Face value

It’s written all over her face.

Whether a person is happy or sad, angry or frightened, most of us take for granted a certain ability to read facial emotions. Without that ability, our behaviour and responses may appear inappropriate, unfeeling or disconnected to what that person is trying to communicate to us. The interactionÐeven the relationship-could quickly derail.

A Toronto Rehab / University of Toronto study in 2003 showed that more than 50% of people who have sustained a recent traumatic brain injury (TBI) have a significant problem reading emotion in people’s faces. The second phase of this study is now underway thanks to new funding from the National Science Engineering Research Committee (NSERC). This 5-year NSERC Discovery Grant of just under $100,000, awarded to Toronto Rehab’s Dr. Robin Green, the principal investigator for this program of research, will allow Toronto Rehab researchers and their colleagues to expand their previous research and study the possibility that facial emotion perception deficits are caused, in part, by deficits in attention.

“In the first phase of our study, we were amazed at how prevalent facial emotion perception deficits were in patients with traumatic brain injury,” says Dr. Robin Green, a scientist and clinical neuropsychologist. “The results help to explain this population’s already well-documented difficulties with psychosocial adjustment. Patients who are recently brain injured have a constellation of problems. They may be impulsive and they may have problems regulating their emotions, including anger. If they have difficulty reading other people’s facial emotions, there’s going to be a cumulative effect that is particularly consequential for them.”

There is already some evidence of a link between social dysfunction and the inability to read emotions. “Therefore, the inability to read emotion on a person’s face has the potential to disrupt every face to face contact with another person-especially if the person with the brain injury does not have insight into the problem,” Dr. Green explains. “Our most basic needs, to some extent, depend on the ability to figure out if another person is afraid of us, angry or pleased. These deficits can affect everything from personal happiness, to safety, to productivity at work.”

In the first phase of their research, Dr. Green and her University of Toronto colleagues Dr. Bill Thompson and Gary Turner were interested in understanding the prevalence and the mechanisms of this impairment. Their findings gave them some leads regarding the mechanisms that they are now exploring in phase two.

Their findings suggested that patients were failing to sustain their attention long enough to properly process the complexities of facial emotions. While, other studies had demonstrated that patients with TBI have low physiological ‘arousal’ to emotional stimuli in general. Dr. Green and graduate student, Katie Mak Fan, will attempt to prove in this second phase of the study that attention is not ‘grabbed’ by emotional faces, as it is with non brain-injured people, in part because of this lack of physiological arousal.

Dr. Green’s first study involved 30 Toronto Rehab patients who had experienced a TBI within the past four months and a group of healthy control subjects. Study participants were given three tasks. In one, they were shown photos of faces and were asked to label the following expressions: happy, sad, angry, frightened and neutral. In the second, they were shown two faces-each with one of the expressions mentioned above-and were asked to decide if the two people were showing the same or different expressions. The third task was to look at two neutral faces and decide whether they were the same or different people.In the third (neutral) face task, both groups performed the same. People with TBI experienced significant problems with the second task-the ability to tell if two faces were showing the same or different emotion. This group’s most pronounced deficit was in the first task-the ability to identify the specific emotional expression on a person’s face.

In the first phase of the study, researchers also recorded the time it took participants to complete the tasks. As expected, it took those with brain injuries longer. The surprise finding, however, was that healthy control subjects took proportionately more time to identify emotional faces (compared to neutral ones), but people with TBI did not allocate this extra time for emotional faces. “That tells us that those with brain injuries can only allocate so much time to look at a face. They are not sustaining their attention for long enough to do the job,” Dr. Green explains.

One of the main reasons the team undertakes these types of studies is “to carefully gain an understanding of the underlying problem so that therapies that are truly effective for the patient can be designed,” Dr. Green adds. The team also has made headway into the neurological underpinnings of emotion perception deficits, finding that areas of the brain that are critical to facial emotion processing are disconnected from one another in TBI.

These types of research studies will help to develop tests that can be used in clinical practice to diagnose deficits in facial emotion perception and more importantly to help remediate their deficits. Until interventions are developed, practical strategies can be used to help patients. These include focusing on other cues to read emotion such as gestures, tone of voice and increasing attention span for faces.

“Our aim is to minimize impairments in perceiving facial emotions, and we hope that this in turn will help patients to get along better with the people around them,” Dr. Green says, “and to have more satisfying and productive relationships with the people in their lives.”