A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury

• Published in: Neuropsychological rehabilitation 2009-04, Vol.19 (2), p.161-176
• Main Authors: Hart, Tessa, Seignourel, Paul J., Sherer, Mark
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Attitude to Health; Awareness; Awareness of deficits; Biological and medical sciences; Brain injured people; Brain Injuries - physiopathology; Brain Injuries - psychology; Brain Injuries - rehabilitation; Deficits; Female; Glasgow Coma Scale; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Injury Severity Score; Longitudinal Studies; Male; Medical sciences; Mental Competency; Middle Aged; Organic mental disorders. Neuropsychology; Predictive Value of Tests; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Regression Analysis; Rehabilitation; Self Concept; Selfawareness; Surveys and Questionnaires; Time Factors; Traumas. Diseases due to physical agents; Traumatic brain injury; Young Adult
• ISSN: 0960-2011; 1464-0694
• DOI: 10.1080/09602010802188393

Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.