Social Perception and Social Communication in Adults with

Traumatic Brain Injury


R01 NIH HD071089; 11/2012 – 7/2018



Lyn Turkstra and Bilge Mutlu


Impairments in social behavior are a hallmark of moderate-to-severe traumatic brain injury (TBI) in adults. Social behavior problems are stable over time, and are a major source of stress and burden for caregivers. These problems can lead to loss of employment and social isolation, which in turn are associated with a high risk of depression, suicidal ideation, and poor quality of life among adults with TBI. Thus, social problems are a common, chronic, and costly problem for individuals with TBI and their caregivers. While TBI can result in a range of cognitive and behavioral disorders, the most common complaint, and perhaps the greatest obstacle to community re-integration and employment, is that persons with TBI have “odd” social behaviors, such as making inappropriate or irrelevant comments, monopolizing conversations, and generally appearing to be insensitive to the social needs of others. These are social communication problems. Social communication problems have been well-documented in studies by our group and others, and are commonly discussed in clinical publications. To date, however, there is little evidence that treatment of these problems generalizes beyond the therapy room to everyday social interactions. One possible reason for treatment failure is that clinicians are targeting the wrong problem, because current therapies focus on re-teaching “appropriate” behaviors (e.g., training eye contact or turn-taking), without considering the underlying causes of these behaviors. Specifically, there is growing evidence that the cause of impaired performance may be failure to read social cues, i.e., impaired social perception. Social perception problems after TBI may range from failure to read basic nonverbal cues such as gaze direction, to errors perceiving complex social cues such as sarcasm. An understanding of social perception problems in adults with TBI is critical for treatment planning: if the patient cannot perceive social cues, he or she will not know when to execute learned behaviors outside of the structured therapy environment. To develop effective treatments, we need to understand social perception problems in adults with TBI and determine how these problems relate to specific communication behaviors. The aims of the proposed research are:  Aim 1: To identify impairments in social perception in adults with moderate-to-severe TBI. Aim 2: To determine the relationship of social perception to social communication. Aim 3: To identify sex-based differences in social perception and social communication. 


Rigon, A., Turkstra, L., Mutlu, B., & Duff, M.C. (2016). The female advantage: Sex as a possible protective factor against emotion recognition impairment following traumatic brain injury. Cognitive, Affective, and Behavioral Neuroscience, 16(5), 866-875.


Turkstra, L., Politis, A., Duff, M.C., & Mutlu, B. (2017). Detection of text-based social cues in adults with traumatic brain injury. Neuropsychological Rehabilitation.  DOI: 10.1080/09602011.2017.1333012


Rigon, A., Turkstra, L., Mutlu, B., & Duff, M.C. (2017). Facial affect recognition deficit as a predictor of social communication impairment following traumatic brain injury. Neuropsychology.

Turkstra, L., Norman, R.S., Mutlu, B., & Duff, M.C. (2018). Impaired theory of mind in adults with traumatic brain injury: A replication and extension of findings. Neuropsychologia, 111, 117-122.

Mutlu, B., Duff, M.C., & Turkstra, L. (2019). Social-cue perception and mentalizing ability following traumatic brain injury: Human robot interaction study. Brain Injury, 33 (1), 23-31.