The influence of emotion processing in recovery from stroke

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The influence of emotion processing in recovery
from stroke

• Clare Scott
• Research Training Fellow

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Acknowledgements

• Dr Maggie Whyte
• Dr Mary-Joan MacLeod
• Dr Steve Hamilton
• Elaine Horne
• All staff and patients from NHS Grampian

• Prof Marie Johnston
• Prof Louise Phillips
• Lisa Robertson
• Andrea Collard
• Tenovus Scotland
• CSO

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Emotion processing and social participation

• Studied independently
• Neurological illnesses can result in impairment
  in these areas
• Growing interest in clinical groups -
  Schizophrenia TBI.

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Stroke

• Leading cause of complex disability -
  participation restriction
• Over 2.8 billion cost to the NHS (national
  office of statistics)
• Traditional rehabilitation focus on functional
  recovery
• WHO defines successful rehabilitation as
  re-integration into social networks and
  participation in community.

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Consequences of Stroke
Stroke
Activity Limitations
Participation Restrictions
Impairment
Difficulties in Social situations
Can not go to the Shop housebound
Physical Impairment
Inability to walk
Emotion Processing
Activity Limitations
International Classification of Functioning,
Disability and Health (ICF). World Health
Organisation (2001)
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Emotion Processing

• Emotion Perception
• ability to accurately perceive emotional cues
  from facials expressions, prosody and body
  posture.
• Emotion Regulation
• awareness, understanding acceptance of
  emotions
• modulating controlling emotions and behaviour
  even when experiencing negative emotions.
• Mood state Depression and Anxiety.

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Stroke Social Participation

• Reduced social networks and contacts
• Key determinant of quality of life
• Predictor of discharge destination

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Pilot Study
Stroke
Social Participation Restrictions
Activity Limitations
Emotion Processing Impairment
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Research Questions

• Are difficulties in emotion perception following
  stroke associated with poorer functional outcome?
• Are any associations between emotion perception
  and functional outcome independent of depression
  and anxiety?

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Participants

• 28 Stroke patients (17 males)
• aged 53 85 years (Mean 68 SD 9).
• Recruited from NHS Grampian stroke register.
• 1 year post stroke
• 366-483 days (Mean 413 SD 30).
• No severe cognitive impairment
• MMSE Score 25-30 (Mean 28.21 SD 1.9).

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Measures

• Primary Measures
• Emotion processing
• Emotion perception - FEEST Faces, TASIT and
  Florida Affect Battery
• Mood state - HADS.
• Social Participation
• Modified Functional Limitation Profile WHOQoL
  BREF
• Activity Limitation
• Modified Functional Limitation Profile.
• Secondary Measures
• Cognitive measures
• ACE-R (includes the MMSE)

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FEEST Faces- emotion labelling
ANGER DISGUST HAPPINESS SADNESS FEAR SURPRISE
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Florida Affect Battery

• HAPPY
• SAD
• ANGRY
• FRIGHTENED
• NEUTRAL

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TASIT

• HAPPY NEUTRAL
• SURPRISED SAD
• ANGRY ANXIOUS
• REVOLTED

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Social Participation (Modified Functional
Limitation Profile)

• 64. I refuse contact with my family for example,
  
• l turn away from them. .... (109)
• 65. I frequently get angry with my family for
• example, l hit them, scream or throw things
  at
• them. .... (103)
• 82. I go out less often to visit people.
  .... (31)
• 83. I take part in fewer social activities than I
  used
• to for example, I go to fewer parties or
  social
• events .... (25)

. . .
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WHO-QoL Bref

• Domain 1 Psychological
• How often do you have negative feelings such as
  blue mood, despair, anxiety, and depression?
• Domain 2 Social
• How satisfied are you with your personal
  relationships?
• Domain 3 Physical
• How satisfied are you with your ability to
  perform your daily living activities?
• Domain 4 Environmental
• Have you enough money to meet your needs?

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Results.
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Results
FEEST FAB TASIT Faces Voices Videos
FEEST Faces .578 .691 FAB
Voices .635 TASIT Videos
Significant to lt 0.01
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Results
HADS FLP FLP WHOQol
WHOQoL WHOQol WHOQoL SP
AL Psychol Environ
Social Physical Emotion Perception
-.201 -.464 -.255 .482
.310 .246 .281
Partial correlations Emotion Perception
---- -.462 ---- .500
---- ---- ---- (Controlling
for HADS)
Significant to lt 0.05
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Emotion Perception Social Participation in
Stroke

• Patient 1
• Emotion Perception total 34
• Participation measure
• I am cutting down on my usual inactive
  past-times, watching less TV, reading lessI go
  out less often to enjoy myselftake part in
  fewer community events.
• I am often irritable with those around me,
  snapping at peopletalk less with others, go out
  less often to visit people and take part in fewer
  social activities than I used to.

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Emotion Perception Social Participation in
Stroke

• Patient 2
• Emotion Perception total 85
• Participation measure
• No change at all.. I am still participating in
  community activities, hobbies, and recreation.
• I engage with family and friends, visit people,
  joke with family and friends and continue to take
  part in social activities and events.

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Conclusion

• Emotion perception predicted participation, but
  not activity limitation.
• Limitations
• Cross-sectional design
• 1 year post stroke
• Small sample.

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So.currently

• CSO funded research training fellowship
• Predictive study
• Approximately 1 month post stroke
• Follow-up 1 year post stroke
• Larger sample - 120.

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ICF
Stroke
Social Participation Restrictions
Activity Limitations
Emotion Processing Impairment
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Research Questions

• Are deficits in emotion processing correlated
  with social participation
• - in the acute phase of stroke?
• - in the chronic phase of stroke?
• Do any emotion-processing deficits in the acute
  phase of stroke predict social participation at
  one-year post stroke?

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Participants

• 120 patients approximately one month post stroke
  to be recruited from NHS Grampian.
• Patient exclusion criteria
• Pre-existing neurological condition, psychiatric
  history or drug/alcohol abuse
• Severe aphasia, or
• Severe cognitive impairment (MMSE score lt 23).

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Measures

• Emotion processing
• Emotion perception- FEEST Faces, TASIT and
  Florida Affect Battery
• Mood State HADS, CES-D.
• Emotion Regulation DERS.
• Social Participation
• Modified Functional Limitation Profile, WHOQoL
  BREF, Social Network Scale Social Self
  Adaptation Scale.

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So far

• Recruited and assessed 70 stroke patients.
• Difficulties
• Recruitment!
• Non-responders at 48
• Uptake is approximately 35

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To summarise

• Emotion processing and health outcomes?
• Is this a key area for further study?
• Pilot Study
• Emotion Processing appears to correlate with
  participation outcome.
• Currently..
• Examining this relationship further.
• Can we predict those who may experience long term
  participation restriction?

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For the future
Understand emotion-processing factors underlying
stroke recovery Increase scientific social
understanding Target patients in rehabilitation
at risk.
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Thank you any questions?