Awareness of disabilities in stroke rehabilitation--a clinical trial

Abstract

Unawareness of disabilities is a significant issue in stroke rehabilitation. Unawareness that persists to discharge from rehabilitation correlates with neuroanatomical variables in right hemisphere damaged patients, and is a negative predictor for some rehabilitation outcomes at follow-up.

Awareness of memory functioning in patients with stroke who have a good functional outcome

“…Impaired awareness of deficits is a frequently observed phenomenon in patients with stroke that may lead to poor outcome [1][2][3][4]. It manifests itself as diminished insight of a specific deficit in sensory, perceptual, motor, behavioural or cognitive functioning [5].…”

Differences in awareness between persons with left and right hemispheric stroke

“…However, if a client demonstrates problems in everyday life and is less aware of these problems, the occupational therapist may carefully consider involving others in the intervention process (e.g. caregivers, spouse, and service staff), as clients with limited awareness may not be able to participate fully in the further rehabilitation process (9)(10)(11)(12)(13)(14)(15). This study has also identified some skills in ADL performance where clinicians should be extra cautious when evaluating persons with right CVA, as they seem to be less aware of problems related to these skills in everyday performance.…”

“…Earlier studies on awareness after a stroke in relation to everyday performance have not identified any differences between persons with left and right CVA (11,17,18). However, one of the limitations of these studies was that they did not evaluate awareness in relation to the performance of relevant and meaningful everyday tasks (19).…”

“…Such type of awareness strongly related to executive functions has in the literature recently been referred to as online awareness (8,9). A reduced awareness of ability has been shown to negatively impact a client's participation in the occupational therapy process (9)(10)(11)(12)(13)(14)(15). Knowing what clients may be more or less aware of concerning functioning in everyday life enables the occupational therapist to work in a client-centered way and to involve the client in the occupational therapy process.…”

Occupational therapists' experiences of rehabilitation of patients with limited awareness after stroke

“…Decreased awareness due to stroke is a common problem and is extensively described in the literature from a neurological, psychological, and neuropsychological perspective (1)(2)(3). Anosognosia, meaning "without knowledge of disease", is a symptom caused by brain injury supposedly due to inability of the supervision and feedback systems of the brain to function properly (4).…”