A questionnaire assessing orientation; awareness of brain injury; and physical, communication, functional and sensory/cognitive impairment was administered to nine institutionalized survivors of brain injury, who were at least 4 years postinjury. All survivors were totally dependent in basic activities of daily living. Six were found to produce reliable test-retest estimates of their self-awareness of impairment, and their responses were compared with staff ratings. Two patterns of self-awareness of impairment were found. Three survivors were more disoriented and showed little awareness of the presence of brain injury or of striking organic symptoms (such as the inability to talk). The other three survivors showed greater awareness of overt physical and functional impairment while still underestimating their level of impairment compared to staff estimations.