摘要:

The failure to recognize the existence of disease is known asanosognosia. This article provides a brief discussion of the evolution of this concept and reviews some qualitative differences in the manner in which the disavowal of neurogenic impairment is expressed. Theoretical explanations for the unawareness of deficit after neurologic illness include motivational-symbolic, cognitive subsystem, and supraordinate system theories. Observations from a clinically derived, structured awareness interview are presented, suggesting three factors that may underlie patients' apparent lack of awareness of deficits after traumatic brain injury. These include diminished awareness of deficits secondary to impaired cognition, especially memory and reasoning deficits; psychological reactance and denial of deficits; and a relatively “pure” inability to recognize areas of impaired functioning as a direct consequence of brain injury. The causes of unawareness are likely to be complex and multiply determined in any given patient, although it may be possible to identify primary, secondary, and even tertiary contributions according to specific behavioral and phenomenological characteristics. The ability of patients to modify their perceptions and acknowledgment of deficits after objective feedback may have particular diagnostic value and clinical utility in this regard

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A prospective study was performed to develop a method for assessing “on-line” error detection and correction during performance of naturalistic action, to determine whether traumatic brain injury (TIM) affects error detection and correction, and to compare actual task performance with verbal self-ratings of performance. Participants included 18 persons who had sustained severe TBI from 34 to 186 days prior to study and who were comparable to controls in their rate of naturalistic action error, along with 18 control subjects chosen to be demographically comparable to subjects with TBI. Subjects performed two different tests of naturalistic action in which they completed everyday activities (eg, wrapping a gift, making toast) at different levels of complexity, as manipulated by the addition of distractor objects, the number of tasks that had to be completed per trial, and other demands on planning and working memory. Using a specially developed coding system, each error on these tasks was scored as to whether the subject corrected it and whether the subject otherwise demonstrated awareness of the error. Error scores were also compared to subjects' responses to a questionnaire in which they rated their own performance on the most challenging level of the naturalistic action test. In general, subjects with TBI corrected and showed awareness of proportionally fewer of their errors when compared to controls. Qualitative patterns for some error types also differed between groups. Despite making more errors than control subjects on the most challenging task, subjects with TBI did not rate themselves as performing more poorly with respect to its cognitive demands. However, for subjects with TBI, the number of errors was correlated with performance ratings on certain questionnaire items. This study showed that error detection and correction can be reliably measured during naturalistic action and appear to be impaired in severe TBI even when the base rate of error is controlled. TBI may affect error detection and correction by reducing, or impairing the allocation of, attentional resources needed for the simultaneous execution and monitoring of routine action

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this prospective, between-subjects study was to look at impaired awareness cross-culturally in patients with traumatic brain injury (TBI) and to relate impaired awareness after injury to the initial estimates of disturbed consciousness at time of injury. The study was conducted in community and inpatient and outpatient rehabilitation centers in Barcelona and Madrid. Participants were 30 persons with primarily moderate to severe TBI who could complete a written questionnaire concerning their functioning and 28 age- and gender-matched controls. A Spanish translation of the Patient Competency Rating Scale (PCRS) was administered to each participant. Relatives or significant others also completed this scale on each participant using the relative's version (PCRS-R). Difference scores, obtained by subtracting PCRS-R from PCRS-P (PCRS-P minus PCRS-R), were used as a marker of impaired awareness. Individuals with TBI were rated (by self and significant others) as being less competent than controls. Forty percent of Spanish patients with TBI who suffered severe injuries tended to overestimate their behavioral competencies. The PCRS-P minus the PCRS-R difference scores tended to correlate with admitting Glasgow Coma Scale (GCS) scores and retrospective estimates of posttraumatic amnesia (PTA). Initial disturbances of consciousness, one measure of severity of brain injury, appeared to relate to later measures of impaired self-awareness in Spanish patients with TBI. Non-brain-injured controls did not tend to report levels of competency that differed from their relatives' reports

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this study was to investigate the relationship between self-awareness, emotional distress, motivation, and outcome in adults with severe traumatic brain injury. A sample of 55 patients were selected from 120 consecutive patients with severe traumatic brain injury admitted to the rehabilitation unit of a large metropolitan public hospital. Subjects received multi disciplinary inpatient rehabilitation and different types of outpatient rehabilitation and community-based services according to availability and need. Measures used In the cluster analysis were the Patient Competency Rating Scale, Self-Awareness of Deficits Interview, Head Injury Behavior Scale, Change Assessment Questionnaire, the Beck Depression Inventory, and Beck Anxiety Inventory; outcome measures were the Disability Rating Scale, Community Integration Questionnaire, and Sickness Impact Profile. A three-cluster solution was selected, with groups labeled as high self-awareness (n=23), low self-awareness (n=23), and good recovery (n=8). The high self-awareness cluster had significantly higher levels of self-awareness, motivation, and emotional distress than the low self-awareness cluster but did not differ significantly in outcome. Self-awareness after brain injury is associated with greater motivation to change behavior and higher levels of depression and anxiety; however, it was not clear that this heightened motivation actually led to any improvement in outcome. Rehabilitation timing and approach may need to be tailored to match the Individual's level of self-awareness, motivation, and emotional distress

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Inaccurate self-awareness is a common finding after traumatic brain injury. Such impaired awareness has been hypothesized to limit patients' eventual functional outcomes by decreasing motivation for treatment and resulting in selection of inappropriate long-term goals. Previous investigations of the association between impaired awareness and employment outcome have produced inconsistent results. The present article reviews these studies and presents the results of our new investigation of this issue. In addition, we studied the comparability of two methods of measuring impaired awareness. Results provided strong support for a positive relationship between accurate self-awareness and favorable employment outcome at follow-up

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

It is widely accepted that awareness deficits present challenges to recovery and should be addressed as part of rehabilitation programming. Response to awareness intervention is commonly Inferred from measurements that rely on reports by subjects and significant others. This article describes the findings from a pilot study that examined the relationship among a variety of awareness indicators in three individuals with brain damage over a 9-month period. Results suggest a dissociation between behavioral and perceptual indices of awareness. Changes in behavioral indicators of awareness selected by care givers were not related to changes in self- or caregiver ratings. The clinical and research implications of the findings are discussed

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Various forms of postacute brain injury rehabilitation programs exist. Comprehensive day treatment programs are the most holistic, being neuropsychological in orientation. The importance of developing a trusting relationship and the use of inventive techniques in the individualization of treatment within a holistic rehabilitation program will be described via a case presentation, stressing the soclocultural aspects of the individual as central to treatment

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID