The development of self-awareness and relationship to emotional functioning during early community reintegration after traumatic brain injury

Impaired self-awareness may affect clients' emotional status, engagement in rehabilitation and community reintegration following traumatic brain injury (TBI). The study aimed to investigate the relationship between self-awareness, emotional distress and community integration in adults with TBI during the transition from hospital to the community. Thirty-four rehabilitation clients with TBI were assessed in the week before and 2 months after discharge home. Measures of self-awareness and emotional functioning were administered predischarge and repeated at follow-up along with a measure of community integration. Nonparametric tests were used to compare levels of self-awareness and emotional distress pre- and postdischarge, their interrelationships and association with community integration. Self-awareness significantly increased following discharge, and a trend towards increased depression was found. There were no consistent relationships found between level of self-awareness, emotional functioning, and community integration. The development of self-awareness in the immediate postdischarge phase suggests this is an important time for clinical interventions targeting compensation strategies and adjustment to disability

Unawareness and/or denial of disability: Implications for occupational therapy intervention

Occupational therapy focus on client-centred, occupational performance intervention may become complicated by the phenomena of self-awareness. The problem of awareness deficits in clients with neurological disorders may be attributed to neurological impairment of self-awareness and/or psychological denial of disability. These phenomena present themselves more commonly in combination than dichotomously and have implications for treatment outcomes. Individuals with impaired self-awareness or denial face difficulties with motivation and participation in therapy, and the adoption of compensatory strategies, which ultimately impacts on rehabilitation outcome. The extent of unawareness versus denial can be assessed by observation of a client's behavior and this information can be very useful in directing the treatment approach. The purpose of this paper is, therefore, to discuss the phenomenon of unawareness and/or denial of disability and its importance to successful rehabilitation outcomes, current thinking and research conducted in different countries. Also, detailed case examples of three clients representing three major populations of traumatic brain injury, stroke and schizophrenia who may exhibit unawareness and/or denial of disability will be presented, including intervention strategies for both phenomena