Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury
ABSTRACT To compare awareness of deficit in 3 domains of function (physical, cognitive, behavioral/emotional) in acute traumatic brain injury (TBI), controlling for severity of impairment in the different domains.
Three inpatient rehabilitation programs.
People with acute TBI (N=161), tested as soon as feasible after posttraumatic amnesia.
Awareness Questionnaire (AQ) completed by the person with TBI and the treating neuropsychologist; and self- and clinician-rating scores calculated in the 3 domains.
For participants who were rated by clinicians as more impaired in at least 1 domain (ie, scored lower on the AQ), self-ratings differed significantly from one another in all 3 domains, with behavioral self-ratings highest, physical self-ratings lowest, and cognitive self-ratings intermediate. In subgroups of participants rated at the same level by clinicians in all 3 domains, physical self-ratings were also lowest, that is, more consonant with clinician ratings. Participants tended to rate themselves as relatively unchanged in cognitive and behavioral domains regardless of the level of clinician ratings on these factors.
Patterns of discrepant awareness of deficit in different functional areas seen in postacute TBI also appear to be present acutely and are not entirely related to differential severity of deficit. We discuss several possible reasons for discrepant awareness of deficit, including differences in internal and external feedback, cultural and psychologic factors, and different levels of ambiguity inherent in causal explanations for different types of problems.
SourceAvailable from: Mary C SullivanExecutive functioning: Role in early learning processes, impairments in neurological disorders and impact of cognitive behavior therapy (CBT)., Edited by K. P. Bennett, 01/2014: chapter Executive function in infants born preterm with varying birth weights and morbidities at emerging adulthood.: pages 81-114; Nova Science Publishers., ISBN: 978-1-63321-193-3
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ABSTRACT: Anger and irritability are important and persistent clinical problems following traumatic brain injury (TBI). Treatment options include medications, behavioral modification, and psychotherapies, but some are impractical and none have proven efficacy with this population. We describe a randomized multi-center clinical trial testing a novel, one-on-one, 8-session psychoeducational treatment program, Anger Self-Management Training (ASMT), designed specifically for people with TBI who have significant cognitive impairment. The trial is notable for its use of a structurally equivalent comparison treatment, called Personal Readjustment and Education (PRE), which was created for the study and is intended to maximize equipoise for both participants and treaters. Fidelity assessment is conducted in real time and used in therapist supervision sessions. The primary outcome is change in self-reported anger on validated measures from pre-treatment to 1week after the final session. Secondary outcomes include participant anger as reported by a significant other; emotional distress in domains other than anger/ irritability; behavioral functioning; and quality of life. An interim assessment after the 4th session will allow examination of the trajectory of any observed treatment effects, and a follow-up assessment 2months after the end of intervention will allow examination of persistence of effects. A treatment enactment phase, in which participants are interviewed several months after the last therapy session, is designed to provide qualitative data on whether and to what extent the principles and techniques learned in treatment are still carried out in daily life. Copyright © 2014. Published by Elsevier Inc.Contemporary Clinical Trials 12/2014; 40. DOI:10.1016/j.cct.2014.12.005 · 1.99 Impact Factor
Dataset: Archives of Trauma Research 1