Participation after traumatic brain injury: the surplus value of social cognition tests beyond measures for executive functioning and dysexecutive behavior in a statistical prediction model

Abstract

Objective: This study evaluates the contribution of measures for social cognition (SC), executive functioning (EF) and dysexecutive behavior to the statistical prediction of social and vocational participation in patients with traumatic brain injury (TBI), taking into account age and injury severity. Method: A total of 63 patients with moderate to severe TBI participated. They were administered a semistructured Role Resumption List for social (RRL-SR) and vocational participation (RRL-RTW). EF was measured with planning-and switching tasks. Assessment of SC included tests for facial affect recognition and Theory of Mind (ToM). Dysexecutive behavior was proxy-rated with a questionnaire. Additionally, healthy controls were assessed with the same protocol. Results: Patients with TBI performed significantly worse on tests and had significantly more behavioral problems compared to healthy controls. Hierarchical multiple regression analyses for the TBI group revealed that SC accounted for 22% extra variance in RRL-RTW and 10% extra variance in RRL-SR, which was significant over and above the amounts of variance explained by EF, dysexecutive behavior, age and injury severity. Conclusions: Our findings underline the added value of measures of SC and dysexecutive behavior in the prediction of social and vocational participation post-TBI. In particular, impairments in ToM, and dysexecutive behavior were related to a lower participation making them important targets for rehabilitation.

The relationship between social cognition and participation in the long term after stroke

“…Contrary to our hypothesis, we found that theory of mind (ToM), empathy, emotion recognition and behavioural control were not associated with restrictions in participation three to four years after stroke. This is inconsistent with the reported relationship between emotion perception and participation in stroke in a previous study (Cooper et al, 2014) and with the literature on the relationship between social cognition and participation in moderate to severe TBI (May et al, 2017;Ubukata et al, 2014;Westerhof-Evers et al, 2018). Several factors may contribute to these contradictory findings.…”

“…Social cognitive deficits were mild as well; even though patients scored significantly lower compared to controls on emotion recognition, ToM and behavioural control, effect sizes were only small (Nijsse et al, 2019b) and a maximum of only 4.2% of the patients were impaired to a degree of two standard deviations or more below control mean. Support for the role of stroke severity in the relationship of social cognition and participation is found in the fact that social cognition does not predict community participation in healthy controls (Pijnenborg et al, 2009) and that studies reporting a relationship in TBI patients involved participants with moderate to severe TBI (Knox & Douglas, 2009;May et al, 2017;Struchen et al, 2008;Ubukata et al, 2014;Westerhof-Evers et al, 2018). Taken together, our results indicate that with mild stroke severity, social cognitive impairments and participation limitations are only mild and not associated.…”

“…Based on the available literature, we cannot rule out an association between social cognition and participation in patients who suffered from greater stroke severity. In addition, other factors, such as executive functioning (Westerhof-Evers et al, 2018), may play a role in participation restrictions as well, considering the small amount of total variance explained by the variables included in our model. Another issue to consider is that the USER-P involves a few social activities (for example work or study, visits to/from family or friends, partner relationship, contact with others) but also covers activities where social interactions are less important (such as housekeeping, mobility, physical exercise, going out or leisure indoors/outdoors).…”

“…Studies in patients with moderate to severe traumatic brain injury (TBI) support the relationship between social cognition and participation (May et al, 2017;Ubukata et al, 2014) and indicate that social cognition is an even stronger predictor than executive functioning (Westerhof-Evers, Fasotti, van der Naalt, & Spikman, 2018). Despite evidence for the role of social cognition in participation in severe TBI, the literature on this relationship in stroke patients is limited to the study of Cooper et al (2014), who report an association between emotion perception deficits and reduced participation, as well as a reduced quality of life.…”

Participation Following Inpatient Rehabilitation for Traumatic Disorders of Consciousness: A TBI Model Systems Study

“…However, less is known about whether these individuals eventually participate in social and productive activities. In fact, many studies of participation after TBI exclude persons with the most severe impairments and lower levels of function for logistical reasons (e.g., inability to complete self-report questionnaires or primary residence in a non-community setting) (7,8). Alternatively, patients with severe TBI and prolonged impairments may be grouped with less severe patient populations (e.g., moderate TBI) (9), thus potentially masking cohort-specific effects (10,11).…”