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Effects of Moderate to Severe Traumatic Brain Injury on Anticipating Consequences of Actions in Adolescents: A Preliminary Study

Published online by Cambridge University Press:  14 January 2013

Lori G. Cook*
Center for BrainHealth, The University of Texas at Dallas, Dallas, Texas School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
Gerri Hanten
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas Department of Psychology, Rice University, Houston, Texas
Kimberley D. Orsten
Department of Psychology, Rice University, Houston, Texas
Sandra B. Chapman
Center for BrainHealth, The University of Texas at Dallas, Dallas, Texas School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
Xiaoqi Li
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Elisabeth A. Wilde
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas Department of Neurology, Baylor College of Medicine, Houston, Texas Department of Radiology, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Kathleen P. Schnelle
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Harvey S. Levin
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas Department of Neurology, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Correspondence and reprint requests to: Lori G. Cook, Center for BrainHealth, The University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235. E-mail:


For this pilot study, we compared performance of 15 adolescents with moderate–severe traumatic brain injury (TBI) to that of 13 typically developing (TD) adolescents in predicting social actions and consequences for avatars in a virtual microworld environment faced with dilemmas involving legal or moral infractions. Performance was analyzed in relation to cortical thickness in brain regions implicated in social cognition. Groups did not differ in number of actions predicted nor in reasons cited for predictions when presented only the conflict situation. After viewing the entire scenario, including the choice made by the avatar, TD and TBI adolescents provided similar numbers of short-term consequences. However, TD adolescents provided significantly more long-term consequences (p = .010). Additionally, for the Overall qualitative score, TD adolescents’ responses were more likely to reflect the long-term impact of the decision made (p = .053). Groups differed in relation of the Overall measure to thickness of right medial prefrontal cortex/frontal pole and precuneus, with stronger relations for the TD group (p < .01). For long-term consequences, the relations to the posterior cingulate, superior medial frontal, and precentral regions, and to a lesser extent, the middle temporal region, were stronger for the TBI group (p < .01). (JINS, 2013, 19, 1–10.)

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