When diplomacy fails: difficulty understanding hints following severe traumatic brain injury

Skye McDonald*, Alana Fisher, Sharon Flanagan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Background: In the absence of aphasia, many people with severe traumatic brain injuries (TBI) have difficulty with communication. In particular, they have difficulty understanding conversational inference. Poor social cognition is also prevalent following TBI. Aims: This study aimed to examine the role of social cognition in the ability to recognise conversational inference in the form of hints. Methods and procedures: 31 adults (22 men: mean age 45 years) with chronic (mean time since injury = 15.12 years) and severe TBI (mean post traumatic amnesia (PTA) of 32.74 days) and 24 adults (14 men: mean age 46.1 years) from the community participated. They were compared for their comprehension of two kinds of video vignettes in which professional actors made progressively more explicit hints. In one version, the conversational tone was neutral, in the other emotional. They were also assessed on an independent measure of social cognition (TASIT). Outcomes & results: The adults with TBI recognised neutral hints at a normal rate but, unlike the community controls, were not facilitated by overtly emotional hints. Social cognition performance was related to performance on both types of hint. Improved performance on the emotional hints was not uniquely predicted by social cognition but, rather, by processing speed and possibly also stress in the group with TBI. Conclusions: People with TBI appear to have difficulty using emotional cues to infer speaker meaning. This may reflect cognitive slowing and also anxiety and stress. This has implications for both remediation of such deficits and for educating others who interact with people with TBI.
Original languageEnglish
Pages (from-to)801-814
Number of pages14
Issue number7
Publication statusPublished - 2016
Externally publishedYes


  • traumatic brain injury
  • communication disorders
  • social cognition
  • conversational inference


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