Efficacy of self-perception after traumatic brain injury.

BACKGROUND: Anosognosia is a lack of awareness of personal deficits that is commonly observed in people with a traumatic brain injury (TBI). OBJECTIVE: The purpose of this paper is to examine whether self-appraisal of executive functioning differs for students with and without TBI. METHODS: Students who had survived a TBI and those who had never had a TBI filled out the Behavior Rating Inventory of Executive Functioning from three different perspectives. Each participant was paired with an observer who was familiar with the person's behavior. Self-appraisal ratings, observer ratings of the participant, and reflective appraisal of how the participant thought the observer would rate them were compared. RESULTS: For the students without TBI, reflective appraisal was significantly correlated with self-appraisal but observer appraisal was not. For students with TBI, neither reflected appraisal nor observer appraisal correlated with self-appraisal. Both TBI and non-TBI participants overestimated their problems on measures of Inhibition, Shifting, Emotional Control, Initiation, and Planning/Organizing. TBI participants underestimated their problems on measures of Working Memory, Organization, and Task Monitoring relative to the non-TBI group. CONCLUSIONS: Students with TBI do not accurately perceive how others perceive their behavior.

Self-appraisal: Estimates of intellectual performance for persons with Acquired Brain Injury.

BACKGROUND: Acquired Brain Injury (ABI) limits a survivor's ability to appraise their task performance. There are, however, few measures of self-appraisal. OBJECTIVE: This study developed a technique for measuring self-appraisal originally proposed by Wilbur, Wilk, Silver, and Parente (2008). METHODS: A multivariate model of self-appraisal that includes measures of predicted performance as well as measures of over- and under-estimation of performance was evaluated with ABI survivors, participants with diagnosed learning disabilities, and others with emotional impairments to determine which measures were the most sensitive to the differences among the groups. RESULTS: This model provided a more accurate assessment of self-appraisal than the one previously proposed by Wilbur et al. (2008). The two measures of self-appraisal measure different psychological processes, and the overall model measures aspects of performance that are unrelated to an individual's IQ. A measure of over- or under-estimation of performance was the most sensitive component of the model. CONCLUSIONS: Self-appraisal is a multi-dimensional concept, with at least two main components. The findings corroborate previous literature suggesting that persons with ABI have difficulty accurately assessing their task performance resulting in inflated performance judgments. This self-appraisal technique can be applied to most assessments of performance.

Efficacy of legal judgments for defendants with traumatic brain injury.

BACKGROUND: Literature has compared the frequency of aggressive behaviors of the TBI population and the non-TBI population, suggesting that the TBI population is predisposed to aggressive tendencies because the injury enables impulsivity, loss of self-control, and the inability to modify behaviors. These behavior changes have consequently, been found to lead to criminal involvement. In fact, the majority of the prison population has sustained at least one TBI in their lifetime compared to the prevalence of brain injuries in the general population. However, there is little research investigating the perceptions of criminality and guilt of these individuals. METHODS: Two experiments were conducted that investigated the perceptions of morality, level of guilt, and appropriate sentencing of crimes committed by defendants with different severities of TBI (i.e., mild, severe, and no TBI). Participants were asked to read scenarios about crimes being committed by the defendant. Experiment 1 used a 1-between (crime), 1-within (TBI) mixed design ANOVA testing three dependent variables (morality, guilt, and sentencing). Using a more in vivo jury approach, Experiment 2 used a 3 (TBI)×2 (crime) independent groups factorial design testing the three dependent measures. RESULTS: Overall, defendants with TBI were found less guilty of their crime, perceived as behaving morally to the crime, and receiving a milder punishment relative to the no-TBI defendants. CONCLUSIONS: In the courtroom, the defense attorney should educate the judge and/or the jury on the effects brain injuries have on the cognition, behavior, and emotions of an individual. Thus, this education will ensure the best verdict is being reached.

Recognition of nonverbal communication of emotion after traumatic brain injury.

BACKGROUND: Individuals who have had a traumatic brain injury (TBI) often have difficulty processing nonverbal communication (Ekman, 1976) The published research in this area has focused on a TBI patient's ability to recognize facial expression, vocal intonation, and postural expression (Croker, 2005; Hopkins, Dywan & Segalowitz, 2002). OBJECTIVE: This study compared the non-verbal processing skills of brain-injured patients versus non-injured controls in all three domains. METHODS: The stimuli were photographs of facial and postural expressions and audio recordings of intonational expressions. RESULTS: The results indicated that persons with TBI have particular difficulty recognizing non-verbal communication resulting from vocal intonations. CONCLUSIONS: The TBI patients had difficulty processing tonality, therefore, it is reasonable to suggest that clinicians, friends, and family members should emphasize the explicit verbal content of spoken language when speaking to a person with TBI.

Using the theory of planned behavior to predict self-medication with over-the-counter analgesics.

Millions of people worldwide use over-the-counter analgesics on a regular basis; yet little is known about how decisions to self-medicate are made. This study used the theory of planned behavior to explore the influence of beliefs about medicines (Beliefs about Medicines Questionnaire) and individual pain experience as predictors of intent to self-medicate. Both emerged as significant predictors of intent to self-medicate. Furthermore, intent to self-medicate significantly predicted reported use of analgesics. These findings indicate that use of over-the-counter pain medication is more likely when the value of the pain relief is greater than concerns about harm.

Measuring and manipulating subjective organization after traumatic brain injury.

This study presents a method for assessing subjective organization (SO) after brain injury and techniques for planning cognitive rehabilitation therapy based on the survivor's SO ability. Eighty-seven college students, 50 persons with traumatic brain injury (TBI), and 30 participants with specific learning disability (SLD) learned two overlapping lists of unrelated nouns in which half of the second list were words that the person had learned on the first list. The study assessed whether different patterns of recall for the overlapping words versus the new words on the second list would discriminate persons with brain injury relative to college students and persons with SLD. The results indicated that college students and the SLD participants showed significantly diminished recall of overlapping words on the second list. However, the TBI participants showed significantly improved recall of the overlapping words. The results indicated that this task provides a simple diagnostic assessment of a participant's SO ability. The results also suggested that a TBI survivor's level of SO may moderate the success of prevocational cognitive rehabilitation therapies.

Validity and reliability of self-monitoring indices.

PRIMARY OBJECTIVE: This research concerns the measurement of self-monitoring in people who were diagnosed with traumatic brain injury (TBI), learning disability (LD) and emotional disorder (ED). Two measures of self-monitoring were evaluated: (1) the correlation between participants' self-predicted and observed standardized sub-test scores (R) on 17 WAIS-III 1 sub-tests and (2) the average difference between the participants' predicted and observed sub-tests scores (B). It was then determined if these measures could discriminate the three diagnostic groups. RESEARCH DESIGN: Canonical analysis assessed the relationship between the self-monitoring measures and four WAIS-III IQ measures. This study also evaluated if the R and B measures could discriminate the diagnostic groups. METHODS AND PROCEDURES: One hundred and twenty-four participants, 42 with TBI, 42 with LD and 40 with ED predicted their performance on 17 WAIS-III sub-tests. MAIN OUTCOMES AND RESULTS: Canonical analysis demonstrated a significant relationship between the R and B measures and four WAIS-III IQ measures. Results of a MANOVA showed that the R and B measures differed significantly among the diagnostic groups. CONCLUSIONS: The R and B measures are two valid and reliable indices of self-monitoring that can be conveniently estimated from the WAIS-III.

Subjective organization and positive transfer of performance with traumatically brain-injured adults.

Two experiments compared the subjective organization of memory in college students and persons with brain injury using a part-whole list-learning task. Previous research attributed the negative transfer of learning that college students experience in the part-whole task to their inability to reorganize part-list words when learning the whole list. We reasoned that persons with brain injury would not experience negative transfer of learning in the part-whole paradigm because of their limited organizational skills. Experiment 1 replicated the usual negative transfer of learning with college students. Experiment 2 showed that brain-injured participants did not experience the same negative transfer of learning effects during the same task.

Mind-operated devices: mental control of a computer using biofeedback.

This study investigated whether people could learn to control a computer using a biofeedback interface that integrated their galvanic skin response (GSR), heart rate, and temperature. Twenty participants played a computer game using the biofeedback device, both individually and in pairs. Results indicated that most people learned to control the game after a single training session. The GSR measure was the most sensitive means of control. Pairs of participants controlled the device more effectively than single individuals did.