (1) moderate/severe TBI (n = 62); (2) mild TBI (n = 58); and (3) fracture control group (n = 38). Setting:University of Canterbury. Main Measures:A semistructured interview assessed lifetime involvement in offending behavior; the Emotional Behavior Scale measured internalizing and externalizing behaviors, including malevolent aggression, social anxiety, and social self-esteem. Results:Compared with controls, there was an increased risk of offending behavior (mild TBI: odds ratio = 8.7; moderate/severe TBI odds ratio = 20.4). Binary logistic regression analysis revealed that the strongest predictors of offending behavior were TBI status, higher levels of malevolent aggression, and age at injury. Conclusions:Individuals who experienced childhood TBI are at increased risk of offending behavior. Emotional behavior measures were useful predictors of offending behavior, offering opportunity for intervention.

Traumatic brain injury and adverse life events: Group differences in young adults injured as children

Abstract Objectives: To investigate whether individuals with a history of traumatic brain injury (TBI) experience a greater number of adverse life events (ALE) compared to controls, to identify significant predictors of experiencing ALE and whether the severity of childhood TBI negatively influences adult life outcomes. Design: A total of 167 individuals, injured prior to age 18, 5 or more years post-injury and 18 or more years of age, were recruited in the Canterbury region of New Zealand, with 124 having sustained childhood TBI (62 mild, 62 moderate/severe) and 43 orthopaedic injury controls. Participants were asked about ALE they had experienced and other adult life outcomes. Results: Individuals with a history of TBI experienced more ALE compared to controls. The number of ALE experienced by an individual was associated with more visits to the doctor, lower education level and lower satisfaction with material standard of living. Conclusions: Childhood TBI is associated with an increased number of ALE and adult negative life outcomes. Understanding factors that contribute to negative outcomes following childhood TBI will provide an avenue for rehabilitation and support to reduce any problems in adulthood.

Self versus Family Ratings of the Frontal Systems Behaviour Scale and Measured Executive Functions: Adult Outcomes following Childhood Traumatic Brain Injury

Traumatic brain injury (TBI) frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0), mild TBI (N=20; mean age, 21.7, SD=2.7), and control (N=14: mean age, 21.6, SD=3.7). Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe), consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05). Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05). Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001). While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001), our results showed that self-ratings were of higher predictive utility for executive functioning compared with family ratings. Further, at 10 years post-TBI, patients show greater awareness of deficits compared with family who rate consistently closer to the normal functioning range.

Sports Media Representations of Concussions in the National Rugby League: Sports media representation of concussion

Objective Concussion is poorly understood by the general public who are regularly exposed to this type of injury via televised sports such as the National Rugby League (NRL). This study investigated media representations of concussion by examining the terminology used by the commentators during the 2010 and 2011 NRL seasons. Method Data was obtained through a surveillance design where commentary statements were recorded for each observable concussion. Results Dramatic terminology was the most frequently used followed by entertaining and humorous terminology. Commentators often portrayed the way the incident had occurred and the players reaction to being concussed. However, information about a player sustaining an injury that required medical attention was rarely conveyed. Conclusion Media tend to trivialise concussion and this may have an impact on the publics knowledge of, and influence their response to, concussion.