Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury

University of Alabama at Birmingham, Birmingham, Alabama, United States
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 10/2004; 85(9):1450-6. DOI: 10.1016/j.apmr.2004.01.030
Source: PubMed


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.
Inception cohort.
Three inpatient rehabilitation programs.
People with acute TBI (N=161), tested as soon as feasible after posttraumatic amnesia.
Not applicable.
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.

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    • "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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