When diplomacy fails: difficulty understanding hints following severe traumatic brain injury

Abstract

Background: In the absence of aphasia, many people with severe traumatic brain injuries (TBI) have difficulty with communication. In particular, they have difficulty understanding conversational inference. Poor social cognition is also prevalent following TBI. Aims: This study aimed to examine the role of social cognition in the ability to recognise conversational inference in the form of hints. Methods and procedures: 31 adults (22 men: mean age 45 years) with chronic (mean time since injury = 15.12 years) and severe TBI (mean post traumatic amnesia (PTA) of 32.74 days) and 24 adults (14 men: mean age 46.1 years) from the community participated. They were compared for their comprehension of two kinds of video vignettes in which professional actors made progressively more explicit hints. In one version, the conversational tone was neutral, in the other emotional. They were also assessed on an independent measure of social cognition (TASIT).Outcomes & results: The adults with TBI recognised neutral hints at a normal rate but, unlike the community controls, were not facilitated by overtly emotional hints. Social cognition performance was related to performance on both types of hint. Improved performance on the emotional hints was not uniquely predicted by social cognition but, rather, by processing speed and possibly also stress in the group with TBI. Conclusions: People with TBI appear to have difficulty using emotional cues to infer speaker meaning. This may reflect cognitive slowing and also anxiety and stress. This has implications for both remediation of such deficits and for educating others who interact with people with TBI.

What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations

“…(230)]. It has been used to demonstrate social cognitive impairment in Alzheimer’s disease (231, 232), frontotemporal dementia (206, 233, 234), semantic dementia (235), schizophrenia (236–238), first-episode psychosis (239), attention deficit-hyperactivity disorder (240), depression (241), ASD (242), bipolar disorder (209), Huntington’s disease (243), traumatic brain injury (68, 244), multiple sclerosis (245), neurofibromitosis (246), agenesis of the corpus callosum (247), and groups featuring substance misuse (248, 249).…”

Social Behavior and Impairments in Social Cognition Following Traumatic Brain Injury

“…Channon, Pellijeff, and Rule (2005) previously reported impaired performance on this task in patients with TBI. McDonald, Fisher, and Flanagan (2015) found no impairment in participants with TBI on an audiovisual version of the task.…”

Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury

“…Speed of processing is frequently impaired following ABI and has been found to adversely affect many aspects of communication including social communication (103,152,153), reading comprehension (154), and discourse (18). Speed of processing is critical to the ability to process complex social interaction, facial expressions, conversational hints, interjections, and contextual influences, not only to keep pace with the complex processing of social situations (103,154,155) but also to inhibit unwanted behaviours in a timely fashion (152). Slower processing after ABI has also been well documented during completion of complex communication tasks that simulate the tasks of work, school, or community interaction (19,32,33).…”