Who benefits from treatment for executive dysfunction after brain injury? Negative effects of emotion recognition deficits

Abstract

Deficits in emotion recognition, a crucial aspect of social cognition, are common after serious brain injury, as are executive deficits. Since social cognition and executive function are considered to be separate constructs, our first aim was to examine the presence of emotion recognition problems in brain injury patients with dysexecutive problems. We studied 65 brain injury patients of mixed aetiology participating in a randomised controlled trial evaluating the effects of a multifaceted treatment for executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010 ) and 84 matched controls with a test for emotion recognition. Results showed that, in patients with acquired brain injury exhibiting executive deficits, emotion recognition deficits are also present. Male patients are more impaired than female patients, irrespective of aetiology. Our second aim was to investigate whether emotion recognition problems negatively predict the results of the treatment programme. Pre-treatment emotion recognition performance significantly predicted resumption of roles in daily life (Role Resumption List; RRL) and performance on an ecologically valid test for everyday executive functioning (Executive Secretarial Task; EST) post-treatment and, in addition, interfered negatively with treatment condition. Moreover, worse pre-treatment emotion recognition skills affect the learning of compensatory strategies for executive dysfunction negatively, whereas pre-treatment dysexecutive deficits do not.

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

“…Together with our prior reviews, the CRTF has now evaluated 491 interventions (109 There is a trend toward the incorporation of interventions for emotional regulation within cognitive rehabilitation. 59,68,83,116 This is consistent with a central tenet of holistic neuropsychological rehabilitation 117,154 as well as increased recognition of the interaction of cognitive and emotional regulation as an integral aspect of cerebral organization. 155 While difficulties with emotional regulation may mediate the effectiveness of cognitive rehabilitation, 116 psychiatric co-morbidities may not.…”

“…59,68,83,116 This is consistent with a central tenet of holistic neuropsychological rehabilitation 117,154 as well as increased recognition of the interaction of cognitive and emotional regulation as an integral aspect of cerebral organization. 155 While difficulties with emotional regulation may mediate the effectiveness of cognitive rehabilitation, 116 psychiatric co-morbidities may not. 63,150,154 Computer-based cognitive interventions represent a larger number of studies in the current review than in prior reviews, directed at both specific cognitive impairments as well as incorporating interventions across multiple cognitive domains.…”

Sex and Gender Differences in Emotion Recognition and Theory of Mind After TBI: A Narrative Review and Directions for Future Research

“…Two additional papers reported scores separately for women and men with TBI (41,42). A third reported sex differences in the context of other findings (48), but the clinical group included participants with etiologies other than TBI, and scores for the TBI subgroup were not reported separately. Thus, that paper was excluded.…”

Relationship between individual differences in functional connectivity and facial-emotion recognition abilities in adults with traumatic brain injury

“…Among the many sequelae of traumatic brain injury (TBI), difficulties in social functioning are major predictors of overall outcome, posing a challenge for patients and clinicians (Morton and Wehman, 1995, Spikman et al, 2013). Several studies have linked overall social and communication impairment to the ability to successfully identify others' emotions from their facial expressions (Knox and Douglas, 2009, McDonald and Flanagan, 2004, Pettersen, 1991, Watts and Douglas, 2006), suggesting that poor interpersonal skill might be attributed—at least partially—to deficits in emotion perception and interpretation.…”