The cortical and subcortical substrates of quality of life through substrates of self-awareness and executive functions, in chronic moderate-to-severe TBI

Figures & data

Table 1. Demographic information of the participants with TBI.

Participant No.	Age (Years)	Education (Years)	Cause of Injury	TSI (Years)	PTA (days)	LoHS (days)
1	21	11	MVC	2	30	61
2	24	12	MCC	2	N/A	88
3	31	8	MCC	4	30	30
4	51	6	PVC	9	183	30
5	44	8	Fall or Work-related Injury	6	21	45
6	26	13	MVC	8	3	N/A
7	37	12	PVC	2	2	18
8	23	12	MCC	3	20	60
9	30	9	MCC	4	80	122
10	26	14	MCC	5	183	10
11	38	12	Object Falling	1	25	53
12	44	12	Fall or Work-related Injury	1	61	61
13	34	12	MVC	2	30	30
14	45	15	Assault	17	N/A	N/A
15	22	15	PVC	4	7	30
16	21	12	MCC	2	28	30
17	18	11	MCC	4	244	95
18	34	12	MVC	1	N/A	N/A
19	43	19	PVC	19	42	42
20	29	11	MCC	4	335	N/A
21	25	13	MCC	3	25	60
22	32	18	MCC	18	22	30
23	23	12	MVC	2	30	30
24	28	16	MVC	1	6	30
25	20	12	MVC	1	7	56
26	31	8	MVC	1	61	122
27	33	16	MVC	1	61	61
28	40	14	Assault	14	3	30
29	29	16	MCC	1	61	61
30	36	12	MVC	17	15	180
31	38	16	MCC	11	335	N/A

MVC, Motor Vehicle Crash; MCC, Motor Cycle Crash; PVC, Pedestrian – Vehicle Collision; TSI, time since injury; PTA, Posttraumatic Amnesia; LoHS, Length of Hospitalization Stay.

Table 2. Correlations between individual z-scores of EF tasks and the EF composite score.

	1	2	3	4	5	6	7
1. Rey Copy	-
2. TMT A	0.69**	-
3. TMT B	0.66**	0.68*	-
4. SDMT	0.66**	0.70**	0.65**	-
5. COWAT Animals	0.48**	0.39**	0.33**	0.52**	-
6. COWAT Letter F	0.36**	0.35**	0.34**	0.43**	0.31*	-
7. Executive Functions Composite	0.75**	0.83**	0.79**	0.87**	0.67**	0.65**	-

p < 0.01, one-tailed

Table 3. Whole-brain VBM analysis.

Anatomical Region	Tissue Type	Side	MNI Coordinates			Peak-z	p-value
			x	y	z
Medial Frontal Cortex	GM	L	−2	33	−18	7.67	0.002
Medial Frontal Gyrus	GM	L	45	−22	0	7.62	0.001
Cerebral	WM	R	30	57	3	7.36	0.002

p < 0.01, one-tailed

Table 4. Group differences in EF and SA-related brain regions.

	Group with TBI			Control Group			Statistics
Executive Functions	Side	M	SD	M	SD	F	P	η^2	Observed Power
EF-related Areas
Caudate	L & R	0.20	0.04	0.24	0.04	21.36	0.000	0.30	0.99
Cingulate Cortex	R	0.44	0.07	0.51	0.09	13.39	0.001	0.21	0.95
Globus Pallidus	L	0.08	0.01	0.09	0.01	29.48	0.000	0.37	1.00
Insula	L & R	0.45	0.06	0.54	0.07	32.15	0.000	0.39	1.00
MPFC	L & R	0.33	0.04	0.36	0.05	11.56	0.001	0.19	0.92
OFC	L & R	0.35	0.05	0.43	0.06	33.31	0.000	0.40	1.00
Putamen	L & R	0.27	0.03	0.31	0.05	17.02	0.000	0.25	0.98
Temporal Cortex	L & R	0.45	0.06	0.51	0.06	24.68	0.000	0.33	1.00
Temporal Pole	R	0.40	0.08	0.47	0.06	17.32	0.000	0.26	0.98
Thalamus	L	0.40	0.08	0.49	0.10	15.34	0.000	0.23	0.97
SA-related Areas
Basal Ganglia	L & R	0.23	0.03	0.27	0.04	30.61	0.0001	0.38	1.00
Cingulate Cortex	L & R	0.44	0.05	0.53	0.08	29.62	0.0001	0.37	1.00
Corpus Callosum	L & R	0.27	0.04	0.33	0.05	34.00	0.0001	0.40	1.00
Globus Pallidus	R	0.10	0.01	0.11	0.01	15.65	0.0001	0.24	0.97
Hippocampus	L & R	0.51	0.06	0.58	0.05	30.27	0.0001	0.38	1.00
Inferior Frontal Gyrus	L & R	0.48	0.06	0.53	0.06	10.77	0.002	0.18	0.90
Insula	L	0.50	0.05	0.57	0.08	22.35	0.0001	0.31	1.00
MPFC	L & R	0.35	0.04	0.43	0.07	31.74	0.0001	0.39	1.00
OFC	L & R	0.41	0.06	0.52	0.09	35.87	0.0001	0.42	1.00
Putamen	L	0.39	0.04	0.45	0.05	31.86	0.0001	0.39	1.00
Temporal Area	L & R	0.19	0.04	0.23	0.06	15.22	0.0001	0.23	0.97
Temporal Cortex	L & R	0.42	0.06	0.49	0.06	28.15	0.0001	0.36	1.00
Temporal Pole	L & R	0.41	0.07	0.47	0.06	18.06	0.0001	0.27	0.99

p < 0.01; Group with TBI, N = 31; Control group, N = 24.

Figure 1. Differences in EF-related brain regions.

Figure 2. Differences in SA-related brain regions.

Table 5. Correlations between EF-related regions & SA-related regions.

	SA
											Temporal
	Basal Ganglia	CC	Corpus Callosum	Globus Pallidus	Hippocampus	IFG	Insula	MPFC	OFC	Putamen	Cortex	Pole	Area
EF
Caudate	0.60*	0.65*	0.68*	0.66*	0.66*	0.60*	0.54*	0.65*	0.61*	0.56*	-	0.56*	-
CC	0.80*	0.75*	0.76*	0.66*	0.61*	0.75*	0.65*	0.82*	0.81*	0.76*	0.55*	0.76*	0.48*
Globus Pallidus	0.70*	0.65*	0.76*	0.80*	0.59*	0.69*	0.72*	0.69*	0.63*	0.55*	-	0.59*	-
Insula	0.88*	0.76*	0.85*	0.83*	0.62*	0.69*	0.91*	0.83*	0.85*	0.66*	0.58*	0.68*	-
MPFC	0.74*	0.71*	0.71*	0.62*	0.61*	0.58*	0.62*	0.85*	0.76*	0.68*	0.63*	0.74*	0.51*
OFC	0.90*	0.77*	0.80*	0.76*	0.55*	0.64*	0.79*	0.84*	0.93*	0.65*	0.52*	0.67*	0.37*
Putamen	0.71*	0.65*	0.73*	0.79*	0.70*	0.72*	0.68*	0.70*	0.64*	0.57*	0.42*	0.60*	0.42*
Temporal Cortex	0.74*	0.81*	0.73*	0.59*	0.62*	0.52*	0.65*	0.73*	0.69*	0.53*	0.53*	0.69*	-
Temporal Pole	0.72*	0.69*	0.67*	0.58*	0.66*	0.48*	0.60*	0.66*	0.67*	0.48*	-	0.61*	-
Thalamus	0.65*	0.60*	-	0.61*	0.59*	0.49*	0.60*	0.55*	0.58*	-	-	0.59*	0.46*

*p < 0.001, one-tailed; N = 53, EF, Executive Functions; SA, Self-awareness; CC, Cingulate Cortex; IFG, Inferior Frontal Gyrus; MPFC, Medial Prefrontal Cortex; OFC, Orbitofrontal Cortex.

Table 6. Correlations between EF-related regions and neuropsychosocial measures.

	EF-Related Areas
	MPFC	Globus Pallidus (L)	OFC	Putamen	Temporal Cortex	Temporal Pole	Thalamus (L)	Caudate	CC (R)
EF Construct	0.49**	0.39*	-	.43**	0.36*	-	0.43**	0.52**	0.56**
DEX-R
F, F, WM	-	-	0.44**	-	-	0.52**	-	0.35*	0.33*
S & S-R	-	-	0.40**	-	0.13	0.42**	-	-	-
M & A	-	0.34*	0.38*	0.32*	0.41**	0.55**	-	-	0.31*
Overall SA	-	-	0.44**	-	-	0.51**	-	-	-
SRSI
Strategic Awareness	−0.52**	−0.37*	−0.39*	−0.54**	−0.39*	−0.50**	−0.39*	−0.53**	−0.52**
Online Awareness	−0.45**	−0.42**	−0.41**	−0.51**	−0.31*	−0.46**	−0.37*	−0.53**	−0.47**
WHOQOL-BREF
Psychological Health	-	−0.33*	−0.37*	-	-	−0.32*	-	-	-
Social Relationships	-	-	−0.36*	-	-	-	-	-	-
Environment	−0.33*	-	−0.34*	−0.38*	-	−0.40*	-	-	−0.41**
Overall QOL	-	-	−0.36*	-	-	-	-	-	-
QOLIBRI
Cognition	-	−0.43**	-	-	-	-	-	−0.33*	-
Self Perception	−0.40**	−0.40**	−0.38*	−0.31*	-	−0.38*	-	−0.32*	−0.37*
DL&A	−0.34*	-	-	-	-	-	-	-	-
Social Relationships	−0.40*	-	−0.45**	-	-	-	-	−0.31*	−0.37*
Emotions	-	-	−0.42**	-	-	-	−0.39*	-	-

**p < 0.01; *p < 0.05; one-tailed; Group with TBI, N = 31; CC, Cingulate Cortex; IFG, Inferior Frontal Gyrus; MPFC, Medial Prefrontal Cortex; OFC, Orbitofrontal Cortex; Flexibility, Fluency & Working Memory,; S & S-R, Social & Self -Regulation; M & A, Motivation & Attention; DL&A, Daily Life & Autonomy.

Table 7. Correlations between SA-related regions and neuropsychosocial measures.

	SA-related regions
					Temporal
	Basal Ganglia	OFC		Insula (L)	Cortex	Pole	Area
DEX-R
F, F & WM	0.35*	0.39*		-	0.44**	0.34*	-
S & S R	-	0.39*		-	0.35*	-	-
M & A	0.39*	0.33*		0.43**	0.48**	0.41**	0.33*
Overall SA	0.35*	0.40**		-	0.43**	0.36*	-
SRSI
Strategic Awareness	−0.33*	−0.35*		−0.37*	−0.50**	−0.48**	−0.42**
Online Awareness	−0.32*	−0.34*		−0.37*	−0.50**	−0.51**	−0.55**
Readiness to Change	-	-		-	-	-	-
WHOQOL-BREF
Psychological Health	−0.32*	−0.31*		−0.35*	-	−0.31*	−0.51**
Social Relationships	-	-		−0.30*	−0.35*	-	-
Environment	−0.41**	-		−0.45**	−0.37*	-	−0.43**
Overall QOL	−0.33*	-		−.33*	-	-	−0.45**
QOLIBRI
Cognition	-	-		−0.34*	-	−0.35*	−0.45**
Self Perception	−0.41**	−0.44**		−0.50**	−0.54**	−0.53**	−0.59**
DL & A	-	−0.33*		-	-	-	−0.32*
Social Relationships	-	−0.44**		-	−0.40*	−0.35*	-
Emotions	-	−0.31*		-	-	-	-
Overall HRQOL	−0.33*	−0.40**		−0.37*	−0.37*	−0.35*	−0.52**
**p < .01; *p < .05; one-tailed; Group with TBI, N = 31; OFC, Orbitofrontal Cortex; Flexibility, Fluency & Working Memory,; S & S-R, Social & Self -Regulation; M & A, Motivation & Attention; DL&A, Daily Life & Autonomy.
	SA-related regions
	IFG	Globus Pallidus (R)	Hippocampus		CC	Corpus Callosum	MPFC
DEX-R
F, F & WM	-	0.30*	0.34*		-	-	0.32*
S & S R	0.33*	-	-		-	-	-
M & A	0.36*	-	0.39*		-	0.32*	-
Overall SA	0.34*	-	0.32*		-	0.31*	-
SRSI
Strategic Awareness	−0.49**	−0.37*	−0.30*		−0.54**	−0.39*	−0.52**
Online Awareness	−0.45**	−0.35*	-		−0.48**	−0.36*	−0.44**
Readiness to Change	-	−0.50**	−0.38*		-	-	-
WHOQOL-BREF
Psychological Health	-	-	−0.34*		−0.36*	−0.33*	-
Social Relationships	−0.33*	-	-		−0.33*	-	-
Environment	−0.13	−0.38*	−0.45**		−0.38*	−0.31*	-
Overall QOL	-	-	−0.31*		−0.36*	-	-
QOLIBRI
Cognition	−0.34*	-	-		-	-	-
Self Perception	−0.43**	−0.33*	−0.50**		−0.53**	−0.46**	−0.44**
DL & A	-	-	-		−0.30*	−0.30*	−0.37*
Social Relationships	−0.52**	-	-		−0.52**	−0.32*	−0.35*
Emotions	-	−0.44**	−0.37*		-	-	-
Overall HRQOL	−0.3	−0.32*		−0.33*	−0.43**	−0.31*	−0.38*

**p < .01; *p < .05; one-tailed; Group with TBI, N = 31; IFG, Inferior Frontal Gyrus; CC, Cingulate Cortex; MPFC, Medial Prefrontal Cortex; Flexibility, Fluency & Working Memory,; S & S-R, Social & Self -Regulation; M & A, Motivation & Attention; DL&A, Daily Life & Autonomy.