Longitudinal study of awareness of deficit after moderate to severe traumatic brain injury

Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA.
Neuropsychological Rehabilitation (Impact Factor: 1.96). 07/2008; 19(2):161-76. DOI: 10.1080/09602010802188393
Source: PubMed


Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.

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    • "Also, by studying the agreement between patient and proxy reported scores, researchers have been able to examine a patient's level of self-awareness [22]. Impaired self-awareness is a common problem after TBI and is often associated with a decreased functional outcome and poor compliance with rehabilitation [26]. Impaired self-awareness can lead to over-or underestimation of the patient's own condition. "
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    ABSTRACT: Objective . To investigate the psychological outcome and the agreement between self-ratings and proxy-ratings in young individuals after severe traumatic brain injury (TBI). Methods . Twenty pairs of former patients who sustained a severe TBI in their adolescence or early adulthood and their significant others (SOs) were contacted around 66 months after injury to complete a measure of psychological and behavioral problems. The Adult Self-Report 18–59 and the Adult Behavior Checklist 18–59 were used. Results . Results showed significant differences compared to the normative sample in the domains withdrawal, attention, and intrusive and internalizing problems. Good or excellent levels of agreement were found between the self-rating and the proxy-rating in overt areas such as somatic complaints and aggressive and intrusive behavior. Fair or poor levels of agreement were found in nonovert areas such as anxiety and depression, withdrawal, thought and attention problems, and personal strength. Conclusion . The findings show that young patients experience psychological dysfunction. Our study suggests that the use of either a self-rating or a proxy-rating would be appropriate for evaluating overt domains, regarding the good to excellent levels of agreement. However, in nonovert domains, such as withdrawal and attention, an additional proxy-rating from a SO could provide supplementary information and build a more complete objective assessment.
    Behavioural neurology 09/2015; DOI:10.1155/2015/406057 · 1.45 Impact Factor
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    • "Awareness of behaviors, emotions, and cognitions is often adversely affected following moderateto-severe (M/S) TBI (Hart et al., 1998, 2009; Sherer et al., 1998; Lanham et al., 2000; Port et al., 2002; Sherer and Hart, 2003; Larson and Perlstein, 2009). Individuals with M/S TBI frequently show difficulty recognizing poor performance and inappropriate behaviors and how their thoughts and behaviors are connected to potential environmental problems (Dockree and Roberston, 2011). "
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    ABSTRACT: Poor awareness has been linked to worse recovery and rehabilitation outcomes following moderate-to-severe traumatic brain injury (M/S TBI). The error positivity (Pe) component of the event-related potential (ERP) is linked to error awareness and cognitive control. Participants included 37 neurologically healthy controls and 24 individuals with M/S TBI who completed a brief neuropsychological battery and the error awareness task (EAT), a modified Stroop go/no-go task that elicits aware and unaware errors. Analyses compared between-group no-go accuracy (including accuracy between the first and second halves of the task to measure attention and fatigue), error awareness performance, and Pe amplitude by level of awareness. The M/S TBI group decreased in accuracy and maintained error awareness over time; control participants improved both accuracy and error awareness during the course of the task. Pe amplitude was larger for aware than unaware errors for both groups; however, consistent with previous research on the Pe and TBI, there were no significant between-group differences for Pe amplitudes. Findings suggest possible attention difficulties and low improvement of performance over time may influence specific aspects of error awareness in M/S TBI.
    Frontiers in Human Neuroscience 07/2015; 9:397. DOI:10.3389/fnhum.2015.00397 · 3.63 Impact Factor
    • "To a degree this is logical and understandable as the injured party is more likely to have had a pre-accident knowledge and understanding of what physical impairment is and feedback gained from failure to be able to carry out a physical task, such as standing, is very direct and even painful (It is worth recalling at this juncture that 90 per cent of people with an acquired brain injury are noted to make a good physical recovery (Higham and Phelps, 1998)). Opportunities to learn and therefore adapt to changes in function are more direct and easily understood (Hart et al., 2009). "
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    ABSTRACT: Purpose-The purpose of this paper is to examine the research into prevalence of acquired brain injury in non-ABI specialist services, the impact of the invisible aspects of executive impairment and loss of insight upon functioning and to question how this is assessed and managed by generalist services. Design/methodology/approach-A literature search was undertaken to identify where people with an ABI may come in to contact with services that are not specifically designed to meet their needs. Findings-ABI is prevalent amongst users of a variety of community, inpatient and criminal justice services. The common albeit invisible consequences of ABI complicate assessment, service use and or treatment particularly in the context of a lack of under pinning knowledge and experience amongst the staff in non-specialist ABI services. As a consequence risks to children and adults are increased, opportunities for rehabilitation and growth are lost and human potential squandered. Addressing the first stage in this process, developing knowledge of the consequences of ABI and how to assess need, is a pre-requisite for change. Practical implications-An absence of basic underlying knowledge of the consequences of ABI impacts upon assessment and so limits the effectiveness of services. A consequence of this is manifest in the over-representation of people with an ABI to be found in non-specialist settings. Originality/value-Little research is undertaken from a social and community perspective into the impact of ABI over the longer term for those who have no contact with specialist services and yet, quite clearly by their use of other services, have unidentified, unrecognised and un-responded to needs.
    Social Care and Neurodisability 11/2014; 5(4-4):201-213. DOI:10.1108/SCN-12-2013-0043
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