Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury
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.
Available from: Joukje van der Naalt
- "This is no problem when patients are able to provide an honest and objective report of their abilities and performance in daily life. However, a complicating factor is that TBI of at least moderate severity frequently results in impaired self-awareness (ISA), also referred to as lack of insight or anosognosia (Abreu et al., 2001; Hart et al., 2004; Sherer et al., 2003). According to McGlynn and Schacter (1989), ISA is an impaired ability to accurately perceive one's deficits, and to understand the impact of these deficits on real-world functioning. "
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ABSTRACT: In patients with moderate to severe traumatic brain injury (TBI), impairments of self-awareness are frequently found and associated with worse functional outcome and poor compliance with rehabilitation. The aim of this study was to investigate whether indications of impaired self-awareness could be found in TBI patients with frontal lesions and executive function deficits. Twenty-two TBI patients with focal frontal injuries were compared to 29 TBI patients without focal frontal injuries visible on neuroimaging. No differences were found on several outcome measures, including the Glasgow Outcome Scale-Extended (GOS-E), the Differential Outcome Scale (DOS), and return to work (RTW), although the frontal injury patients were more severely injured as indicated by the Glasgow Coma Scale (GCS) and duration of post-traumatic amnesia (PTA), and had impaired performance on a neuropsychological test of executive functioning. Even more so, the frontal injury group had a significantly lower score on the Sickness Impact Profile (SIP), indicating that they had fewer complaints than the patients without frontal injury, and scored significantly higher on the percentage of recovery (PoR) score, which expresses the extent of recovery as a percentage of their previous level of functioning. In contrast to the non-frontal-injury group, their PoR scores were not related to RTW, reflecting an erroneous perception of their actual working status. The positive results on these different outcome measures, which are partly or entirely self-reported, were seen as an indication of an impaired self-evaluative ability in the frontal injury patients. To determine outcome in a patient with frontal injuries and executive dysfunction, the judgment of several relevant other persons in the patient's life (e.g., partners, therapists, and employers) of the patient's daily life functioning should be sought.
Journal of neurotrauma 04/2010; 27(7):1195-202. DOI:10.1089/neu.2010.1277 · 3.71 Impact Factor
Available from: medik.net
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ABSTRACT: This paper investigates fault surveillance and fault
identification mechanisms and open fiber management protocols for a
transparent optical network in which data travels optically from the
source node to the destination node without going through any
optical-to-electrical (O/E) or electrical-to-optical (E/O) conversion.
These mechanisms allow non-intrusive device monitoring without requiring
any prior knowledge of the actual protocols being used in the data
Global Telecommunications Conference, 1996. GLOBECOM '96. 'Communications: The Key to Global Prosperity; 12/1996
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