People with a more severe kind of traumatic brain injury (TBI) are more prone to misjudge when faced with situations involving disputes or requiring discipline, according to new research.
The study is among the first to assess how people with TBIs punish, a key indicator of how they will function in society, according to researchers.
“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.”
A penetrating injury, also called an open head injury, is when an object penetrates the skull and enters the brain. Prior research has shown that, though less prevalent than closed head trauma like concussions, penetrating TBI carries a worse prognosis.
TBI affects nearly two million patients each year, as well as countless others, including family members, colleagues, and people encountered in everyday activities.
Impartial third-party punishment (TPP) is the ability to judge the severity of a crime and assess a reasonable punishment. If a patient struggles with TPP, he or she likely struggles with several important social skills, such as interpreting another person’s intentions, showing empathy and making rational judgments, Grafman explained.
The absence of these skills, which regulate behavior, indicate poorer prognoses for resuming normal work, school, and family life, he noted.
From 2009 to 2012, researchers worked with 114 Vietnam War veterans who suffered penetrating brain injuries as part of the ongoing Vietnam Head Injury Study, an investigation launched in 1967. The study includes more than 100 research projects. Grafman has been lead investigator for the Vietnam War-related projects since 1990.
In the latest study, researchers used whole-brain imaging to pinpoint damage in the veteran’s brains. They also gave them a series of tests to measure various abilities, including the ability to put items in order, remember things, or judge the severity of a crime.
To test the ability to judge severity, they showed each veteran index cards describing 24 different scenarios, ranging from innocuous activities, such as delaying an oil change, to graphic violence. The veterans rank-ordered the cards to reflect the relative degree of punishment deserved.
The researchers repeated the experiment with 32 non-injured Vietnam-era combat veterans, who served as a control group.
The study found that veterans with frontal lobe injuries did worse than the control group when it came to assigning inappropriate punishments.
It also pinpointed the brain locations of the underlying problems, according to the researchers. For example, veterans with altruism deficits tended to have right frontal lobe injuries, while those who had trouble forming concepts — the ability to determine the overall theme from different pieces of information — showed left lobe damage.
“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.”
The study was published in Social Cognitive and Affective Neuroscience (SCAN).