Treatment to improve self-awareness in persons with acquired brain injury

Abstract

The self-awareness intervention significantly but selectively improved self-awareness during IADL task performance as well as functional performance. The need for a larger study with more treatment sessions is discussed.

Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury

“…25,38,41 In 2 studies, the effects were not statistically tested, but the authors reported a positive treatment effect on awareness (PND 36%-81%). 40,43 However, in these studies, the positive treatment effects appeared to be task specific.…”

“…In 2 studies, therapists recommended patients for awareness treatment based on clinical judgment of evidence of impaired self-awareness. 38,43 In one study, patients were included if they underestimated their memory deficits (incongruence between predicted memory performance and actual performance), 40 and in another study, patients had a SADI score greater than 0 (mean SADI score at baseline was 5). 25 Furthermore, studies reported high SRSI scores (range: 6-10), 42,44 high SADI scores (8), 39 and a large difference score on the AQ (range: [22][23][24][25][26][27][28][29][30] 42 at baseline.…”

“…41 In the remaining studies, the etiology of the brain injury was mixed (eg, TBI, stroke, anoxia). 38,40,43 Severity of brain injury was mentioned in 4 studies 25,[38][39][40] and ranged from moderate to severe on the basis of the Glasgow Coma Scale, posttraumatic amnesia, or duration of coma. In 7 studies, patients were in the chronic phase after injury (>6 months postinjury) at the start of the awareness intervention.…”

“…Three studies reported follow-up measurements. [42][43][44] Awareness was measured with the Awareness Questionnaire (AQ) discrepancy score (the difference in scores between the patient and an informant; N = 4), 38,39,42,44 the AQ patient score (N = 1), 45 the self-awareness of deficit interview (SADI; N = 2), 25,39 the self-regulation skills interview (SRSI; N = 3), 38,42,44 the assessment of awareness of disabilities (N = 2), 38,41 the Competency Rating Scale difference score (N = 1), 43 the difference in predicted versus actual scores on a memory test (N = 1), 40 25 community integration, 38 feelings of competency, 43 and quality of life. 45 The specifics of the functional outcome measures appear in Table 1.…”

“…In 7 studies, patients were in the chronic phase after injury (>6 months postinjury) at the start of the awareness intervention. [38][39][40][42][43][44][45] In addition, in 7 studies, patients received outpatient treatment. [38][39][40][41][42]44,45 In the 2 studies in which patients were hospitalized, 1 group was in the subacute phase 25 and the other was in the chronic phase 43 after injury.…”