PubMed · 8448690
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J Smith. 1993-03-15. A case for smaller bombs.. https://pubmed.ncbi.nlm.nih.gov/8448690/
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Impairments in the identification of facial and vocal emotional expression were demonstrated in a group of patients with ventral frontal lobe damage who had socially inappropriate behaviour. The expression identification impairments could occur independently of perceptual impairments in facial recognition, voice discrimination, or environmental sound recognition. The face and voice expression problems did not necessarily occur together in the same patients, providing an indication of separate processing. Poor performance on both expression tests was correlated with the degree of alteration of emotional experience reported by the patients. There was also a strong positive correlation between the degree of altered emotional experience and the severity of the behavioural problems (e.g. disinhibition) found in these patients. A comparison group of patients with brain damage outside the ventral frontal lobe region, without these behavioural problems, was unimpaired on the face expression identification test, was significantly less impaired at vocal expression identification and reported little subjective emotional change. The expression identification deficits in ventral frontal patients may contribute to the abnormal behaviour seen after frontal lesions, and have implications for rehabilitation.
Clinicians require a reliable and valid method of evaluating facial function after facial nerve injury. This tool should be clinically relevant and easy to administer, provide a quantitative score for reporting purposes, and be sensitive enough to detect clinically important change over time or with treatment. The proposed facial grading system has all essential information, including precise definitions for each item, presented on one page. The facial grading system is based on the evaluation of resting symmetry, degree of voluntary excursion of facial muscles, and degree of synkinesis associated with specified voluntary movement. Different regions of the face are examined separately with the use of five standard expressions. All items are evaluated on point scales, and a cumulative composite score is tabulated. Construct validity was addressed by comparing the proposed facial grading system to prerehabilitation and postrehabilitation treatment scores of 19 patients with varying degrees of facial nerve injury. All patients had documented change in a controlled study of feedback training. The proposed system reports results in a more continuous manner with a wider response range than the House-Brackmann grades. Each component of the grading system is sensitive to change and individually contributes to a change in the composite score. Tests of interrater reliability are currently near completion.
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