Study Shows Severe Traumatic Brain Injuries Affect Judgement

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Individuals who have experienced one of the most severe forms of traumatic brain injury (TBI) are likely to struggle with judging situations involving disputes or requiring discipline, according to a study recently published in Social Cognitive and Affective Neuroscience (SCAN).

Brain Scan

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“The ability to judge such things as a business dispute, family argument or a child’s misbehavior and then assess reasonable discipline is fairly indicative of one’s ability to rationally and socially integrate within society,” said Dr. Jordan Grafman, study investigator and director of brain injury research at the Rehabilitation Institute of Chicago.

“This study finds that those suffering from penetrating TBI may not have the capacity to appropriately assess proper punishments, a factor which suggests how people will do in the real world.”

The researchers say this study is among the first to evaluate how TBI assess punishment situations.

Penetrating injuries, also referred to as an open head injury, occurs when the skull is penetrated and an object enters the brain. While these injuries make up only a small fraction of traumatic brain injuris, they are associated with significantly worse outcomes than most TBI cases.

Grafman explains that impartial third-party punishment (TPP) is the ability of an individual to assess the severity of a crime or transgression and assign a reasonable punishment. If an individual struggles with TPP, they are also likely to struggle with several important social skills like interpreting others’ intentions or showing empathy.

For this study, the researchers worked with 114 Vietnam War veterans who suffered penetrating brain injuries as a part of the ongoing Vietnam Head Injury Study, which was launched in 1967. Between 2009 and 2012, the researchers used whole-brain imaging to identify damage in the veterans’ brains.

The veterans were also given a series of tests designed to evaluate various abilities such as the ability to put items in order, remember things, or judge the severity of a crime.

To assess these individuals’ ability to judge the severity of a transgression, the veterans were shown index cards describing 24 different scenarios, ranging from innocuous activities like delaying an oil change, to graphic violence. The veterans then rank-ordered the cards to reflect their relative severity and the relative punishment called for by the scenario.

A group of 32 non-injured Vietnam-era combat veterans acted as a control group for the study.

According to the findings, the veterans who experienced frontal lobe injuries performed significantly worse than the control group when they were asked to assign appropriate punishments.

“This is a translational study with important implications for clinical and real-world settings,” said Grafman.

“Having deeper understanding of challenges faced by patients with frontal lobe injuries — whether due to a traumatic brain injury, stroke, tumor, or other neurological disorder — can guide doctors in providing patients with more effective treatment. The goal is always to find new and better ways to help patients recovering from traumatic brain injuries — and their families — at home, at work, and in society.”

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