Impaired self-awareness

Sherer, Mark and Fleming, Jennifer (2014). Impaired self-awareness. In Mark Sherer and Angelle M. Sander (Ed.), Handbook on the neuropychology of traumatic brain injury (pp. 233-255) New York, NY, USA: Springer. doi:10.1007/978-1-4939-0784-7_12

Author Sherer, Mark
Fleming, Jennifer
Title of chapter Impaired self-awareness
Title of book Handbook on the neuropychology of traumatic brain injury
Place of Publication New York, NY, USA
Publisher Springer
Publication Year 2014
Sub-type Chapter in reference work, encyclopaedia, manual or handbook
DOI 10.1007/978-1-4939-0784-7_12
Open Access Status Not yet assessed
Series Clinical Handbooks in Neuropsychology
ISBN 9781493907830
Editor Mark Sherer
Angelle M. Sander
Chapter number 12
Start page 233
End page 255
Total pages 23
Total chapters 20
Language eng
Formatted Abstract/Summary
Persons with neurologic disorders often show impaired ability to accurately perceive the effects of their disorders on their physical, cognitive, and behavioral abilities. For conditions that have a sudden onset such as stroke or traumatic brain injury (TBI) the degree of impairment of this ability is greatest early after onset so that, for example, soon after right hemisphere stroke, the person with stroke may not perceive motor impairment on the left side of the body, but gradually becomes more aware of this impairment as he/she recovers. For progressive conditions such as the various dementias, the degree of impairment of self-awareness worsens as the condition progresses so that a person with Alzheimer’s disease may be aware of subtle memory impairment in early stages of the disease, but unaware of very severe memory impairment once the disease has progressed. In either case, the perception of impairment is least when the actual impairment is greatest and greatest when the actual impairment is least.

Impaired self-appraisal of functioning is referred to as anosognosia in conditions such as the neglect syndrome after right hemisphere stroke or Anton’s syndrome (unawareness of cortical blindness) after bilateral posterior cerebral artery strokes where the lack of awareness may be complete. In TBI, this condition is simply called impaired self-awareness (ISA) as persons with injury usually have some awareness of their deficits once they recover from the confused state (post-traumatic amnesia).

For persons with TBI, severity of ISA is greatest in early recovery. By definition, patients in coma or the vegetative state have no self-awareness. Though not directly assessed, minimally conscious patients are assumed to have extremely limited self-awareness. Once patients recover to the confused state, they remain with very severe impairment of self-awareness. Often after resolution of confusion, patients may deny that they have sustained TBI at all and deny any residual effects of the injury. Even when acknowledging injury, we have seen patients insist that their cognitive abilities after severe TBI are much better than they were prior to sustaining TBI. Patients who are unable to walk safely may attempt to remove restraints to leave their beds or wheelchairs to go to the toilet or simply to attempt to leave the room. Patients may refuse therapies because they do not believe that they have impairments that need to be treated. In the post-acute period of recovery, patients may attempt to drive in spite of motor and sensory deficits or pursue employment or independence goals that are at odds with their current functional limitations. To ensure patient safety, compliance with needed therapies, and the best possible outcomes for patients, neuropsychologists and others treating persons with TBI must assess and, when needed, provide treatment for deficits in self-awareness.

This chapter will: (1) review the nature of ISA after TBI and describe its impact on rehabilitation therapies and patient outcome, (2) describe approaches to assessment of ISA, (3) review the literature on interventions to improve self-awareness in persons with TBI, and (4) provide practical guidance illustrated with clinical cases for intervening with patients with ISA.
Keyword Self-awareness
Traumatic brain injury
Q-Index Code BX
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Book Chapter
Collection: School of Health and Rehabilitation Sciences Publications
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Citation counts: Scopus Citation Count Cited 6 times in Scopus Article | Citations
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Created: Thu, 19 Mar 2015, 23:36:46 EST by Dr Jennifer Fleming on behalf of School of Health & Rehabilitation Sciences