Impaired Self-awareness Research Articles

Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness.

To further explore the phenomenon of impaired self-awareness of motor symptoms in patients with Parkinson's Disease by using an evaluated measurement approach applied in previous studies, while also examining its connection with dispositional mindfulness and possible correlates of functional connectivity. Recently, the phenomenon of impaired self-awareness has been studied more intensively by applying different measurement and imaging methods. Existing literature also points towards a possible connection with mindfulness, which has not been examined in a cross-sectional study. There is no data available concerning correlates of functional connectivity. Non-demented patients with idiopathic Parkinson's Disease without severe depression were tested for impaired self-awareness for motor symptoms following a psychometrically evaluated approach. Mindfulness was measured by applying the German version of the Five Facet Mindfulness Questionnaire. A subset of eligible patients underwent functional MRI scanning. Spearman correlation analyses were performed to examine clinical data. Whole-brain voxelwise regressions between seed-based connectivity and behavioral measures were calculated to identify functional connectivity correlates of impaired self-awareness scores. A total of 41 patients with Parkinson's Disease were included. 15 patients successfully underwent resting-state fMRI scanning. Up to 88% of patients showed signs of impaired self-awareness. Awareness for hypokinetic movements correlated with total mindfulness values and three facets, while awareness for dyskinetic movements did not. Three significant clusters between scores of impaired self-awareness in general and for dyskinetic movements were identified linking behavioral measures with the functional connectivity of the inferior frontal gyrus, the right insular cortex, the supplementary motor area, and the precentral gyrus among others. Impaired self-awareness for hypokinetic movements did not have any neural correlate. Clinical data is comparable with results from previous studies applying the same structured approach to measure impaired self-awareness in Parkinson's Disease. Functional connectivity analyses were conducted for the first time to evaluate neural correlates thereof. This data does not support a connection between impaired self-awareness of motor symptoms and dispositional mindfulness.

Effects of Self-awareness and Cognitive Impairment on Depression Status in Adults with Traumatic Brain Injury

<h3>Research Objectives</h3> To examine the association of self-awareness and cognitive impairments on depression after controlling for potential covariates in a sample of adults with chronic complicated mild to severe traumatic brain injury. <h3>Design</h3> Secondary analysis of a cohort study. <h3>Setting</h3> Community. <h3>Participants</h3> The study included a volunteer sample of sixty-five community-dwelling individuals with a history of complicated-mild-to-severe TBI. Inclusion criteria were: 1) documented history of TBI; 2) over six months post-injury; 3) living in the community; 4) older than 18 years old. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Depression status was measured using the Patient Health Questionnaire (PHQ9) questions and dichotomized as Current Major or Minor Depression and No Current Depression. Logistic regression models were formed using self-awareness, cognitive impairments, and their interaction as independent variables with dichotomized depression as the dependent variable. <h3>Results</h3> Sixty-three participants with complete data were included in the analysis. Participants were aged 18 to 83 years old (mean=45.51 + 15.90 years), were primarily men (79.37%), and 85.71% of participants had current major or minor depression. Disability was identified as a covariate based on a significant bivariate correlation with depression (r=.286, p < .05). The logistic regression revealed no significant associations of self-awareness and cognitive impairments on depression after controlling for disability, but disability was significantly associated with depression status (p < .05). <h3>Conclusions</h3> Cognitive impairment, self-awareness, and their interaction may not contribute to depression status in chronic TBI, but those with depression did have more disability. It is possible that more impaired cognition and self-awareness acutely after injury contribute to later disability and, subsequently, depression, but a longitudinal prospective study is required to test this hypothesis. <h3>Author(s) Disclosures</h3> The study was supported in part of the SHRS Dissertation Development Fund.

Self-awareness in Adults With Traumatic Brain Injury: Exploring the Profile of Intellectual Awareness in Rehabilitation

<h3>Research Objectives</h3> To investigate the profile of self-awareness for patients with traumatic brain injury and to make recommendations for practice in rehabilitation. <h3>Design</h3> Non-interventional cohort study with clinical audit of self-awareness interview applying thematic analysis. <h3>Setting</h3> A large public acquired brain injury rehabilitation unit in Australia. <h3>Participants</h3> A convenience sample of adults aged 18-70 years with TBI (n=106) admitted to inpatient rehabilitation who received self-awareness assessment. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Self-awareness of deficits interview (SADI). <h3>Results</h3> Total SADI scores ranged from 0-9, with 72% of participants scoring 4 or above indicating moderate to severe impairment of self-awareness. Awareness of deficits: Seventeen impairment areas were identified, with impaired physical function most frequently cited (83%), along with memory impairment (46%) and other cognitive impairment (40%). Functional implications of deficits: Nineteen functional areas were identified, with driving (49%) and work (39%) most frequently cited, and 36% of participants reporting no TBI-related problems; 24% of participants stated the need for further exposure to activities to understand functional implications. Ability to identify realistic goals: Thirty-two goal areas were identified, with work most frequently cited (54%) and skills improvement (41%). Fifty-three percent of participants in the 7-9 SADI score category (i.e., severe impairment) stated that their TBI would not have an impact in 6 months' time, while 43% of the participants in the ≤1 SADI score category (i.e., no impairment) reported that TBI would have an ongoing impact. <h3>Conclusions</h3> A clinical interview such as the SADI provides an opportunity to understand the patient's perspective of their abilities, impairments and goals, and provides a comprehensive profile of self-awareness to inform treatment planning. <h3>Author(s) Disclosures</h3> Jennifer Fleming is also the author of the SADI.

The Association of White Matter Tracts with Alexithymia among Individuals with Major Depressive Disorder.

Alexithymia is characterized by impairments in the processing of emotions. Although the disruptions in the white matter (WM) integrity in Major depressive disorder (MDD) has frequently been reported, the underlying relationship with alexithymia remains unclear. In the present study, we investigated WM tracts with Tracts Constrained by UnderLying Anatomy approach to discover potential associations between alexithymia and WM integrity to identify the neural basis of impaired emotional self-awareness in MDD. 101 patients with MDD and 99 healthy sex- and age-matched individuals underwent diffusion-weighted imaging. All participants were assessed with the 20-item Toronto Alexithymia Scale (TAS). TAS scores were significantly higher in MDD patients than in controls. Patients with MDD exhibited significantly lower FA values in the left inferior longitudinal fasciculus and it also showed negative associations with TAS. These results contribute to the neurobiological evidence on the association between MDD and alexithymia. Additionally, they suggest that reduced white matter integrity in the regions constitutes a principal pathophysiology underlying impaired emotional recognition and description in MDD.

Clinician reports of self-awareness after traumatic brain injury: a retrospective chart review

BackgroundImpaired self-awareness (i.e., a lack of insight) is experienced by most individuals who have sustained a moderate to severe traumatic brain injury (TBI). During the early recovery period post-injury, these individuals may not be able to recognize their abilities and limitations, hence, negatively impacting their daily life and function. Although there are assessments and interventions to improve self-awareness after TBI, little is known about how clinicians assess and address this impairment in an inpatient rehabilitation setting.ObjectiveTo examine how clinicians assess, report, and provide interventions for impaired self-awareness after TBI.MethodsA retrospective chart review was conducted on interdisciplinary rehabilitation clinician entries for individuals with TBI (n = 67) who received inpatient rehabilitation within a five-year period (2014–2019). A reflexive thematic analysis was used to identify themes pertaining to self-awareness.ResultsThree themes were generated to explore clinician responses to their clients’ impaired self-awareness: 1) ‘recalling and understanding’ described clinician observations of client behaviors and expressions of self-awareness, 2) ‘applying and analyzing’ identified clinicians providing relevant tasks and advice to clients, and 3) ‘evaluating and creating’ described clinicians actively interacting with clients by providing feedback, guided prompts, and a follow-up plan.ConclusionClinicians produced varied responses to clients’ impaired self-awareness after TBI. Findings may help to develop research priorities and integrated knowledge translation initiatives to increase evidence-based practice for impaired self-awareness after TBI.

Improving self-awareness of prospective memory function after TBI using experiential feedback on a board game activity: An observational study

ABSTRACT This study investigated whether experiential and video feedback on performance of prospective memory (PM) tasks embedded within a board game activity improved self-awareness of PM function in adults with moderate-severe traumatic brain injury. An observational pre–post study design with 26 participants from a larger trial of a 6-session PM rehabilitation programme. Sessions 3 and 4 included a board game activity with embedded time-, event-, and activity-based PM tasks. Verbal feedback was provided by therapists during the game and video feedback afterwards. Self-ratings of performance were used to divide the sample into under-estimators (n = 7), accurate estimators (n = 9) and over-estimators (n = 10) of actual PM performance. The discrepancy between self- and therapist ratings of PM performance was measured before and after the game, and following video feedback, and compared between timepoints using non-parametric statistics. Post-task self-evaluations were more accurate than pre-task self-evaluations for the under- and over-estimator groups. Under-estimators showed significant improvement in accuracy of ratings for activity-based PM. Over-estimators showed improvement for event-based PM. Further improvements after video feedback were not significant. The board game activity provided a vehicle for experiential feedback and a means of engaging both those with impaired self-awareness and heightened self-awareness of PM in cognitive rehabilitation.

Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke.

There is growing evidence that the side of brain lesions results in distinct upper extremity deficits in motor control, movement behavior, and emotional and cognitive function poststroke. We investigated self-evaluation errors, which are the differences in scores between patient self-evaluation and clinician evaluations, and compared patients with left hemisphere damage (LHD) and right hemisphere damage (RHD) poststroke. Twenty-eight patients with chronic stroke (LHD = 16) performed the actual amount of the test twice with a one-week interval. We videotaped the participants' movements, and participants with stroke and evaluators graded the quality of movement scores by watching video recordings. Self-evaluation errors were significantly lower in patients with LHD than in those with RHD (t = 2.350, p = .019). Interestingly, this error did not change after the clinician provided the correct score as feedback. Chi-squared analysis revealed that more patients with LHD underestimated their movements (χ2 = 9.049, p = .002), while more patients with RHD overestimated (χ2 = 7.429, p = .006) in the send evaluation. Furthermore, there were no correlations between self-evaluation error and age, cognitive function, physical impairment, ability to control emotions, or onset months poststroke. Patients with stroke and therapists evaluated the same movements differently, and this can be dependent on hemispheric damage. Therapists might need to encourage patients with LHD who underestimate their movement to ensure continuous use of their more-affected arm. Patients with RHD who overestimate their movement might need treatment to overcome impaired self-awareness, such as video recordings, to protect from unexpected dangerous situations.

Support for Returning to Work for a Patient of Social Behavior Disorder with Impaired Self-awareness

Support for Returning to Work for a Patient of Social Behavior Disorder with Impaired Self-awareness

Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson's Disease - A Randomized Controlled Trial.

Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease (PD).Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients’ mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”).Methods: IPSUM’s effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms.Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients’ feedback regarding the training concept and material was excellent.Conclusion: Insight into Parkinson’s Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.

Neural and Behavioral Correlates of Impaired Insight and Self-Awareness in Substance Use Disorder.

Clinical insight is an emerging interest in substance use disorder research, but is difficult to study empirically. We reviewed recent research examining the behavioral and neural correlates of several psychological processes tapping into self-awareness that may in turn contribute to insight. Individuals with substance use disorder exhibit deficits in self-monitoring (especially self-report / behavior dissociations), metacognition, alexithymia, readiness for behavior change, and interoception. Behavioral impairments have been further linked to neural abnormalities in a diverse network of brain regions encompassing cortical midline areas, insula, and frontal cortex, among others. Various treatment modalities may target these deficits, though corresponding effects on neural circuitry remain to be determined. Compromised insight in substance use disorder may be relevant to a constellation of behaviors that suggest a lack of behavioral awareness linked to drug use. Future work needs to refine and advance the measurements, continuing to investigate insight problems in addiction that may become important therapeutic targets.

Impaired self-awareness of cognitive deficits in Parkinson's disease relates to cingulate cortex dysfunction.

Impaired self-awareness of cognitive deficits (ISAcog) has rarely been investigated in Parkinson's disease (PD). ISAcog is associated with poorer long-term outcome in other diseases. This study examines ISAcog in PD with and without mild cognitive impairment (PD-MCI), compared to healthy controls, and its clinical-behavioral and neuroimaging correlates. We examined 63 PD patients and 30 age- and education-matched healthy controls. Cognitive state was examined following the Movement Disorder Society Level II criteria. ISAcog was determined by subtracting z-scores (based on controls' scores) of objective tests and subjective questionnaires. Neural correlates were assessed by structural magnetic resonance imaging (MRI) and 2-[fluorine-18]fluoro-2-deoxy-d-glucose-positron emission tomography (FDG-PET) in 47 patients (43 with MRI) and 11 controls. We analyzed whole-brain glucose metabolism and cortical thickness in regions where FDG-uptake correlated with ISAcog. PD-MCI patients (N = 23) showed significantly more ISAcog than controls and patients without MCI (N = 40). When all patients who underwent FDG-PET were examined, metabolism in the bilateral superior medial frontal gyrus, anterior and midcingulate cortex negatively correlated with ISAcog (FWE-corrected p < 0.001). In PD-MCI, ISAcog was related to decreased metabolism in the right superior temporal lobe and insula (N = 13; FWE-corrected p = 0.023) as well as the midcingulate cortex (FWE-corrected p = 0.002). Cortical thickness was not associated with ISAcog in these regions. No significant correlations were found between ISAcog and glucose metabolism in controls and patients without MCI. Similar to Alzheimer's disease, the cingulate cortex seems to be relevant in ISAcog in PD. In PD-MCI patients, ISAcog might result from a disrupted network that regulates awareness of cognition and error processes.

Neural correlates of self-awareness of cognitive deficits in non-demented patients with Parkinson's disease.

The aim was to investigate the neural correlates of impaired self-awareness of cognitive deficits (IACd) in non-demented patients with Parkinson's disease (PD). This cross-sectional study enrolled 153 drug-naïve and non-demented PD patients who underwent brain magnetic resonance imaging, dopamine transporter (DAT) positron emission tomography, detailed neuropsychological testing, and the Cognitive Complaints Interview at baseline. Based on the presence of mild cognitive impairment and subjective cognitive complaints, patients were grouped into those with IACd (PD-IACd+, n=33) and those with normal recognition of cognitive function (n=82) or underestimation of cognitive function (n=38). Cortical thickness, white matter (WM) integrity, DAT availability and cognitive function were compared between the groups. The prevalence of IACd was 21.6% in drug-naïve patients with PD. The PD-IACd+ group had a lower z-score in the Stroop color reading test than the other groups. Patients in the PD-IACd+ group had WM disintegrity, especially in the genu of the corpus callosum and anterior limb of the internal capsule, compared to those without IACd, whilst cortical thickness or striatal DAT availability was comparable regardless of the presence of IACd. Amongst patients with mild cognitive impairment, those with IACd had more severe WM disintegrity than those without IACd. Structural connectivity between and from the frontal lobes is closely associated with self-awareness of cognitive deficits in PD. Evaluating frontal structural connectivity from the early stages of PD will be important in assessing the actual cognitive and daily life performance of patients with PD.

Bodies in the Novel Infinite Jest.

This manuscript provides a literary analysis of the use of bodies in the novel Infinite Jest by David Foster Wallace. The novel describes a world where oversaturation of external stimulation leads to the perception of mind and body of self of an individual as prosthetic parts, malleable and deformed, wherein the mind fails to feel bodily sensations and characters experience a complete disconnectedness from the self and others. Indeed, the disembodiment of characters and sensations of disconnection leads them to a compulsive quest for connectedness through the use of masks, made-up feelings, mind–body hybrid pain, corporeal malleability, and prostheses. These portrayals of the disordered and disconnectedness between body and mind or self will be described and compared to clinical conditions characterized by a disconnection between mind and body and impaired body self-awareness. Through this exercise, we argue that the use of scientifically inspired pathologized bodies is a means of conveying the stance of Wallace on or criticism of the degradation of society through excessive entertainment.

A-103 Examining Self-Awareness in Acute Stroke and Traumatic Brain Injury Populations

Abstract Objective Following acquired brain injury (ABI), self-awareness of deficits is frequently diminished. A review of the literature suggests most investigations of self-awareness following ABI have been in traumatic brain injury (TBI) populations, with emerging research in those with stroke (e.g., Al Banna et al., 2016). Therefore, this study examined self-awareness across diagnoses, neuroanatomical correlates, and demographics. Method Participants included 82 patients (TBI n = 59 and stroke n = 23) from an inpatient ABI unit. Patients, neuropsychologists, and family members completed the Awareness Questionnaire (AQ). The difference between patient-clinician or patient-family total score was examined, with scores &amp;gt;20 suggestive of impaired self-awareness. Results Participants with left-hemisphere (LH) injury endorsed higher functioning (Patient Total) compared to those with right or bilateral injury, p 0.05. However, there was greater difference scores between those with TBI compared to stroke on patient-clinician total cognitive scores t(80) = 2.125, p = 0.037 and patient-family behavioral/affective total scores t(15.86) = 4.045, p &amp;lt; 0.001 such that those with TBI’s were more aware of their deficits. Regarding demographics, level of education predicted level of patient awareness, but no demographic factors predicted the overall difference score. Conclusions Individuals with LH injury may be more prone to reduced awareness than expected. Additionally, specific domains of functioning may be more useful in examining awareness deficits across diagnostic groups than overall scores.

Impaired self-awareness and denial of disability in a community sample of people with traumatic brain injury

Purpose To examine the nature and severity of impaired self-awareness (ISA) and denial of disability (DD) in a community-dwelling traumatic brain injury (TBI) population. Additionally, to investigate reliability, internal consistency, and feasibility of the Clinician’s Rating Scale for evaluating Impaired Self-Awareness and Denial of Disability after brain injury (CRS-ISA-DD). Materials and methods ISA and DD were studied using the CRS-ISA-DD in a cross-sectional study with 78 TBI patients (3.1 years post-injury). Results 42% of individuals approached consented to participate in this study. Most participants showed one or more symptoms of ISA and DD, but severity scores were in the lower range (ISA: 13.2 ± 16.2; DD: 9.4 ± 10.7). The CRS-ISA-DD takes <10 min to complete, has excellent inter-rater reliability (ISA: ICC(2,1) = 0.928; DD: ICC(2,1) = 0.835), and acceptable-good internal consistency (ISA: α = 0.819; DD: α = 0.645). ISA severity correlated with neuropsychological test scores (rs = −0.30 to −0.47) and injury severity. DD severity correlated with anxiety (rs = −0.22) but not with avoidance coping or defense mechanisms. Conclusions Low levels of ISA and DD occurred in this sample of TBI patients. The CRS-ISA-DD is a reliable and feasible instrument. We recommend using it as a diagnostic tool to differentiate between ISA and DD once self-awareness problems have been identified. IMPLICATIONS FOR REHABILITATION Unawareness of deficits can persist into the chronic stage when rehabilitation treatment has ended. The two main factors of unawareness, impaired self-awareness and denial of disability, are related to different neurological and psychological mechanisms. The Clinician’s Rating Scale for evaluating Impaired Self-Awareness and Denial of Disability after brain injury (CRS-ISA-DD) can be used to distinguish the two main factors of unawareness.

Pathological correlates of impaired self-awareness of memory function in Alzheimer\u2019s disease

IntroductionImpaired self-awareness of memory function, a.k.a. anosognosia, is a common symptom in Alzheimer’s disease (AD); however, its pathological correlates remain unclear. Here, we investigated the impact of amyloid and tau on memory self-awareness.MethodsTwo hundred thirty-six clinically normal (N) and 102 impaired (I) participants from the ADNI cohort were included. Amyloid (global) and tau burden (in entorhinal and inferior temporal cortices) were assessed using positron emission tomography (PET). Self-awareness of memory was assessed using discrepancy indexes of subjective participant-informant ratings, as well as participant-objective scores of memory performance. Subjective and objective values were derived from the Everyday Cognition memory questionnaire and Logical Memory (delayed recall).ResultsLower awareness (both methods) of memory function was associated with higher levels of pathology in the I group as compared to N. There was a significant effect of tauopathy, but not amyloidosis, on individual complaint, such that higher levels of tau associated with lower awareness.DiscussionImpaired self-awareness appears progressively in the evolution of the disease related to AD biomarkers. Discordant subjective and objective measures may be important for clinical consideration.

Impaired self-awareness after traumatic brain injury: A systematic review. Part 2. Consequences and predictors of poor self-awareness.

Impaired self-awareness (ISA) has frequently been found both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI). This is the second of a two-part systematic review on ISA after TBI, focusing on the consequences and predictors of ISA after TBI. Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included; 46 were specifically related to this second part of the review. Among 16 studies that investigated the effect of ISA on outcome, most (n=13) found poor self-awareness associated with poor rehabilitation, functional, social and vocational outcome and with increased burden on relatives. Multiple factors have been found associated with increased frequency of ISA. ISA was found significantly related to injury severity in 8 of 10 studies, impaired executive functions in 12 of 15 studies, and poor social cognition in 3 studies, but paradoxically inverse associations were repeatedly found between self-awareness and emotional status (11 of 12 studies). Finally, although research in the field is still scarce, ISA seems associated with a dysfunction within brain networks involving the anterior cingulate cortex, anterior insula and fronto-parietal control network. ISA is a complex and multifaceted disorder associated with poor rehabilitation outcome, severe injuries, and deficits of executive functions and social cognition but has an inverse association with mood impairments.

Assessment of impaired self-awareness by cognitive domain after traumatic brain injury.

To examine self-awareness in chronic traumatic brain injury (TBI) by cognitive domain, compare domain-specific self-awareness to global impaired self-awareness, and evaluate change in self-appraisal of cognitive ability from before to after neuropsychological testing. Secondary analysis of a cross-sectional cohort of 59 participants with chronic TBI. We grouped participants as underestimators, fair estimators, and overestimators of their memory and executive functioning. We then compared these groups by global self-awareness measures, other clinical measures, and pre- to-posttest change in self-appraisal of cognitive performance. Analyses revealed no significant differences in global self-awareness measures or depression between fair or underestimators and overestimators in Memory or Executive Function Domains. Only 12.50% of participants in the Memory Composite Domain and 6.89% of participants in the Executive Function Composite Domain changed their pre- to postneuropsychological test self-appraisal of cognitive ability. This study revealed most participants did not change their self-appraisal in response to completing neuropsychological testing alone. In conjunction with our findings that suggest global self-awareness measures may not adequately capture domain-specific self-awareness deficits in chronic TBI, this study provides support for development of targeted self-awareness assessment tools and the need for structured feedback, rather than naturalistic feedback alone, to improve self-awareness in chronic TBI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment, clinical aspects and recovery.

Impaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI). The present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery. Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included. ISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness. ISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.

Clinician Responses to Impaired Self-Awareness after Traumatic Brain Injury

Clinician Responses to Impaired Self-Awareness after Traumatic Brain Injury