Impaired self-awareness after moderately severe to severe traumatic brain injury

Patients with moderately severe to severe traumatic brain injury (TBI) can demonstrate disturbances in self-awareness several months or years after injury. Patients may underreport cognitive and behavioral difficulties, which are the true residuals of their brain injury. Increasingly, research indicates that the residuals of these disturbances in consciousness greatly affect the process and outcome of rehabilitation. A recent model for conceptualizing disturbances of self-awareness after various forms of brain injury is reviewed. © 2005 Springer-Verlag

A longitudinal study of self-awareness: Functional deficits underestimated by persons with brain injury

A longitudinal study of 55 adults with severe traumatic brain injury (TBI) investigated the areas of function for which they lacked self-awareness of their level of competency. Data were collected at 3 and 12 months post-injury using the Patient Competency Rating Scale. Self-awareness was measured by comparing patient self-ratings with the ratings of an infor mant. The results were consistent with previous studies, indicating that self-awareness was most impaired for activities with a large cognitive and socioemotional component, and least impaired for basic activities of daily living, memory activities, and overt emotional responses. For most areas of function that were overestimated at 3 months post-injury, self-awareness subsequently improved during the first year after injury

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

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