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Table 6.46 Effectiveness of Pragmatic and Emotional Intelligence Interventions

Author Year

Country

Research Design

PEDro

Sample Size

 

Methods

 

Outcomes

Westerhof-Evers et al. (2017)

Netherlands

RCT

PEDro=7

NInitial=61

NFinal=56

Population: TBI; Mean Age=43.2 yr; Gender: Male=83, Female=17; Severity: Moderate to severe.

Treatment: Participants were randomly assigned to receive Treatment for Impairments in Social Cognition and Emotion Regulation (T-ScEmo, n=30) protocol or Cogniplus (n=29) training. The TScEmo protocol is aimed at enhancing emotion perception, perspective taking, theory of mind, goal-directed social behaviour through 20 individual treatment sessions offered 1-2x/wk by neuropsychologists. Cogniplus is an individually administered computerized attention training aimed at improving general cognition. Outcomes were assessed baseline (T0), post-intervention (T1), and 3-5 mo follow-up (T2).

Outcome Measure: The Awareness of Social Inferences Test (TASIT-short), Sixty faces test (FEEST), Cartoon test, Faux Pas test (FP), Wechsler Adult Intelligence Scale (WAIS-III digit span), Trail Making Test (TMT A and B/A), Test of Everyday Attention Lottery (TEA lottery), Dysexecutive Questionnaire-Social scales (DEX-Soc-self, DEX-Soc-proxy), Brock’s Adaptive Functioning Questionnaire-Social monitoring scale (BAFQ-SM-self, BAFQ-SM-proxy), BAFQ empathy scale (BAFQ-Emp-self, BAFQ-Emp-proxy), Role Resumption List (RRL), Quality of Life after Brain Injury (QOLIBRI satisfaction, QOLIBRI burden), Treatment Goal Attainment (TGA), Relationship Quality Scale (RQS-self, RQS-life partner).

1.       For the primary outcome of TASIT-short, there was no significant improvements over time in either group or no significant differences between groups.

2.       Significant Time x Group interactions from T0 to T1 were observed for FEEST (p=0.01), CT (p=0.02), RRL (p<0.01), and TGA (p<0.01). No significant interactions from T0 to T1 were observed for FP, DEX-Soc-self, DEX-Soc-proxy, BAFQ-SM-self, BAFQ-SM-proxy, BAFQ-Emp-self, BAFQ-Emp-proxy, QOLIBRI satisfaction, QOLIBRI burden, RQS-self, RQS-life partner, WAIS-III digit span, TMT A, TMT B/A, or TEA lottery.

3.       Significant Time x Group interactions from T0 to T2 were observed for FEEST (p<0.01), CT (p=0.02), BAFQ-Emp-proxy (p=0.02), RRL (p<0.01), QOLIBRI burden (p=0.04), RQS-life partner (p=0.02), and TGA (p<0.01). No significant interactions from T0 to T2 were observed for FP, DEX-Soc-self, DEX-Soc-proxy, BAFQ-SM-self, BAFQ-SM-proxy, BAFQ-Emp-self, QOLIBRI satisfaction, RQS-self, WAIS-III digit span, TMT A, TMT B/A, or TEA lottery.

Neumann et al. (2015)

USA

RCT

PEDro=9

NInitial=71

NFinal=60

 

Population: TBI; Faces (n=24): Mean Age=41 yr; Gender: Male=23, Female=1; Mean Time Post Injury=10.5yr; Mean GCS=6.9; Stories (n=23): Mean Age=41.5 yr; Gender: Male=18, Female=5; Mean Time Post Injury=10.9 yr; Mean GCS=4.4; Control (n=24): Mean Age=39.5 yr; Gender: Male=16, Female=8; Mean Time Post Injury=9.8yr; Mean GCS=5.3.

Treatment: Participants randomly assigned to one of three interventions for 1 hr sessions 3 days/wk for 3 wk. Faces intervention taught individuals to recognize emotions in facial expressions, whereas stories intervention taught individuals to recognize emotion within stories. Control group underwent cognitive training. Participants assessed at pre-treatment and post-treatment within 4 days, at 3 mo and 6 mo.

Outcome Measure: Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces (DANVA 2-AF), Emotional Inference from Stories Test (EIST), Interpersonal Reactivity Index (IRI), Neuropsychiatric Inventory (NPI) Irritability and Aggression domain.

1.       According to DANVA 2-AF, participants trained in the face’s intervention had a significant improvement across all follow-up time points compared to controls (p=0.031).

2.       No significant improvement for the story’s intervention on DANVA 2-AF compared to controls (p=0.239).

3.       No significant improvement on EIST for the story’s intervention (p=0.167) and faces (p=0.349) compared to controls.

4.       Across all post-treatment assessments, there was a main effect of time as performance decreased for the story’s intervention on EIST compared to controls (p=0.001).

5.       NPI irritability and aggression and IRI empathy were not significant for faces or story interventions compared to controls.

McDonald et al. (2013)

Australia

RCT

PEDro=6

N=20

Population: Severe TBI=16, CVA=3, Other=1; Mean Age=45.62 yr; Gender: Male=15, Female=5; Mean Time Post Injury=9.41 yr. Treatment: Patients were assigned to either a treatment group (n=10) or a control group (n=10). Patients receiving treatment attended 2hr/wk treatment sessions for 3 wk. Sessions consisted of a therapist and two participants. The program was tailored to focus on prosodic cues that may be seen in expressions of emotions. Outcome Measure: Awareness of Social Interference Test Form B-Part 1 (audio presentation), Prosodic Emotion Labelling Task, Communication Questionnaires. 1.       No significant treatment effects were found for the TASIT B, while accuracy on the prosody task (p=0.074) and rating of intensity of emotions (p=0.076) approached significance. 2.       The treatment group showed a significant change on the self-report communication questionnaire (p=0.013).
Radice-Neumann et al. (2009) USA

RCT

PEDro=5

Nintial=21

Nfinal=19

Population: TBI=19, ABI=2; Mean Age=43 yr; Gender: Male=12, Female=8; Mean Time Post Injury=12 yr; Mean GCS=4.08.

Treatment: Patients were randomly assigned to receive either the facial affect recognition (FAR; n=10) training or the stories of emotional inference training (SEI; n=9). In the FAR training, individuals practiced identifying and discriminating emotions from facial expressions and focused on processing their internal emotions. SEI involved reading stories and answering questions. Sessions were 1:1 for 1 hr, 3 x/wk for 2-3 wk.

Outcome Measure: Levels of Emotional Awareness Scale (LEAS), Diagnostic Assessment of Nonverbal Affect – adult faces/adult paralanguage (DANVA2-AF and DANVA2-AP), Brock Adaptive Functioning Questionnaire (BAFQ).

1.       The FAR group improved on the DANVA2-AF over time (p<0.001), with changes being seen from pre-post (p<0.001) but not post to follow-up (p=0.244).

2.       The SEI group also improved on the DANVA2-AF (p=0.006). The change occurred between the two pre-tests (p=0.004).

3.       No significant changes were found for either group on the DANVA2-AP or the ability to infer emotions on video.

4.       Both groups improved on their ability to infer emotions from contextual situations (LEAS; both p=0.019).

5.       On the BAFQ, caregivers, indicated those in the FAR group showed improvement in the behaviour of patients (p=0.042); out of 4 emotional behaviours, only aggression changed significantly (p=0.047); SEI did not improve in perceived behaviour.

Gabbatore et al. (2015a)

Italy

Pre-Post

NInitial=20

NFinal=15

Population: TBI; Mean Age=36.7 yr; Gender: Male=10, Female=5; Mean Time Post Injury=76.13 mo; Mean GSC=4.5.

Treatment: Participants received a control procedure with non-communication activities for 3 mo. This was followed by a 3-mo cognitive pragmatic training program (2 sessions/wk) consisting of 5-patient groups focussed on improving pragmatic abilities, self awareness, and executive function.

Outcome Measure: Assessment Battery for Communication (ABaCo-comprehension, production, linguistic, extralinguistic, paralinguistic, and context), Attentive Matrices, Trail Making test, Verbal Span, Spatial Span, Immediate and Deferred Recall test, Tower of London test, Wisconsin Card Sorting test (WCST), Coloured Progressive Matrices Raven, Aachener Aphasie test-denomination scale (AAT), Sally and Ann Task, Strange Stories Task.

1.       No significant improvements in ABaCo (production and comprehension) were observed during the nonspecific control period.

2.       Participants showed significant improvements from pre-training to post-training for ABaCo comprehension (p<0.001), production (p<0.001), linguistic (p=0.005), extralinguistic (p=0.008), paralinguistic (p=0.02), and context (p=0.01).

3.       At 3 mo follow-up post-treatment, AbaCo scores did not show significant differences from post-treatment.

4.       From pre-training to post-training, no significant differences were observed for Verbal Span, Spatial Span, Attentive Matrices test, Trial Making test, Tower of London test, Raven’s Colored Progressive Matrices, AAT, Sally and Ann task, or the Strange Stories task. Improvements were observed for the Immediate and Deferred Recall task (p=0.01) and Wisconsin Card Sorting test (p=0.003).