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.

Keywords:

• traumatic brain injury
• communication disorders
• social cognition
• conversational inference

Acknowledgement

We are indebted to the people with traumatic brain injuries as well as the members of the community who gave their time to participate in this study.

Disclosure statement

The first author receives royalties for sales of The Awareness of Social Inference Test-Revised.

Notes

1. PTA could not be determined for two participants due to inconsistent or non-reporting in medical records. Self-report indicated presence of PTA lasting at least 24 hours.

Additional information

Funding

This research was funded by the Australian Research Council.