UNILATERAL BRAIN DAMAGED PROCESSING FACIAL EXPRESSION AND PROSODY

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ABSTRACT

Nonverbal aspects such as prosody and facial expression are contributing better understanding in communication. Interdisciplinary approach to these phenomena is essentially in evaluation of unilateral brain damaged patients.

Three groups of participants were evaluated in prospective clinical trial. One group of thirty patients with right hemispheric deficit (RHD), second group of thirty patients with left hemispheric deficit ( LHD) and the group of thirty healthy persons (CG).

An adapted neuropsychological test ( Test of Aprosody in Serbian- TAS 2004 ) is improved in verifying unilateral brain damage.

Our results confirm the fact of  the right hemispheric role in facial expression and emotional prosody processing, with certain role in linguistic prosody processing. The main left hemispheric role in linguistic prosody processing is confirmed too, with certain activity in facial expression and emotional prosody processing.

KEYWORDS

Prosody, facial expression, right hemispheric deficit, left hemispheric deficit, Test of Aprosody in Serbian

Introduction

The basic question in cognitive neuroscience - What is happening in the brain, where and when  – needs interdisciplinary approach. Synthetic work of phoniatricians, neurophysiologists, neurologists, logopedics could give the some kind of answer.

The secret of the phenomena of voice, speech and language probably will never be discovered. It is clear that phonation is product of interaction of numerous factors including intact psychological status and vocal box, with neuro, neuroendocrine and neurovegetative system helping, being synchronized with visual, audio, proper and deeper sensibility feed back. This complex mechanism is coordinated by central nervous system.

The anatomic base of the processes of interpersonal communication is integrated in audio- vocal system, with the very true that material component is of the less importance.

“Intellectum dat qui auditum”- input of acoustic waves is transformed into neuroelectric waves in the ear. Auditor input is passing through adequate nerve pathway which is two-way road with its efferent component too. The output of the audio- vocal system is also well known, with its afferent component from the neuroreceptors in the larynx.

The most important, central, part of this system, based on integration of parallel and sequential brain processing, is mostly unexplained. That is more complicated with the fact that the map of the cortex is not only the neuron network, but equally the neurotransmitters with their receptors. Multimodal cortical areas of frontal, parietal and temporal lobe are the place of analysis and synthesis of sensomotor cognitive data. Their connections with limbic and para limbic areas give emotional evaluation of stimulus and modification of  affects. Limbic system is transducer of information of emotional meanings of the external stimulus, and anterior cortex is modulating adequate motor activity.

From the modern technology aspect such as ultra electronic microscope, audio- vocal system is the pathway with input in mitochondria of the inner and external cochlear cells with stereocyllias. Their depolarisation liberates neurotransmitter glutamate, which activates action potentials of neurons. The middle part of this pathway is synaptic cleft and the end of output is specific mitochondria of the neuromuscular junctions of the vocal folds.

Is it coincidence that the oldest information of the human race is stored in mitochondrial DNA?

The origin of the word prosody is in Latin prosodia, equally with Greek просоидиа, that means accentuation and intonation, as nonverbal aspects of communication. We are talking about linguistic and emotional prosody. Brain lateralisation makes organisation of the neuropsychological functions.

The clinical importance of the affect in communication was recognized in 1915 (38) , but the systematic approach to the dysprosodic syndromes was since 1947 (56). The first authors pointed on the fact that right hemispheric deficit makes no difference in recognition of sad or happy voice, although such patients can understand the meaning of what was said (37). Very soon it was shown that linguistic prosody recognition is also damaged in right hemispheric deficit (82). EEG parameters confirmed the hypothesis of the connection between RHD and failure in prosody expression (83).

In the early 80-s of the last century, the specific neuropsychological test for aprosody identification was introduced  (12,13). FAB test by Dawn Bowers and ass. was designed 1991. for the evaluation of facial expression and prosody recognition  in unilateral brain damaged.

Method

In the prospective clinical study three groups of participants were evaluated by the experts’ team, consisted of neurologist, psychologist, vocal and speech pathologist and phoniatrician. Two groups of 30 patients equally in the stabilisation neurological phase after cerebrovascular insult (7 – 14 days after the stroke), one group of patients with focal ischemic lesion of the right brain (RHD), and second group with focal ischemic lesion of the left brain (LHD). Third group (CG) of 30 healthy (20 men and 10 women in each group) made the control. Unilateral brain damaged patients were in the hospital, just before their living home. CT has given clearly confirmation of strategic unilateral lesion with neurological examination. They were all MMSE (Mini Mental State Examination) over 27 points, adequately motivated and animated for testing. They all had audiometric proved social level preserved hearing.

TAS 2004 (Test of Aprosody in Serbian) was introduced. That is originally modified and adapted version of commercially available  (Revision 1998.) FAB test ( Bowers and ass).  The FAB subtests in recognition of the mimics was used in integral version, with little corrections . The group of subtests for recognition of the prosody was designed with authentic sentences in Serbian, given in neutral form. 10 nonsonor consonants of Serbian language were excluded. Integral version has 14 subtests. We used 11 of them, that are adequate to our patients possibilities.

In the group of subtests of the recognition of facial expression were: subtest of recognition of the face identity, subtest of the recognition of facial expression identity, subtest of nomination of the emotion in facial expression, subtest of the discrimination of the emotion in the group of five ( happiness, sadness, anger, fear, and without emotion), and subtest of identification of given emotion in the group of five.

In the group of prosodic subtests were: subtest of discrimination of the linguistic prosody, subtest of identification of the linguistic prosody, subtest of discrimination of the emotional prosody, subtest of identification of emotional prosody, subtest of matching facial expression with given emotional prosody, subtest of matching emotional prosody with given facial expression.

One experienced actress helped in making our CD with neutral sentences given in five emotional and two linguistic frames.

Every participant had enough time for answering, if necessary the example was repeated, especially in three last subtests.

The standard descriptive and analytical statistic methods were used for data evaluation.

Results and discussion

The localisation of the brain lesions is shown in the Tab 1. In RHD group, there was little wider topographic spectrum, but the most frequent localisations are the same. It is little better distribution than usually level of congruency (8,9) We are on the stand of point that this is the main problem in designing such studies. The gold standard should be identical focal lesion for all groups, but also it must be wide accepted as the strategic one in the field of prosody and facial expression processing.

The post stroke period was 8,7 days in RHD and 9,97 days in LHD group with no statistical significant difference. In most cases it was the day before their living home, with the maximal motivation for testing that last maximally two hours, all patients had afternoon bed rest before testing, and also could take a rest during testing.

 

Tab 1-Localisation of the brain lesions in RHD and LHD group

LOCALISATION RHD GROUP

No

LOCALISATION LHD GROUP

No

Paraventricular

8

Paraventricular

8

Basal ggl

5

Parietal

6

Parietal

5

Basal ggl

3

Frontal

2

Parietotemporal

3

Paraventricular + Basal ggl

2

Paraventricular + Basal ggl

3

Frontoparietal + Basal ggl

2

Temporal

3

Parietotemporal

1

Frontotemporal

2

Parietal + Paraventricular

1

Parietal + Paraventricular

1

Parietal + Basal ggl

1

Frontoparietal

1

Temporal

1

 

 

Temporoparietal + Paraventric.

1

 

 

Capsula int + Basal ggl

1

 

 

 

There was no significant differences in age or educational level between three groups.

RHD mean age was 63 years,  with the youngest in 30, and the oldest in 77 years.

LHD mean age was 62, with youngest as 44, and the oldest as 79.

CG  mean age was 58 , 37 and 83.

We tried to match the groups as well, because of the well known fact of the age influence on understanding emotional prosody (59).

The average educational level was 10 years in RHD and LHD groups, and 12,5 in CG.

The results are given in percentage of correct answers. The analysis is given between RHD and LHD, as well as each of the two toward CG. The results of each subtest separately, the results of the group of subtests of facial emotion, the group of subtests of linguistic prosody and the group of subtests of emotional prosody are given in these relations, as well as for the all 11 tests together.

In subtest 1 results ( ability to recognize the same person on the photos, it is some kind of introduction test) there was high percentage of correct answers in all groups with significant difference between RHD (94,50 %) and CG (99,93%).

In subtest 2 results ( ability to recognize the same facial expression of emotion) there was high statistical difference between RHD and CG as well as between LHD and CG, but also between RHD and LHD. RHD patients gave statistically high incorrect ability to facial expression discrimination.

In subtest 3 results ( ability to nominate the emotion in facial expression) there was high statistical significance between RHD and CG, as well as between LHD and CG, but no statistical difference between RHD and LHD group.

In subtest 4 results ( ability to identification certain emotion among photos of different facial expressions) there was statistical high difference between RHD and LHD, as well as between RHD and CG, but also statistical significant between LHD and CG.

In subtest 5 results ( ability to recognize the emotion given on one photo, among various facial expressions given on other photos) there was statistically high difference between RHD an LHD as well as between LHD and CG, but also between LHD and CG.

Finally, the all five subtests together ( Tab 2 ), as subtests of recognition of emotion in facial expression, showed that RHD patients had statistically high incorrect processing of facial expression compared with LHD patients, as well as compared with CG participants.

The right hemisphere is the site for facial expression processing, but the left hemispheric role is present here, too.

 

Tab 2- Results of subtests 1- 5 together

GROUP

No

Correct %

sd

Minimum

Maximum

RHD

30

77,37

10,26

63,00

97,00

LHD

30

84,93

7,86

64,00

98,00

CG

30

97,77

2,81

91,00

100,00

 

In subtest 6 results (ability to recognize the difference in linguistic prosody)  there was statistically high difference between LHD and RHD group as well as between LHD and CG, but also statistical significance between RHD and CG.

In subtest 7 results (ability to nominate linguistic prosody) there was the same statistically significance as in subtest 6.

The results of these two tests together ( Tab 3 ), as the tests of processing of linguistic prosody, showed that LHD patients had statistically high incorrect processing in linguistic prosody compared with RHD patients, as well as compared with CG participants.

The left hemisphere is the site for linguistic prosody processing, but the right hemispheric role is present too (34). There is, of course, high controversy in the theory of hemispheric specialisation (8), especially in the field of sub cortical activity.

 

Tab 3- Results of subtest 6- 7 together

GROUP

No

Correct %

sd

Minimum

Maximum

RHD

30

93,33

5,43

81,25

100,00

LHD

30

71,67

11,60

46,88

96,88

CG

30

98,96

2,37

90,63

100,00

 

In subtest 8 results (ability to discriminate emotional prosody) we can see that RHD, as well as LHD  patients, had statistically high incorrect discrimination of emotional prosody, compared with control group.

In subtest 9A results (ability to identification emotional prosody) there were the same high statistically differences as in subtest 8 results. We must note the only 85% of correct answers as the maximum in RHD group.

Subtest 10, as the matching subtest showing ability of connection facial expression with given emotional prosody, results were also high statistically significant as in previous two subtests, but also RHD patients had statistically significant incorrect answers compared with LHD patients.

Subtest 11, showing ability to connect emotional prosody with given facial expression, gave the same results as in the subtests 8 and 9A.

The results of these four tests together ( Tab 4 ),  as the tests of ability of identification of emotional prosody, showed that RHD patients had statistically high incorrect processing of emotional prosody compared with CG ( where the average result was 91,58%), as well as LHD patients, but there were no statistically significant difference between RHD and LHD group.

 

Tab 4- Results of subtests 8- 11 together

GROUP

No

Correct %

sd

Minimum

Maximum

RHD

30

57,46

11,61

37,50

83,75

LHD

30

62,75

8,56

45,00

83,75

CG

30

91,58

10,92

65,00

100,0

 

 

We showed incorrect emotional prosody processing in unilateral brain damaged patients, as it was previous mentioned ( 6 ), but we did not prove the main role of right hemispheric structures in emotional prosody processing, as it was mentioned too (45).

Finally, we made an analysis of all subtests together (Tab 5 ), and could see that  RHD patients gave high statistically worse answers than CG participants, LHD patients gave high statistically worse answers than CG participants, too, but there was no statistically significance between RHD and LHD group.

We could see also that TAS battery found its place in such studies, there was in most subtests more than 95% correct answers in CG, with 88% minimum in the last subtests.

 

Tab 5- Results of all subtests together

GROUP

No

Correct %

sd

Minimum

Maximum

RHD

30

73,03

8,65

59,09

90,45

LHD

30

74,45

7,02

53,98

89,77

CG

30

95,73

5,09

82,61

100,00

 

Conclusions

RHD patients

- have high statistically significant incorrect facial expression and emotional prosody processing compared with CG

- have statistically significant incorrect linguistic prosody processing compared with CG

- have high statistically better linguistic prosody processing then LHD patients

Right hemispheric structures have active role in facial expression and emotional prosody processing, but also take a part in linguistic prosody processing, too.

 

LHD patients

- have high statistically incorrect linguistic prosody processing compared with RHD patients

- have high statistically significant incorrect facial expression, linguistic and emotional prosody processing compared with CG

- have high statistically better facial expression processing compared with RHD patients

Left hemispheric structures are the place of linguistic prosody, but also have an active role in facial expression and emotional prosody processing, too.

 

The neuropsychological battery used here showed high significant of sensitivity in discrimination of ability of facial expression and prosody processing in unilateral brain damaged patients compared with control group participants, as well as in discrimination of right and left hemispheric damage, especially in linguistic prosody processing.

Evaluation of brain damaged patients needs interdisciplinary approach in giving the answers about management of these disorders. Neuropsychological battery that is used here gives the answer about localisation of the lesion, evaluation of the rest of no damaged potential of the patient, and prognosis of the rehabilitation success.

There should be always on our mind that modern technology has advantages but also with numerous borders, so neuropsychological testing still has its place. We are proud of forming the first Test battery in Serbian that can be used in our struggle with crebrovascular stroke, and maybe in early recognition of threatening unilateral ischemic deficit. With experienced expert, there is no longer of 60 minutes of testing, designed not to be boring for patient, it can be shorter or longer, depending of the aim of investigation. It can be used as annually test in rescue groups of patients with ischemic symptoms, as well as in planning of rehabilitation, or evaluation of success of therapy.

Integral version of the test is recommended in healthy population, especially as qualification testing in some professions.

There is very interesting situation in modern science that cognitive neuroscience in the field of language is not present enough as the role that the language has in human life. Different fields such as psycholinguistics, neurolinguistics, neurobiology, neuropsychological have the similar aim, but there are no much communication among them. Imperative of the future investigations is the closest work between different neurosciences, using different methods in the same time. Priority should be in testing of conversational speech, expression as well as perception. The main question is ability of no damaged part of the brain in activating the rest of communication ability.

In the beginning of the evaluation of such patients the precise anamnesis is of the great importance because laryngeal pathology can be only the sign of some lesion or some disorder elsewhere . Interdisciplinary approach include examination of the neurological, pulmonary and digestive factors.

Focusing on one medicine field gives the opportunity of synthetic work such as logic connection between phoniatricians and neuropsychological work, many of phoniatric disorders need neuropsychological evaluation.

There is urgent need for Communication Disorders Care Centre opening in this part of South-Eastern Europe.

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