There is clinical evidence that social cognition impairment plays a crucial role on the prospects for functional recovery and reintegration after traumatic brain injury (TBI). The study by Ubukata et al. (2014) aim to find evidence of a link between social cognition and functional outcomes after TBI. Traumatic brain injury is referring to an acquired brain injury caused by a physical impact. As a result of TBI, patients may develop several cognitive deficits. Cognition includes functions such as attention, memory, and executive functions, but also what is called social cognition. Social cognition refers to all the abilities that enable a person to communicate, identify emotions and have appropriate social interactions. More specifically there are a variety of more or less complex processes in social cognition.
This article has assessed social cognition using an emotion perception task and several task that required different type of theory of mind. Theory of Mind (TOM) is the ability to infers others mental state in a given situation. To assess this capacity the authors used the Faux Pas Test, which is a verbal task where a situation between several characters is described.
The aim of the first question “What does Sebastien think?” is to assess if the participant perceived what is implicitly said. Participants answer either “That Linda had an accident” or “That Linda is late as usual”, the latest is the expected answer.
For the second question “Why hasn’t Linda arrived yet?” participant have to choose between two answers “Because she is late as usual” or “Because she had a car crash”. This question is used to verify whether the participant has understood the situation.
A second test has been used to assess the capacity to infers someone emotion just from the facial expression, in particular this test use photographs of eyes and it is asked to choose among four the most suitable emotion, it is called Reading the mind in the eyes and assess nonverbal TOM.
A third TOM task has been used to assess automatic TOM, which is the capacity to interpret intentional movement in a simulation of social interactions. They used the Moving Shapes paradigm; participants were presented twelve silent animated movies of a big red triangle and a small blue triangle. The participants had to answer what they thought the triangles were doing in tree condition. On the first triangles were moving randomly, on the second they moved like they are fighting and in the third triangles moved like they seduce each other.
The last task has been used in order to evaluate the capacity to perceived and identify emotion on 48 photographs of faces illustrating the six Ekman emotion: anger, happiness, fear, disgust, sadness, and surprise.
The authors made the hypothesis that social cognition can be a relevant predictor of functional outcomes. Based on a few studies that proved a relationship between social cognition capacities and how the patients succeed or not in their activities in the “real world”. To test this hypothesis, in addition to the above-mentioned social cognition tests, twenty participants with TBI were asked to answer a questionnaire measuring a degree of social and community participation. The Revised Craig Handicap Assessment and Reporting Technique (R-CHART) assess several aspects of handicap based on the World Health Organization definition. These are physical independence, cognitive independence, mobility, occupation, social integration, and economic self-sufficiency.
After comparison of the participants scores with a normal control database, correlation and multiple regression analysis, the results in this study show impairment in cognitive function, social cognition for most patients. Although the physical independence score at R-CHART shows little or no physical handicap the participants social integration seems to be impaired. Surprisingly, the authors found only one significant correlation between nonverbal social cognition (Read in The Mind task) and Cognitive independence dimension of the functional outcomes measurement (R-CHART). It can be explained by multiple methodological limitations. In this way it demonstrates the difficulty of conducting research on social cognition but also on the brain-damaged patient population. One main limitation of this study is that they did not take into account the level of self-awareness of their patients, this might have skewed the R-CHART response. Because it is a self-administered questionnaire and low self-awareness is common among TBI patients, meaning they may have minimized their difficulties. Another limitation is that they did not consider the location of the brain lesion, when that have a huge impact on the severity of social cognition impairment. Despite these limitations, at that time this study was at the beginning of the emergent interest for social cognition on the cerebral lesion patient population.
Currently the extent of social cognition impairment and their negative impact on the rehabilitation prospects of people with brain injury is well documented (Joly-Pottuz et al. 2001 ; Maarten Milders, 2019) In spite of that, the assessment and the rehabilitation of social cognition abilities are not widely practiced in dedicated medical facilities. Kelly et al. (2017) has questioned clinicians working in brain injury rehabilitation field. She found that although the majority of patients and their family report social cognition impairment, most of the clinicians did not assess social cognition systematically. In this study, 45% of clinicians had never assessed theory of mind using the Faux Pas Test or another one.
More research and rehabilitation programs adapted to the institutional constraints are needed to enable people with TBI to benefit from a better capacity to enter in relation with their social environment.
Words I have learned:
- In the vicinity : dans les environs, à proximité
- Pretense (US) or Pretence (UK) : faux-semblant
- Endeavor (US) or endeavour (UK) : entreprise (effort) example “Future studies could endeavour to attract greater representation from other countries.”
- To hinder : gêner, entraver
Theoretical concepts and knowledge I have learned:
- Moving-Shapes Paradigm
- The six dimensions defining the handicap according to the World Health Organization definition. These are physical independence, cognitive independence, mobility, occupation, social integration, and economic self-sufficiency.
References :
- Joly-Pottuz, B., Desrichard, O., & Carbonnel, S. (2001). Difficultés de réinsertion sociale des traumatisés crâniens graves: une altération des auto-présentations normatives. L’orientation scolaire et professionnelle, (30/3).
- Kelly, M., McDonald, S., & Frith, M. H. (2017). A survey of clinicians working in brain injury rehabilitation: Are social cognition impairments on the radar?. Journal of Head Trauma Rehabilitation, 32(4), E55-E65. https://doi.org/10.1097/HTR.0000000000000269
- Maarten Milders (2019) Relationship between social cognition and social behaviour following traumatic brain injury, Brain Injury, 33:1, 62-68. https://doi.org/10.1080/02699052.2018.1531301
- Ubukata, S., Tanemura, R., Yoshizumi, M., Sugihara, G., Murai, T., & Ueda, K. (2014). Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury. Neuropsychiatric disease and treatment, 10, 2061. https://doi.org/10.2147/NDT.S68156