Processing of pragmatic and facial affective information by patients with closed-head injuries.

Although several affective impairments have been demonstrated to occur following closed-head injury (CHI), deficits of the communicative function of language, particularly sentenial and suprasentential pragmatic aspects, have been suggested, but not demonstrated, to occur. This study compared 31 normals and 31 severely closed-head injured patients matched for age, sex and education. The dependent measures consisted of a facial test of emotion (FTE) and a contextual test of emotion (CTE). The former task consisted of 36 slides representing facial expressions of the six emotions demonstrated by Ekman and colleagues to be transcultural, namely, job, sadness, fear, anger, surprise and disgust. The subject was required to name the appropriate emotion for each slide. The latter task consisted of correctly identifying the appropriate emotion for each of 36 brief verbal narratives representing contexts connotative of the same six transcultural emotions. The CHI patients were impaired overall on the FTE but not the CTE. However, the ability to identify anger was significantly impaired on both tasks when considered in isolation from the other emotions. It was concluded that a processing deficit of primary emotional material, particularly anger, does exist following CHI, but that this deficit is not necessarily independent of task and/or modality parameters. It was also concluded that evidence of a pragmatic deficit of the language function following CHI remains to be provided at this time.