Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T08:28:33.631Z Has data issue: false hasContentIssue false
  • English
  • Français

Self-Awareness After Brain Injury: Relation with Emotion Recognition and Effects of Treatment

Published online by Cambridge University Press:  23 November 2016

K.F. Lamberts ,
L. Fasotti ,
D.H.E. Boelen  and
J.M. Spikman
K.F. Lamberts
Affiliation:
Department of Medical Psychology, Martini Hospital, Groningen, the Netherlands
L. Fasotti
Affiliation:
Klimmendaal Rehabilitation Center, Arnhem, the Netherlands Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
D.H.E. Boelen
Affiliation:
Klimmendaal Rehabilitation Center, Arnhem, the Netherlands Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
J.M. Spikman*
Affiliation:
Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands Department of Neurology, University Medical Center, Groningen, the Netherlands
*
Address for Correspondence: Prof. Dr. Jacoba M. Spikman, clinical neuropsychologist, Associate Professor, Department of Neurology, University Medical Center Groningen, Poortweg 4, 2e verdieping, Postbus 30.001, 9700 RB Groningen, the Netherlands. E-mail: J.M.Spikman@rug.nl
Get access

Abstract

Self-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17–70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n = 29) had better self-awareness after training than control patients (n = 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.

Keywords

self-awarenessemotion recognitionacquired brain injuryexecutive dysfunctionneuropsychological rehabilitationsocial cognition
Type
Articles
Information
Brain Impairment , Volume 18 , Special Issue 1: Disorders of Social Cognition; Advances in Theory, Assessment and Treatment , March 2017 , pp. 130 - 137
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adolphs, R. (2002). Neural systems for recognizing emotion. Current Opinion in Neurobiology, 12 (2), 169–177.CrossRefGoogle ScholarPubMed
Andrés, P. (2003). Frontal cortex as the central executive of working memory: Time to revise our view. Cortex, 39, 871–895.CrossRefGoogle ScholarPubMed
Babbage, D.R., Yim, J., Zupan, B., Neumann, D., Tomita, M.R., & Willer, B. (2011). Metaanalysis of facial affect recognition difficulties after traumatic brain injury. Neuropsychology, 25, 277–285.CrossRefGoogle ScholarPubMed
Barker, L.A., Andrade, J., Romanowski, C.A.J., Morton, N., & Wasti, A. (2006). Implicit cognition is impaired and dissociable in a head-injured group with executive deficits. Neuropsychologia, 44, 1413–1424.CrossRefGoogle Scholar
Barker, L.A., Andrade, J., Morton, N., Romanowski, C.A.J., & Bowles, D. (2010). Investigating the ‘latent’ deficit hypothesis: Age at time of head injury, implicit and executive functions and behavioral insight. Neuropsychologia, 48, 2550–2563.CrossRefGoogle ScholarPubMed
Barker, L.A., Morton, N., Morrison, T.G., & McGuire, B.E. (2011). Inter-rater reliability of the dysexecutive questionnaire (DEX): Comparative data from non-clinician respondents-all raters are not equal. Brain Injury, 25 (10), 997–1004.CrossRefGoogle Scholar
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547–558.CrossRefGoogle ScholarPubMed
Burgess, P.W., & Simons, J.S. (2005). Theories of frontal lobe executive function: Clinical applications. In Halligan, P.W., & Wade, D.T. (Eds.), Effectiveness of rehabilitation of cognitive deficits. Oxford: Oxford University Press.Google Scholar
Croker, V., & McDonald, S. (2005). Recognition of emotion from facial expression following traumatic brain injury. Brain Injury, 19 (10), 787–799.CrossRefGoogle ScholarPubMed
Goveror, Y., Johnston, M.V., Toglia, J., & DeLuca, J. (2007). Treatment to improve self-awareness in persons with acquired brain injury. Brain Injury, 21 (9), 913–923.CrossRefGoogle Scholar
Ham, T.E., Bonnelle, V., Hellyer, P., Jilka, S., Robertson, I.H., Leech, R., & Sharp, D.J. (2013). The neural basis of impaired self-awareness after traumatic brain injury. Brain: doi:10.1093/brain/awt350.Google ScholarPubMed
Hart, T., Sherer, M., Whyte, J., Polansky, M., & Novack, T.A. (2004). Awareness of behavioural, cognitive, and physical deficits in acute traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 1450–1465.CrossRefGoogle ScholarPubMed
Hart, T., Whyte, J., Kim, J., & Vaccaro, M. (2005). Executive function and selfawareness of ‘real-world’ behaviour and attention deficits following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20, 333–347.CrossRefGoogle ScholarPubMed
Henry, J.D., Phillips, L.H., Crawford, J.R., Ietswaart, M., & Summers, F. (2006). Theory of mind following traumatic brain injury: The role of emotion recognition and executive dysfunction. Neuropsychologia, 44, 1623–1628.CrossRefGoogle ScholarPubMed
Horberg, E.J., Oveis, C., Keltner, D., & Cohen, A.B. (2009). Disgust and the moralization of purity. Journal of Personality and Social Psychology, 97 (6), 963–976.CrossRefGoogle ScholarPubMed
Marker, K.R. (1987). COGPACK. The cognitive training package manual. Heidelberg & Ladenburg: Marker Software.Google Scholar
McDonald, S. (2013). Impairments in social cognition following severe traumatic brain injury. Journal of the International Neuropsychological Society, 19 (3), 231–246.CrossRefGoogle ScholarPubMed
Milders, M., Ietswaart, M., Crawford, J.R., & Currie, D. (2006). Impairments in theory of mind shortly after traumatic brain injury and at 1-year follow-up. Neuropsychology, 20, 400–408.CrossRefGoogle ScholarPubMed
Morton, N., & Barker, L.A. (2010a). Top down or bottom up? Executive and implicit function contributions to awareness after traumatic brain injury. Brain Injury, 24, 38.Google Scholar
Morton, N., & Barker, L.A. (2010b). The contribution of executive and implicit processes to awareness of deficits post head injury. Journal of the International Neuropsychological Society, 16, 1–10.CrossRefGoogle Scholar
Ownsworth, T., & Clare, L. (2006). The association between awareness deficits and rehabilitation outcome following acquired brain injury. Clinical Psychology Review, 26, 783–795.CrossRefGoogle ScholarPubMed
Sbordone, R.J. (2000). The executive functions of the brain. In Groth-Marnat, G. (Ed.), Neuropsychological assessment in clinical practice; a guide to test interpretation and integration. (pp. 437–456). New York, NY, USA: John Wiley & Sons, Inc.Google Scholar
Schmidt, J., Fleming, J., Lannin, N.A., Ownsworth, T., & Khan, A. (2012). Feedback Interventions for improving self-awareness after Brain injury: A protocol for a pragmatic randomized controlled trial. Australian Occupational Therapy Journal, 59 (2), 138–146.CrossRefGoogle Scholar
Schmidt, J., Lannin, N., Fleming, J., & Ownsworth, T. (2011). Feedback interventions for impaired self-awareness following brain injury: A systematic review. Journal of Rehabilitation Medicine, 43, 673–680.CrossRefGoogle ScholarPubMed
Sherer, M., Hart, T., Whyte, J., Nick, T.G., & Yablon, S.A. (2005). Neuroanatomic basis of impaired self-awareness after traumatic brain injury: Findings from early computed tomography. The Journal of Head Trauma Rehabilitation, 20, 287–300.CrossRefGoogle ScholarPubMed
Spikman, J. M., Boelen, D., Lamberts, K.F., Brouwer, W.H., & Fasotti, L. (2010). Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on indications of executive functioning in daily life. Journal of the International Neuropsychological Society, 16, 118–129.CrossRefGoogle ScholarPubMed
Spikman, J.M., Boelen, D.H.E., Pijnenborg, G.H.M., Timmerman, M.E., van der Naalt, J., & Fasotti, L. (2013a). Who benefits from treatment for executive dysfunction after brain injury? Negative effects of emotion recognition deficits. Neuropsychological Rehabilitation: An International Journal, 23 (6), 824–845.CrossRefGoogle ScholarPubMed
Spikman, J.M., Milders, M.V., Visser-Keizer, A.C., Westerhof-Evers, H.J., & Herben-Dekker, M. (2013b). Deficits in facial emotion recognition indicate behavioral changes and impaired self-awareness after moderate to severe traumatic Brain injury. Plos One, 8 (6), e65581. doi:10.1371/journal.pone.0065581.CrossRefGoogle ScholarPubMed
Spikman, J.M., Timmerman, M.E., Milders, M.V., Veenstra, W.S., & van der Naalt, J. (2012). Social cognition impairments in relation to general cognitive deficits, injury severity, and prefrontal lesions in traumatic brain injury patients. Journal of Neurotrauma, 29, 101–111.CrossRefGoogle ScholarPubMed
Spikman, J.M., & van der Naalt, J. (2010). Indices of impaired self-awareness in traumatic brain injury patients with focal frontal lesions and executive deficits: Implications for outcome measurement. Journal of Neurotrauma, 27 (7), 1195–1202.CrossRefGoogle ScholarPubMed
Sprengelmeyer, R., Rausch, M., Eysel, U.T., & Przuntek, H. (1998). Neural structures associated with recognition of facial expressions of basic emotions. Proceedings of the Royal Society of London B, 265, 1927–1931.CrossRefGoogle ScholarPubMed
Tate, R., Kennedy, M., Ponsford, J., Douglas, J., Velikonja, D., Bayley, M., & Stergiou-Kita, M. (2014). INCOG recommendations for management of cognition following traumatic brain injury, Part III: Executive function and self-awareness. Journal of Head Trauma Rehabilitation, 29 (4), 338–352.CrossRefGoogle ScholarPubMed
Toglia, J., & Kirk, U. (2000). Understanding awareness deficits following brain injury. NeuroRehabilitation, 15 (1), 57–70.CrossRefGoogle ScholarPubMed
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioural assessment of the dysexecutive syndrome. Bury St. Edmunds: Thames Valley Test Company.Google Scholar
Woolley, J.D., Strobl, E.V., Sturm, V.E., Shany-Ur, T., Poorzand, P., Grossman, S., . . . & Rankin, K.P. (2015). Impaired recognition and regulation of disgust is associated with distinct but partially overlapping patterns of decreased gray matter volume in the ventroanterior insula. Biological Psychiatry, 78 (7), 505–514.CrossRefGoogle ScholarPubMed
Young, A., Perrett, D., Calder, A., Sprengelmeyer, R., & Ekman, P. (2002). Facial expressions of emotion-stimuli and tests (FEEST). Bury St Edmunds, England: Thames Valley Test Company.Google Scholar