The expression and perception of facial emotion in brain-damaged patients

Neuropsycholoy~o, Vol 24. No 2, pp. 169.-1X0. 1986. Prmted m Great Britam

THE EXPRESSION

JOAN

C. BOROD,*?

c

002&393?R6 53 OO/O.oO 1986 Pergamon Press Ltd

AND PERCEPTION OF FACIAL EMOTION BRAIN-DAMAGED PATIENTS

E~.ISSA KOFF,~

MARJORIE

PERLMAN

LORCH?

and MARJORIE

IN

NlCHOLASt

*Department of Psychiatry, New York University School of Medicine; tAphasia Research Center and Department of Neurology, Boston University School of Medicine; +Department + of Psychology, Wellesley College (Accrpted

24 July 1985)

Abstract&This study examined the expression and perception of facial emotion in patients with unilateral cerebrovascular pathology. Subjects were 12 right brain-damaged (RBD). I5 left braindamaged (LBD) aphasic, and 16 normal control (NC) right-handed males. Expressions were elicited during posed and spontaneous conditions. Both positive and negative emotions were studied. RBDs were significantly impaired. relative to LBDs and NCs, in expressing and perceiving facial emotion. There were no group difierences as a function of condition, but there were differences as a function of emotional valence. Qualitative performance differences also were observed. There was no evidence that the ability to produce a particular emotion was related to the ability to identify the Same emotion. Overall, these findings support the notion that the right cerebral hemisphere is dominant for expressing and perceiving facial emotion.

INTRODUCTION A SPECIAI~ role for the right hemisphere has recently been suggested for both the perception and expression of facial emotion (for review, see [9]). In normals, perception studies have demonstrated a left visual-field (i.e. right hemisphere) advantage for perceiving emotional facial expression [35,45,47, 58, 593. Expression studies with normals have documented that the left hemiface (presumably controlled by the right hemisphere) moves more extensively [4. 6, 1 I, 491 and appears more intense [ 16,26.37,54,56] during emotional expression than the right hemiface. Clinical studies have suggested that deficits in the perception of emotional facial expression are associated primarily with right-hemisphere brain damage 12, 19. 24, 30). Studies of the production of emotional facial expression in brain-damaged patients are less common. and tend to focus on spontaneous, in contrast to posed. expression. BWX and DUWY [ 151 and BOROI),KOFF, PERI.MANLORCHand NICHWAS [IO] found that spontaneous emotional facial expressions were less likely to occur in right brain-damaged patients than in left brain-damaged patients and normal controls. In a case study of two right brain-damaged patients. Ross and MESULAM [53] observed that spontaneous facial expression seldom occurred. On the other hand, KOLR and MII.NER [43] reported that spontaneous facial expressions and movements (it is not clear what percent of these were emotional) occurred with equal frequency in a group of right and left brain-damaged patients. but less frequently

‘Dr Bored IS now in the Departments of Psychology. Queens College, and Neurolog>, Mount Medicine. City University ofNew Yorh. Addresscorrespondence to: DrJoan C. Borod, Department Queens College. Flushing. NY 11367, U.S.A. lh9

Sinai School of of Psychology.

in those patients with frontal, relative to posterior, damage. In the only report (anecdotal) of posed facial expression among brain-damaged subjects, HEILMAN and VALENSTEIN [36] observed no performance differences between a small number of right and left braindamaged patients. Since posed and spontaneous expressions are considered to reflect separate and possibly independent neuroanatomical pathways and origins [21, 32, 41, 48, 601, both types of expression should be studied in the same patients. While perception and expression have been of great interest, none of the above studies examined both functions in the same individuals. In the case of brain-damaged patients, one would like to know whether a deficit in one function co-occurs with a deficit in the other. In the case of normals, one would like to know if the two functions are correlated. It could be argued that individuals with deficits in classifying or perceiving a particular emotional expression would have difficulty in producing or modeling that same expression. While the bulk of the evidence suggests an overall right-hemisphere dominance for emotion [9, 46, 611, recent studies have speculated about right-hemisphere dominance for negative emotions and either left-hemisphere or bilateral involvement for positive ones [ 1, 5, 8, 13, 23. 25, 42, 51, 551. One possible explanation for this apparent inconsistency with respect to emotional valence is that the type of behavior (i.e. perception or expression) being observed might affect the results. HIRSCHMAN and SAFER [38], in fact, have speculated that valence is a more salient variable in studies ofexpression than in studies ofperception. Recent literature (e.g. [22. 621) has suggested that the site of lesion within a single hemisphere could moderate emotional processing as well. The current study was designed to examine expression and perception of facial emotion within the same individuals. Subjects were patients with right- and left-hemisphere lesions in whom location of lesion could be determined. A demographically similar normal control group was also included. Both positive and negative emotions were studied. and posed and spontaneous expressions were elicited. METHODS ‘Twelve males with unilateral right (RBD) and 15males with unilateral left (LBD) hcmiaphcre pathology sxved a> subjects; 16 normal males (NC) served as controla. Patient\ were recruited from the ncurolog) kards of the Boston VA ?dedical Center. All subJects were right-handed by beif-report or familial-report. The three groups did not dilkr on formal a\scssment of lateral dominance [X)1: the m+;urity of sublects were right-footed (X6?;,) and rlpht-eyed (X6”‘u). The three subject groups did not differ signiticantly on demographic variables. v,ith an overall mean age of 57 g(S.D. =X.1), 13 yr ofcducation(S.D. =2.X), ~tndanoccupational level 1391 of3.‘)(S.D. = 1.5). The typical
IC occlusion General CVA Hemorrhagic infarct General CVA Hemorrhagic infarct MCA stroke Lacunar state General CVA IC occlusion General CVA Hemorrhagic infarct Embolism

Etiology

Demographics

+ + + + + + +

53 61 52 62 71 35 50 55 60 52

7 80

3 1 78 3 1 2

2 24

Frontal

51 58

Age

1 58

MPO

=internal carotid. IC =cerebrovascular accident. CVA MCA = middle cerebral artery. MPO =months post onset. SWM =subcortical white matter. =subcortical grey structures. SGS = present. + *For visual field defect. + = partial and + + = dense

I2

8 9 IO 11

1

6

4 5

2 3

1

ID No.

Patient

+ +

+ + +

+ +

+ +

+ +

Panetal

+

+ + + +

+ +

Temporal

Leston location

+

+

Occipital

Table l(a). Characteristics

+ +

+ + + +

+

+

+ +

SWM

+ +

+ +

+

+

SGS

of the RBDs

+ +

+ + + + + +

+

paralysis

+ +

+ + +

+

+

Facial Hemiparesis

Clinical neurological

+

+ ++ ++

++

++

+

status Visual field defect*

+

+ + +

+

+ +

Visual neglect

90

98 67

96

96

PIQ

WAIS

=: 2 L 2 I 5

5 c

; ? s 2 c z z

MCA stroke IC occlusion MCA stroke Thrombosis MCA stroke MCA stroke Hemorrhagic infarct MCA stroke General CVA IC occlusion MCA stroke General CVA IC occlusion IC occlusion IC occlusion

13 14 15 I6 17

Key as Table l(a).

20 21 22 23 24 25 26 27

19

18

Etiolog\

9 22 6 3 3 XX 20 49 38

22 75 ‘9 X44 2 2X

MPG

Demographics

ID No.

Patient

71 57 6; 42 54 54 54 55 49

5X hi

56 5X 63

Age

_i i +

-

: t

+

Frontal

i&

+ i,f + +

-I

-t

Parictal .--__

+ t

+

+

+ + +

-c

-r

+

Temporal Occipital -_l__-

Lesion iocation

+ + +

+ f +

f it

SWM

Table lfbt. Characteristics

+ t +

A

SGS

+ + + + + + +

i

+ i

+ i

Facial paralysis

+ + + + i

+

+ +

i-

Hemiparesis

Clinical neurological

of the LBDs

+

+ ++

++

+

++

+

status Visual field defect*

66 100 X9

94 95 122 104 72

105 72 106 101

100

PIQ

WAIS

- I .O

-0.5 ~ 1.3 -0.5 - 1.3 -0.3 +0.3 ~ 1.3

+ 0.5 - 1.5 - I .5 - 1.O

~-2.0

BDAE z-score

Wernicke’s Wernicke’s Conduction Conduction Mixed Broca’s Mixed Mixed nonfluent Mixed nonfluent

Global Broca’s Broca’s Global Wernicke’s Wernicke’s

type

Aphasia

Language

” 3j E t 2 :

FA(‘I4L

EMOTION

AND

RR 4lN

1?.4bMGF

173

on the side contralateral to their lesion: these were hemiplegia (58% of RBDs, 60% of LBDs); facial paralysis (75% of RBDs, 80% of LBDs); and visual field loss (58% of RBDs, 47% of LBDs). Although all of the LBDs were aphasic [34] (three Broca’s, two Mixed Non-fluents, two Globals, two Conductions, four Wernicke’s, two Mixed or Uncategorized), all had sufficient auditory comprehension (mean BDAE 1343 z-score= -0.88, SD. =0.7) and cognitive functioning (mean WAIS-R Performance IQ =94, S.D. = 16) to perform the experimental tasks. All subjects had adequate visuo-perceptual skill, as assessed by the ability to correctly describe two practice slides-the TAT card 3GF [SO] and a scene from a kindergarten classroom [14]. Research design All subjects were tested for expression (both posed and spontaneous) and perception of positive and negative facial emotions. All subjects were tested by the same examiner in the following task order: spontaneous expression, posedverbal expression, perception, and posed-visual expression. Demographic and lateral dominance data were collected at the end of the session. Expression procedures Spontaneous condition. Slides designed to elicit spontaneous expressions of positive (pleasant) and negative (unpleasant) emotion [14] were presented to each subject; there were 10 positive and six negative slides. Positiue slides included exemplars from each of the following categories: pleasant scenes, e.g. a little baby picking flowers; scenic views, e.g. a beautiful sunset; sexual material, e.g. a nude couple embracing; and familiar people, e.g. a photograph of the examiner. Negatioe slides were selected from the following categories: disgusting materials, e.g. a surgical procedure; sad scenes, e.g. a young victim of starvation; and unusual photographs, e.g. a photographic double exposure. There were two slides from each category, except for familiar people, where there were four. Valence categories were based on findings from earlier studies of normal adults [7, 1 I] in which facial expressions in response to these stimulus slides were rated by trained judges for the degree of pleasant vs unpleasant affect on a seven-point Likert scale. A significant majority of the responses to ‘positive’ slides were rated as pleasant (73% for pleasant scenes, 64% for scenic views, 77% for sexual material), and a significant majority of the responses to ‘negative’ slides were rated as unpleasant (83% for disgusting materials, 85% for sad scenes, 66% for unusual photographs). Slides were presented on a Singer Caramate projector positioned directly in front of the subject and slightly below eye level, using procedures developed by BUCK 1141 and by BORODet al. [l 11.The order and orientation (original and mirror-reversed) of the slides were counterbalanced across subjects. Subjects were seated facing a one-way mirror covered with a dressing screen, behind which was a videocamera for recording facial expressions. The examiner sat beside to the subject, and side ofsubject was counterbalanced. A headrest was used to keep the subject’s head upright and relatively immobile, to ensure that the camera could record the full face for later ratings. The subject wore a microphone around his neck for voice recording. Each slide was presented for 6 set, after which the subject was requested to describe his feelings about and reactions to the slide. The slide was then left on the screen for l&15 set during which time the subject talked about these feelings. After describing his feelings, the subject was asked to respond to the question-“Does this picture make you feel good, bad, or indifferent?“* Following this response was a 3-set intertrial interval to allow the subject’s face to return to a neutral expression, to allow the examiner to check the headrest position, and to advance to the next slide. Posed condition. There were two posed subconditions, verbal and visual. Both auditory verbal and visual nonverbal instructions were used to avoid a bias toward one hemisphere or input modality. The same expressions were used in both subconditions. Positive expressions included happiness, pleasant surprise and sexual arousal; negative expressions included sadness, anger, fear. disgust and confusion. Again. expressions were classified as positive or negative in light of ratings of posed expressions (under both verbal and visual conditions) made during earlier studies [7, Ill. A significant majority of the posed positive expressions were rated as pleasant (98% for happiness, 92% for sexual arousal), and a significant majority of the posed negative expressions were rated as unpleasant (91% for sadness. 90% for disgust, 82% for confusion). In the posed-verbal subcondition, subjects were requested to pose each of the eight expressions upon oral command from the examiner, e.g. “Look happy”. In the posed-visual subcondition, subjects were shown slides from the EKMAN and FKIESENseries 1291 of an adult male posing prototypical facial emotional expressions. For ‘sexual arousal’, a happiness photograph 1291 was used, and for ‘confusion’, a photograph of a puzzled expression [4,6] was used. Subjects were required to pose each expression in turn. As the subjects were viewing the slides, they were

*To assess the correspondence between our valence labels, and the feelings reported by the subjects, we assigned ratings of 1 to bad, 2 to neutral (i.e. indifferent or descriptive rather than affective) and 3 to good, and submitted these ratings to a two-way analysis of variance for Group(3) x Valence(Z). There was no effect for Group, and a main effect for Valence (F= 16.61; df= 1, 40; P
174

.I. C‘. BOKOI) (‘, r/l.

simultaneously instructed to look like the man in the picture: the following type oforal command, “Look happy, like the man in the picture looks” was used. They were told that a direct imitation of the poser’s facial pattern was not essential. To facilitate deliberate control over the expressions produced in the posed conditron and to ensure that the patients understood the task and were sufficiently motivated and attentive for each pose, subjects were required to practice each expression before it was actually filmed. For the verbal subcondition, if the subject were unable to pose to command, coaching was used to facilitate a response. e.g. “Show me how you would look if you found a large sum of money and were very happy”. There was a standard vignette for each of the eight expressions. During actual filming of the posed subconditions, subjects were requested to make each expression immediately following a command of “Ready. go”, to make one complete expression, and to then return to a neutral baseline (i.e. a resting face). The pose following “Ready, go” was used for data analysis. Prrcrption

procedures

For the perception task, subjects viewed slides of the same photographs of the adult male posers used during the posed-visual subcondition. The same positive (happiness, sexual arousal, surprise) and negative (sadness, anger. fear, disgust, confusion) expressions were used. along with a neutral one [29]. The subjects were required to label/identify each expression being portrayed in the nine slides. Responses were recorded verbatim. If an LBD aphasic had unscorable speech output, a multiple-choice format with three options was used. For the posed-visual expression task and the perception task, the slides were presented to the subject on the Caramate TV screen. The order and orientation (original and mirror-reversed) of the slides were randomized and counterbalanced across subjects.

Expression. Two judges viewed the videotapes of the experimental sessions and rated each facial expression for accuracy. For the spontaneous condition, the videotape was run from the onset ofeach slide until the occurrence of the first complete facial expression, determined by rater consensus. For the posed condition, the expression following “Ready, go” was rated. Each videotape segment was played through and reviewed several times to identify the point at which maximum or peak expression occurred; ratings were made at that point. To rule out the possibility that the ratings might be affected by a bias on the part of the perceiver to attend preferentially to the left hemispace (e.g. [ 17, 33, 44]), half of the videotapes were rated under mirror-image conditions on a TV monitor especially modified to reverse the video image. For both the spontaneous and posed conditions, each expression was scored as accurate,‘successful (score= I) or unsuccessful (score=O). To be rated as successful, an expression had to be appropriate to the stimulus. Prior to rating, the judges were trained as follows. For the .spontunrous task. the judges were familiarized with the emotionally-laden slides 1141 used in the actual experiment and shown a training tape of two adult subjects responding appropriately to these slides. For the posed task, the judges examined the stimulus photographs used in the posed-visual subcondition and the perception task. In addition, they were familiarized with exemplars of prototypical expressions of happiness, surprise, sadness, anger, fear. disgust [28.40]. sexual arousal and confusion [4, I I]. Interrater agreement, determined from a sample of 244 observations, yielded complete agreement in 95% of the judgments. If the judges could not agree, the expression was scored as unsuccessful. Prrcuptim Each subject’s labeling of the photographed expressions was scored as accurate (score= I) or inaccurate (score = 0). Synonyms and literal paraphasras were acceptable for all expressions: ‘happiness’ was acceptable for sexual arousal. For the aphastc LBDs. a modified scoring system was used whereby a score of I was assigned to a correct free response or a correct forced choice response when no free response had heen produced.

RESULTS

E.upre.ssion. Accuracy scores for individual expressions were examined within valence categories (positive, negative) using x2 tests. Since almost all comparisons were nonsignihcant, expressions were pooled according to valence. For the sponturwous condition, each subject received separate mean scores for positive and for negative emotions. For the pc~ed condition, each subject received separate mean scores for positive emotions under verbal and visual subconditions. Since there were no significant differences between subconditions for or for negative (F=O.27: iI’= I. 40; P>OSOO) positive (I;=O.Ol; d[= 1, 40; P>O.500) emotions, scores were averaged across subconditions. Table 2 displays the mean accuracy scores for the expression variables (spontaneous positive, spontaneous negative, posed positive, posed negative) by subject group. Prrcrption. Accuracy scores for individual perception trials were examined within valence

Table 2. Mean accuracy

Task Expression

Perception

scores for expression

Variable Spontaneous positive Spontaneous negative Posed positive Posed negative Positive Negative Neutral

RBDs (N= 12) B SD. 0.25 0.42 0.63 0.67 0.83 0.38 0.42

0.26 0.36 0.35 0.19 0.25 0.28 0.52

and perception

tasks, by subject group

LBDs (N= 15) x S.D. 0.54 0.57 0.81 0.59 0.79 0.76 0.93

0.30 0.32 0.18 0.21 0.26 0.19 0.27

NCs (N= 16) R SD. 0.45 0.54 0.89 0.79 0.94 0.71 0.81

0.27 0.32 0.21 0.20 0.20 0.26 0.40

categories (positive, negative) using x2 tests. Since most comparisons were nonsignificant, scores were pooled according to valence. Table 2 displays the mean accuracy scores by subject group, for positive and negative emotions and for the neutral expression. Analyses of variance

We conducted a series of analyses of variance (ANOVAs) on the expression and perception data. For expression, the effects of Group (RBD, LBD, NC), Condition (posed, spontaneous) and Valence (positive, negative) were examined. For perception, the effects of Group and Valence (positive, negative, neutral) were examined. Post hoc tests, with the conventional significance level (PI 0.05), were performed using the Newman-Keuls multiple comparison procedure [64]. Expression. A three-way repeated measures ANOVA was conducted to examine the effects of Group (3), Condition (2) and Valence (2) on the mean accuracy ratings. Overall, there was a main effect of Group (F=4.89; df=2, 40; PO.300). There was also a main effect of Condition (F= 23.98; df= 1, 40; PC O.OOl), such that posed expressions (x=0.73) were expressed more accurately than spontaneous expressions (x=0.46). Finally, there was a significant Condition by Valence interaction (F= 12.39; df’= 1, 40; P
176

J. C. &)ROl,

<‘I t/l.

Perception. A two-way repeated measures ANOVA on the identification accuracy scores was performed for Group (3) and Valence (3). There was a main effect of Group (F= 8.17; df=2, 39; P~O.005). Using the post hoc Newman-Keuls procedure, overall, the RBDs (8= 0.55) were significantly less accurate in their perception of facial emotion than either the LBDs (x=0.82) or the NCs (x=0.82). There was also a significant Group by Valence interaction (F= 4.63; df= 4, 78; P < 0.005). Using the post hoc Newman-Keuls procedure to test group differences for each valence category, RBDs were significantly less accurate than LBDs and NCs in their perception of negative and neutral expressions; the groups did not differ, however, in their perception of positive expressions. Post hoc tests were used to examine valence differences within each group. There were no significant differences for LBDs, but negative emotions were identified less accurately than positive ones by NCs, and negative and neutral emotions were identified less accurately than positive ones by RBDs. Finally, there was a main effect of Valence (F= 9.13; cEf=2, 78; P
between expression

and perception

To examine the relationship between performance on the expression and perception tasks. expression accuracy scores were correlated with perception accuracy scores, separately for the three subject groups. Since there were four expression variables (posed positive, posed negative) and three perception variables negative, spontaneous positive, spontaneous (positive, negative, neutral), each of the three subject group correlation matrices had 12 entries. Of the 36 resulting correlations, only two were significant, and no systematic patterns emerged. When the data for all subjects were combined, only two of the 12 correlations were significant. To look more closely at the relationship between perception and production of emotional expression, the distribution for each of the posed expressions was compared to the distribution for its perceptual analogue (e.g. posed verbal happiness vs perceived happiness, posed visual happiness vs perceived happiness); Fisher Tests of Exact Probability [57] were carried out on these comparisons. Of the 16 analyses conducted (eight emotions for posedverbal plus eight emotions for posed-visual) for each of the three subject groups, all but two (of 48) were nonsignificant. The e&t

qf lesion location on task performance

Since our two patient groups were not matched for lesion distribution within each hemisphere, the data were examined for effects of intrahemispheric location of lesion. Patients were classified as ‘posterior’ (five RBDs, six LBDs) if their lesions were confined to parietal, temporal, and/or occipital lobe structures; as ‘anterior’ (four LBDs) if their lesions involved pre-Rolandic structures; and as ‘anterior,‘posterior’(seven RBDs. five LBDs) if their lesions involved frontal and parietal, temporal, or occipital structures. The medians were determined for the total accuracy scores for the expression variable (mean of posed positive, posed negative, spontaneous positive and spontaneous negattve scores) and for the perception variable (mean of positive, negative, and neutral scores) and are listed by lesion

FACIAL

EMOTION

AYD

RRAlh

177

DAMAGE

subgroup in Table 3. As can be seen in Table 3, the presence of an anterior/posterior lesion had opposite effects within the two brain-damaged groups. Among RBDs, impairment appeared to be related to the presence of lesions in both anterior and posterior regions, while among LBDs, impairment appeared more related to the presence of lesions in the posterior region only.

Table 3. Median

total accuracy

scores for expression site

and perception

Lesion Side Right Left

Site

N

Anterior/posterior Posterior Posterior Anterior Anterior/posterior

7 5 6 4 5

tasks, by lesion side and

Expression median 0.43 0.49 0.50 0.72 0.73

Perception median 0.40 0.69 0.82 0.88 0.89

DISCUSSION These data suggest that patients with right-hemisphere pathology have deficits in processing facial emotion when compared to patients with left-hemisphere pathology or normal controls. This appears to be the case for both perception, and for spontaneous and posed expression, of emotion. The data are in agreement with previous studies that have examined either perception (e.g. [24]) or expression (e.g. [15]) of facial emotion. To our knowledge, this is the first study to assess both of these functions in the same subjects. In examining the correlations between expression and perception accuracy scores, no systematic relationships emerged for the total group or for any of the individual subject groups. Thus, the ability to pose a particular emotion did not appear related to the ability to identify the emotion. The fact that there were negligible correlations between expression and perception variables suggests that these two types of performance may be tapping relatively separate aspects of emotional processing. Several studies indicate that the two hemispheres might process emotional valence somewhat differently. In the current study, there was a relationship between affected hemisphere and valence for both expression and perception, but not in the same direction. For perception, the finding that RBDs, relative to LBDs, were impaired for negative but not for positive emotions is consistent with findings in normals that the right hemisphere is specialized for negative emotion (e.g. Cl]). For expression, the findings were more complex: RBDs, relative to LBDs, were impaired for positive but not negative emotions-but only for the posed condition. Despite the lack of a significant interaction between Group, Condition, and Valence, we thought that post hoc analyses might elucidate this complex relationship. Post hoc tests revealed that RBDs were significantly more impaired than LBDs for posed positive, spontaneous positive, and spontaneous negative emotions. For posed negative emotions, the two groups did not differ. Lesion location within a hemisphere also appeared to have an effect on both expression and perception. Among patients with right-hemisphere pathology, those with lesions involving both anterior and posterior structures were more impaired in performance on tasks of facial emotion than patients with posterior lesions. However, among patients with left-hemisphere pathology, those with posterior lesions were more impaired than patients

178

J. C‘.,k)ROI)

(‘I

(I/.

with anterior, or anterior plus posterior, lesions. It is important to note that the intrahemispheric effects were examined with regard to location only and not extent or size of lesion. Size of lesion is a relevant variable, which we were not able to control in this study because our neuroanatomical data were not amenable to this type of analysis. The data for the LBD aphasics appear consistent with reports of emotional behavior in aphasics [3, 12, 31, 521 in which some anterior aphasics are observed to display illnessappropriate (though often extreme) emotional reactions, while some posterior aphasics are described as unconcerned with, or unaware of, their illness. It occurred to us that aphasia subtype and/or auditory comprehension difficulties might underlie the deficits among the posterior aphasics. Since the four Wernicke’s and the two Conduction aphasics included in this study were the only LBDs with exclusively posterior lesions, it is difficult to separate the effects of lesion location from diagnostic type among these LBDs. When the BDAE comprehension z-scores were correlated with the total mean accuracy scores for the perception and expression variables, there was no relationship between auditory comprehension and facial perception (p = +0.07, P>O.50)but a substantial negative correlation between auditory comprehension and facial expression (p= -0.59. Pt0.05). The more impaired a patient’s comprehension, the more emotionally expressive he was. There are reports in the clinical literature (e.g. [IS]) that aphasics can communicate nonverbally, even in the face of severe language disturbances. One might also raise the question of whether bucco-facial apraxia was present among these LBD aphasics. These LBDs demonstrated significant (PtO.O1) impairments, relative to the NCs and RBDs, on praxis tasks (using standard procedures developed by GOOD~;LASS and KAPLAN [34]). When performance scores for the praxis tasks were correlated with posed and spontaneous expression accuracy scores, no significant relationships emerged for any of the groups. In addition to quantitative differences in the performance of RBDs relative to LBDs on tasks of facial emotion, the quality of responses also differed. On the expression task, a variety of inappropriate responses were observed. Among these were what we have termed ‘paramotias’ (i.e. a part of the total facial expression was inaccurate), unrecognizable facial expressions, facial groping (i.e. a disorganized performance of multiple facial movements without production of any one specific or recognizable configuration), and vocalization (e.g. saying “happy” when requested to look happy). RBDs demonstrated significantly (P< 0.05. one-tailed r-test) more paramotias, unrecognizable facial expressions, and facial groping than NCs, and RBDs tended (P-CO. 10) to show more paramotias and unrecognizable expressions than LBDs. LBDs produced significantly more vocalization responses than RBDs or NCs. On the perception task, when the NCs and LBDs erred, they tended to give responses that approximated the target, e.g. “fear” for surprise, “concerned” for confusion, “anger” for disgust. The incorrect responses of the RBDs, however, were harder to reconcile with the target, e.g. “happy” for confusion, “sexually aroused” for sadness and “jerky” for disgust. In conclusion, the finding that RBDs are impaired relative to both LBDs and NCs in expressing and perceiving facial emotion is consistent with the notion that the right hemisphere has a predominant role in the processing of emotional stimuli [9, 46, 613. This interhemispheric effect appeared to override the effects of elicitation condition but was moderated by the valence of the emotion and the location of the lesion within a hemisphere. This research demonstrates that facial behaviors are amenable to qualitative, as well as quantitative, analysis. While the data are suggestive, additional studies using a similar design and procedures are necessary to substantiate these conclusions.

Acknowledgements-Portions of this paper were presented at the International Neuropsychology Society Annual Meetings in Pittsburgh, 1982 and Mexico City, 1983. This research was supported by USPHS Grants NS06209 to the Aphasia Research Center of Boston University Medical School and MH37592 to New York University Medical School, and by Biomedical Research Support Grant No. 1-S07RR07186-02 to Wellesley College. We are grateful to Dr Ross Buck, Karen Olsen, Hope Heller, Nancy Lefkowitz, and Fern Cytryn for their assistance in this project, to Dr Joan Welkowitz for statistical assistance, to the reviewers for their comments, and to the Neurology and Medical Research Services of the Boston VA Medical Center.

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