Perceived Clinical Characteristics of Children With History of Opioid Exposure: A Speech-Language Pathology Perspective.

PURPOSE: This research was conducted to describe the clinical characteristics of children with a history of opioid exposure as perceived by the speech-language pathologists (SLPs) treating them. METHOD: Three focus groups were conducted. Participants consisted of 20 SLPs working in the schools in West Virginia who had experienced working with children with a confirmed or suspected history of opioid exposure. A thematic, qualitative analysis was conducted, whereby focus group sessions were transcribed verbatim and information was coded, organized into themes, and interpreted. RESULTS: Themes of perceived clinical characteristics (speech, language, executive function, and other developmental delays) are reported to address the research question. Additionally, themes derived from the data regarding perceived significant differentiators (greater severity/needs, inconsistent performance, and atypical manifestation) and perceived confounding characteristics (safety and well-being, aspects of home environment, and effects on school environment) that are often reported in children with a history or suspected history of opioid exposure are presented. CONCLUSIONS: Perceived clinical characteristics of this population, both intrinsic and situational, highlight the complex profile of this population and demonstrate the importance of considering each child from a multidimensional perspective. Additional research is needed to represent the profile of these children more completely and to identify successful supports that will improve their speech and language outcomes, educational achievement, and their overall quality of life.

Perceptions of Speech-Language Pathologists' Service Provision in the Opioid Epidemic: A Focus Group Study.

PURPOSE: This research intended to identify current practices being implemented with children who have a history or suspected history of opioid exposure, as well as challenges faced by speech-language pathologists in the schools. METHOD: Focus group data from three groups totaling 20 speech-language pathologists (SLPs) working in schools in West Virginia, also used in a previous study, were analyzed using qualitative thematic analysis to better understand SLP service provision to children with a history or suspected history of opioid exposure. RESULTS: Results revealed two primary themes, reported as (a) service delivery in action (current practice trends and challenges) and (b) affective/cognitive manifestations (uncertainty about their role and various emotions expressed) of the SLPs who participated in the focus groups. CONCLUSIONS: This study revealed important clinical implications derived from the reports of participants. Particularly, the importance of communication and advocacy in the care of these children and the need to rethink what our scope of practice means when working with this vulnerable population are discussed.

Traumatic brain injury and creative divergent thinking.

PRIMARY OBJECTIVE: The current study examined how creative divergent thinking (i.e., the ability to produce varied and original solutions to a problem) is impacted by moderate-to-severe traumatic brain injury (TBI). RESEARCH DESIGN: Descriptive, observational. METHODS AND PROCEDURES: We administered two tasks of divergent thinking, the Abbreviated Torrance Test for Adults (ATTA) and the Alternative Uses Test (AUT), as well as a battery of neuropsychological tests and psychosocial variables (assessing memory and learning, processing speed, set shifting and psychological distress), to 29 individuals with TBI and 20 demographically-matched healthy comparison participants. MAIN OUTCOMES AND RESULTS: Individuals with TBI performed similarly to healthy individuals on both tests of creative thinking, although they were impaired on the neuropsychological tasks. Moreover, there was no significant correlation between performance on the ATTA and performance on neuropsychological tests, but within the TBI group AUT performance and memory were significantly and positively associated. CONCLUSIONS: Our findings reveal that divergent thinking, as measured by the ATTA and AUT, might be spared following moderate-to-severe TBI. These findings further our understanding of the higher-level cognitive sequelae of TBI and suggest that divergent thinking might be leveraged during treatment planning.

Spatial relational memory in individuals with traumatic brain injury.

Introduction: Relational memory is the ability to bind arbitrary relations between elements of experience into durable representations and the flexible expression of these representations. It is well known that individuals with traumatic brain injury (TBI) have declarative memory impairments, but less is known about how TBI affects relational memory binding, the deficit at the heart of declarative, or relational, memory impairment. The aim of the current study is to examine such deficits.Method: We used a spatial reconstruction task (SRT) with 29 individuals with TBI and 23 normal comparison (NC) participants to investigate four different types of spatial relations: (A) identity-location relations, i.e., the relationship between a specific item and its known location; (B) item-item relations, or the relationship between one item and another; (C) item-display relations, or the relationship between an item and its position in the display; and (D) compound-item relations, i.e., relations that involve combinations of A, B, and C.Results: Our data revealed that individuals with TBI showed impairments in learning identity-location relations and increased compound errors compared to NCs. We also found evidence that when item identity is disregarded, individuals with TBI do not perform differently from NCs. An exploratory analysis revealed that while relational memory performance was significantly correlated with scores on the California Verbal Learning Test (CVLT), more participants with TBI exhibited impairment on the SRT than of the CVLT.Conclusions: Our findings show that relational memory is impaired following TBI, and provide preliminary evidence for an easy-to-administer task with increased sensitivity to memory impairment.

Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance and Individual Differences on the Rotary Pursuit Task.

The impact of traumatic brain injury (TBI) on procedural memory has received significantly less attention than declarative memory. Although to date studies on procedural memory have yielded mixed findings, many rehabilitation protocols (e.g., errorless learning) rely on the procedural memory system, and assume that it is relatively intact. The aim of the current study was to determine whether individuals with TBI are impaired on a task of procedural memory as a group, and to examine the presence of individual differences in performance. We administered to a sample of 36 individuals with moderate-severe TBI and 40 healthy comparisons (HCs) the rotary pursuit task, and then examined their rate of learning, as well as their retention of learning. Our analyses revealed that while individuals with TBI spent a significantly shorter amount of time on target as a group, they did not retain significantly less procedural learning, and as a group their rate of learning was not different from HCs. However, there were high individual differences in both groups, indicating that some individuals might not be able to take advantage of treatment methods designed to leverage intact procedural memory system. Future work is needed to better assess and characterize procedural memory in individuals with TBI across a larger battery of tasks in experimental and clinical setting as memory and learning status may predict rehabilitation success.

Characterizing computer-mediated communication, friendship, and social participation in adults with traumatic brain injury.

BACKGROUND: Adults with traumatic brain injury (TBI) report loss of friendship and reduced social participation after injury, but there is limited information regarding quantity of friends and methods of communication. Our objective was to characterize friendship networks, social participation, and methods of communication, including computer-mediated communication (CMC), used by adults with TBI compared to uninjured adults. METHODS: Participants were 25 adults with TBI and 26 uninjured healthy comparisons (HC) adults, who completed the Participation Assessment with Recombined Tools-Objective (PART-O) and the Social Network Questionnaire (SNQ). RESULTS: Adults with TBI had significantly fewer total friends and significantly lower levels of productivity and overall social participation. Face-to-face interaction was the preferred method of contact for both groups. Adults with TBI were significantly less likely to use texting as a primary method of communication than their uninjured peers, but used other methods of communication at similar rates. CONCLUSION: Our study supports prior findings of reduced friendships and reduced social participation after TBI and adds new information about similarities and differences in communication methods between adults with and without TBI.

White matter correlates of different aspects of facial affect recognition impairment following traumatic brain injury.

Although facial affect recognition deficits are well documented in individuals with moderate-to-severe traumatic brain injury (TBI), little research has examined the neural mechanisms underlying these impairments. Here, we use diffusion tensor imaging (DTI), specifically the scalars fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD), to examine relationships between regional white-matter integrity and two facial affect sub-skills: perceptual affect recognition abilities (measured by an affect matching task) and verbal categorization of facial affect (measured by an affect labeling task). Our results showed that, within the TBI group, higher levels of white-matter integrity in tracts involved in affect recognition (inferior fronto-occipital, inferior longitudinal, and uncinate fasciculi) were associated with better performance on both tasks. Verbal categorization skills were specifically and positively correlated with integrity of the left uncinate fasciculus. Moreover, we observed a striking lateralization effect, with perceptual abilities having an almost exclusive relationship with integrity of right hemisphere tracts, while verbal abilities were associated with both left and right hemisphere integrity. The findings advance our understanding of the neurobiological mechanisms that underlie subcomponents of facial affect recognition and lead to different patterns of facial affect recognition impairment in adults with TBI.

Functional neural correlates of facial affect recognition impairment following TBI.

Facial affect recognition deficits following traumatic brain injury (TBI) have been well documented, as has their relationship with impairment in several other cognitive domains. However, little is known about the neurobiological mechanisms underlying affect recognition deficits, in particular mechanisms underlying different aspects of facial affect recognition (e.g., perceptual and interpretive processes). In the current study, 33 adults with moderate-to-severe TBI and 24 demographically matched healthy comparison (HC) participants completed an fMRI facial affect recognition study. While in the scanner, participants were asked to match the affect of a target face to either (a) one of two faces differing in affect (perceptual condition) or (b) one of two written affect labels (interpretative condition). In both groups we found activations in regions typically involved in affect recognition. Our results revealed that in the perceptual condition individuals with TBI tended to activate the left dorsolateral prefrontal cortex less than HCs, and within the HC group individuals with higher perceptual affect recognition scores showed higher levels of activation in the same brain region. Individuals with TBI who were specifically impaired at interpretative affect recognition showed less activation than HCs in the right fusiform gyrus. Moreover, in the labeling condition individuals with TBI tended to de-activate medial prefrontal regions less than HCs. A region of interest analysis revealed that individuals with TBI showed significantly less activation than HCs in the FFA for all the contrasts of interest. Our results suggest involvement of several brain regions in facial affect recognition impairment post TBI, and provide neurobiological support for the notion that distinct aspects of facial affect recognition can be differentially impaired following TBI.

Lonely But Not Alone: Neuroticism Mediates the Relationship Between Social Network Size and Loneliness in Individuals With Traumatic Brain Injury.

Objectives: Although individuals with traumatic brain injury (TBI) often report higher levels of social isolation, little is known about the factors influencing their self-perception of loneliness. The aim of the current study was to investigate the relationship between loneliness, social network size, and personality variables (neuroticism and extraversion) after TBI, and in particular whether specific personality variables mediate the relationship between social network size and perception of loneliness. Methods: Here, we assessed self-reported loneliness, personality variables, and social network size of 24 individuals with moderate-to-severe TBI and 41 healthy comparison participants. We then carried out a mediation analysis to examine whether personality variables mediated the relationship between loneliness and social network size. Results: Our results indicate that individuals with TBI reported higher levels of loneliness and neuroticism, but there was no group difference in social network size or extraversion. The mediation analysis revealed that the association between social network size and loneliness was mediated by neuroticism, but not by extraversion. Conclusions: Our findings show that neuroticism is an intervening variable in the relationship between social network size and self-perception of loneliness in individuals with moderate-to-severe TBI, and presents a new possible target for clinicians and rehabilitators seeking to address reports of loneliness and social isolation in TBI. (JINS 2019, 25, 266-274).

Convergent thinking and traumatic brain injury: an investigation of performance on the remote associate test.

OBJECTIVE: While deficits in several cognitive domains following moderate-to-severe traumatic brain injury (TBI) have been well documented, little is known about the impact of TBI on creativity. In the current study, our goal is to determine whether convergent problem solving, which contributes to creative thinking, is impaired following TBI. METHODS: We administered a test of convergent problem solving, the Remote Associate Task (RAT), as well as a battery of neuropsychological tests, to 29 individuals with TBI and 20 healthy comparisons. RESULTS: A mixed-effect regression analysis revealed that individuals with TBI were significantly less likely to produce a correct response, although on average they attempted to respond to the same number of items. Moreover, we found that the TBI (but not the comparison) group's performance on the RAT was significantly and positively associated with verbal learning and memory, providing further evidence supporting the association between declarative memory and creative convergent thinking. CONCLUSION: In summary, our findings reveal that convergent thinking can be compromised by moderate-to-severe TBI, furthering our understanding of the higher-level cognitive sequelae of TBI.

Facial-affect recognition deficit as a predictor of different aspects of social-communication impairment in traumatic brain injury.

OBJECTIVE: To examine the relationship between facial-affect recognition and different aspects of self- and proxy-reported social-communication impairment following moderate-severe traumatic brain injury (TBI). METHOD: Forty-six adults with chronic TBI (>6 months postinjury) and 42 healthy comparison (HC) adults were administered the La Trobe Communication Questionnaire (LCQ) Self and Other forms to assess different aspects of communication competence and the Emotion Recognition Test (ERT) to measure their ability to recognize facial affects. RESULTS: Individuals with TBI underperformed HC adults in the ERT and self-reported, as well as were reported by close others, as having more communication problems than did HC adults. TBI group ERT scores were significantly and negatively correlated with LCQ-Other (but not LCQ-Self) scores (i.e., participants with lower emotion-recognition scores were rated by close others as having more communication problems). Multivariate regression analysis revealed that adults with higher ERT scores self-reported more problems with disinhibition-impulsivity and partner sensitivity and had fewer other-reported problems with disinhibition-impulsivity and conversational effectiveness. CONCLUSIONS: Our findings support growing evidence that emotion-recognition deficits play a role in specific aspects of social-communication outcomes after TBI and should be considered in treatment planning. (PsycINFO Database Record

Different aspects of facial affect recognition impairment following traumatic brain injury: The role of perceptual and interpretative abilities.

It is well established that many individuals with traumatic brain injury (TBI) are impaired at facial affect recognition, yet little is known about the mechanisms underlying such deficits. In particular, little work has examined whether the breakdown of facial affect recognition abilities occurs at the perceptual level (e.g., recognizing a smile) or at the verbal categorization stage (e.g., assigning the label "happy" to a smiling face). The aim of the current study was to investigate the integrity of these two distinct facial affect recognition subskills in a sample of 38 individuals with moderate-to-severe TBI and 24 demographically matched healthy individuals. Participants were administered an affect matching (perceptual skills) and an affect labeling (verbal categorization skills) task. Statistical analyses revealed that, while individuals with TBI showed significantly higher levels of impairment in the verbal categorization task than in the perceptual task, they performed less well than healthy comparison participants on both tasks. These findings indicate that facial affect recognition impairment can occur at different cognitive stages following TBI, suggesting the necessity of careful screening to offer targeted treatment. Moreover, they provide further neuropsychological evidence supporting the notion that distinct types of subskills are necessary to achieve successful recognition of facial affects.

Frontal and Temporal Structural Connectivity Is Associated with Social Communication Impairment Following Traumatic Brain Injury.

OBJECTIVES: Although it has been well documented that traumatic brain injury (TBI) can result in communication impairment, little work to date has examined the relationship between social communication skills and structural brain integrity in patients with TBI. The aim of the current study was to investigate the association between self- and other-perceived communication problems and white matter integrity in patients with mild to severe TBI. METHODS: Forty-four individuals (TBI=24) and people with whom they frequently communicate, as well as demographically matched normal healthy comparisons (NC) and their frequent communication partners, were administered, respectively, the La-Trobe Communication Questionnaire Self form (LCQ-SELF) and Other form (LCQ-OTHER). In addition, diffusion tensor imaging data were collected, and fractional anisotropy (FA) measures were extracted for each lobe in both hemispheres. RESULTS: Within the TBI group, but not within the NC group, participants who were perceived by their close others as having more communication problems had lower FA in the left frontal and temporal lobes (p<.01), but not in other brain regions. CONCLUSIONS: Frontotemporal white matter microstructural integrity is associated with social communication abilities in adults with TBI. This finding contributes to our understanding of the mechanisms leading to communication impairment following TBI and can inform the development of new neuromodulation therapies as well as diagnostic tools. (JINS, 2016, 22, 705-716).

The female advantage: sex as a possible protective factor against emotion recognition impairment following traumatic brain injury.

Although moderate to severe traumatic brain injury (TBI) leads to facial affect recognition impairments in up to 39% of individuals, protective and risk factors for these deficits are unknown. The aim of the current study was to examine the effect of sex on emotion recognition abilities following TBI. We administered two separate emotion recognition tests (one static and one dynamic) to 53 individuals with moderate to severe TBI (females = 28) and 49 demographically matched comparisons (females = 22). We then investigated the presence of a sex-by-group interaction in emotion recognition accuracy. In the comparison group, there were no sex differences. In the TBI group, however, females significantly outperformed males in the dynamic (but not the static) task. Moreover, males (but not females) with TBI performed significantly worse than comparison participants in the dynamic task. Further analysis revealed that sex differences in emotion recognition abilities within the TBI group could not be explained by lesion location, TBI severity, or other neuropsychological variables. These findings suggest that sex may serve as a protective factor for social impairment following TBI and inform clinicians working with TBI as well as research on the neurophysiological correlates of sex differences in social functioning.

Structural and functional neural correlates of self-reported attachment in healthy adults: evidence for an amygdalar involvement.

The concept of attachment in long-term interpersonal relationships has been linked to relationship outcome and social-emotional health. To date, no relationship between the structural properties of the human amygdala and attachment in romantic relationships (measured through self-reported attachment related anxiety and avoidance) has been described. The aim of the current study was to investigate the relationship between amygdala structure as well as amygdala structural and functional connectivity and attachment anxiety and avoidance. To this end, we collected self-report attachment data on a sample of female young adults. We then examined associations between attachment and mean diffusivity, fractional anisotropy and resting state functional connectivity MRI (rs-FC) of the amygdala and its white matter connections with the prefrontal cortex. We found that lower integrity of the left amygdala was linked with attachment avoidance (e.g., being less comfortable in seeking proximity with others and depending on others) and that greater structural integrity of the uncinate fasciculus was positively associated with avoidance. Lastly, we found that stronger rs-FC between the bilateral amygdala and medial prefrontal regions was linked with greater avoidance. Our findings are compatible with and expand previous results reported by studies that have taken a task-related fMRI approach, furthering our understanding of the neurobiological mechanisms of attachment, and in particular implicating the system formed by amygdala and prefrontal areas in the patterns of behavior that regulate emotional proximity in romantic relationships. These findings have the potential to further our understanding of the affective mechanisms underlying attachment behavior.

Is Traumatic Brain Injury Associated with Reduced Inter-Hemispheric Functional Connectivity? A Study of Large-Scale Resting State Networks following Traumatic Brain Injury.

Traumatic brain injury (TBI) often has long-term debilitating sequelae in cognitive and behavioral domains. Understanding how TBI impacts functional integrity of brain networks that underlie these domains is key to guiding future approaches to TBI rehabilitation. In the current study, we investigated the differences in inter-hemispheric functional connectivity (FC) of resting state networks (RSNs) between chronic mild-to-severe TBI patients and normal comparisons (NC), focusing on two externally oriented networks (i.e., the fronto-parietal network [FPN] and the executive control network [ECN]), one internally oriented network (i.e., the default mode network [DMN]), and one somato-motor network (SMN). Seed voxel correlation analysis revealed that TBI patients displayed significantly less FC between lateralized seeds and both homologous and non-homologous regions in the opposite hemisphere for externally oriented networks but not for DMN or SMN; conversely, TBI patients showed increased FC within regions of the DMN, especially precuneus and parahippocampal gyrus. Region of interest correlation analyses confirmed the presence of significantly higher inter-hemispheric FC in NC for the FPN (p < 0.01), and ECN (p < 0.05), but not for the DMN (p > 0.05) or SMN (p > 0.05). Further analysis revealed that performance on a neuropsychological test measuring organizational skills and visuo-spatial abilities administered to the TBI group, the Rey-Osterrieth Complex Figure Test, positively correlated with FC between the right FPN and homologous regions. Our findings suggest that distinct RSNs display specific patterns of aberrant FC following TBI; this represents a step forward in the search for biomarkers useful for early diagnosis and treatment of TBI-related cognitive impairment.

Conversational synchrony in the communicative interactions of individuals with traumatic brain injury.

PRIMARY OBJECTIVE: To assess conversational synchrony in moderate-to-severe traumatic brain injury (TBI). Conversational synchrony, assessed by the similarity and co-ordination of words and words per turn, allows for effective and efficient communication and enhances the development of rapport. RESEARCH DESIGN: Eighteen participants with TBI (seven females) and 19 healthy comparison participants (CP; eight females) engaged in a 10-minute conversation with an unfamiliar partner. METHODS AND PROCEDURES: Conversational synchrony was assessed in these conversations by measuring the degree to which the participants' productions of words and words per turn became more similar to one another over the course of the session. MAIN OUTCOMES AND RESULTS: Significantly more sessions with participants with TBI (11/18 for words, 9/18 for words per turn) compared to CP sessions (5/19 for words, 4/19 for words per turns) did not display conversational synchrony. Likewise, synchrony was significantly correlated with subjective ratings of the interaction from raters who were blind to participant status and the study hypotheses. CONCLUSIONS: These results suggest that TBI can disrupt conversational synchrony and can, in turn, negatively impact social perceptions. The relationship between impaired conversational synchrony and other social communicative deficits in TBI warrants further study.