Self-awareness and traumatic brain injury outcome

Abstract

Primary Objective Impaired self-awareness following a traumatic brain injury (TBI) can reduce the effectiveness of rehabilitation, resulting in poorer outcomes. However, little is understood about how the multi-dimensional aspects of self-awareness may differentially change with recovery and impact outcome. Thus, we examined four self-awareness variables represented in the Dynamic Comprehensive Model of Awareness: metacognitive awareness, anticipatory awareness, error-monitoring, and self-regulation. Research Design We evaluated change of the self-awareness measures with recovery from TBI and whether the self-awareness measures predicted community reintegration at follow-up. Methods and Procedures Participants were 90 individuals with moderate to severe TBI who were tested acutely following injury and 90 age-matched controls. Forty-nine of the TBI participants and 49 controls were re-tested after 6 months. Main Outcome and Results Results revealed that the TBI group’s error-monitoring performance was significantly poorer than controls at both baseline and follow-up. Regression analyses revealed that the self-awareness variables at follow-up were predictive of community reintegration, with error-monitoring being a unique predictor. Conclusions Our results highlight the importance of error-monitoring and suggest that interventions targeted at improving error-monitoring may be particularly beneficial. Understanding the multi-dimensional nature of self-awareness will further improve rehabilitation efforts and understanding of the theoretical basis of self-awareness.

Networks underlying trait impulsivity: Evidence from voxel-based lesion-symptom mapping

“…Therefore, it may be difficult to interpret how our results might generalize to a more diverse population, particularly given that impulsivity has been associated with distinct brain structures in men versus women [Diekhof et al, ]. Furthermore, our use of a self‐report measure in this patient population could be concerning, as there is evidence to suggest that some TBI patients may lack insight or awareness regarding their conditions, potentially weakening the validity of their responses [Kelley et al, ; Robertson and Schmitter‐Edgecombe, ]. As explained above, this concern was addressed by an additional analysis, which made use of available data from a measure that incorporates both patients' and caretakers' reports of the patients' behavioral changes following frontal lobe injury (FrSBe).…”

Psychological traits predict impaired awareness of deficits independently of neuropsychological factors in chronic traumatic brain injury

“…The present study also offers practical implications. Impaired awareness can significantly hinder TBI rehabilitation (e.g., Langer & Padrone, ; Lucas & Fleming, ; Medley, Powell, Worthington, Chohan, & Jones, ; Ownsworth & McFarland, ; Robertson & Schmitter‐Edgecombe, ), often due to low compliance levels (e.g., Gasquoine, ). However, direct attempts to increase awareness often lead to negative reactions that can also hinder rehabilitation (e.g., resistance, indifference, agitation; Richardson, McKay, & Ponsford, ).…”

Providing Effective Speech-Language Pathology Group Treatment in the Comprehensive Inpatient Rehabilitation Setting

“…The literature has demonstrated that self-awareness is vital for successful rehabilitation following acquired brain injury, particularly for several areas included at the Activity and Participation Levels of the World Health Organization's International Classification of Functioning, Disability, and Health, 24 including patient safety, social participation, employability, and community reintegration. 25,26 Hart et al conducted a longitudinal study in the traumatic brain injury population that demonstrates that self-awareness deficits are the most severe during the early stages of recovery, which includes a patient's time in acute rehabilitation. 27 Because stroke survivors also experience impaired insight, this impairment should be considered in the early stages of stroke recovery.…”