Decision making and somatic markers in conversation after traumatic brain injury

Background: Social decision making has been investigated in a range of client groups, resulting in the identification of the ventromedial prefrontal cortex (VMPC) as a significant structure in social decision making and the formulation of the somatic marker hypothesis (Damasio, 1994) to explain some of the mechanisms involved. The vulnerability of the VMPC following traumatic brain injury (TBI) suggests a potential degree of overlap between decision-making research and behaviour observed following TBI. Despite this, relatively little awareness of these concepts is evident in research on TBI in general and on communication after TBI in particular. Aims: To review the literature on decision making and the mechanisms thought to mediate it. To examine the potential application of decision-making theory to conversational behaviour following TBI. Main Contribution: The article will highlight the potential role of decision making in conversation, together with the mechanisms that support it, thereby raising awareness among clinicians and researchers of a potentially important contributor to communication after TBI. Conclusions: Social decision making and the somatic marker hypothesis are important constructs for our understanding of behaviours associated with TBI, including conversation.