Excerpts

Introduction

While there are some potential positive gains to having poor awareness following brain injury (e.g. unrealistic expectations may initially act as a buffer, protecting the patient from grim reality), it is generally agreed by therapists and families that a persisting lack of self awareness is a major obstacle to successful rehabilitation and reintegration. For instance, individuals who do not admit their problems may be cooperative and compliant in therapy but discontinue compensation strategies on leaving the rehabilitation center. As a result, their functional status will decrease. Even well learned compensation strategies are of little value to a person who is unaware of the deficits they are designed to compensate for.

“Patients who lack an awareness of their deficits or the functional implications of these deficits may, if compliant go through the motions of rehearsing a strategy but are clearly not engaged in the process. Consequently the likelihood of the patient’s learning or putting the strategy to functional use is minimal” (Ylvisaker et al, 1987).

It is therefore important to treat poor awareness as a matter of the highest priority within rehabilitation programs.

Owing to the artificial nature of the rehabilitation center, with its structure and expectations of therapists, the full extent of impaired self awareness is not always apparent unless specific assessments for this area are implemented by the team.

A distinction between awareness and adjustment/acceptance can be usefully made.

Stuss (1991) suggests that self awareness exists on 2 levels:

1) The objective knowledge of the existence of one’s deficits.

2) The associated understanding of the personal significance of those deficits.

The term awareness can be used when referring to the individual’s ability to perceive difficulties. The terms adjustment or acceptance can be used when referring to the individual’s ability to understand or internalize the problems.

The individuals who are able to list their problems, but in a detached way as though the problems have no personal meaning, are demonstrating only good awareness. They may be exhibiting knowledge but fail to use it or be unaware of the implications of that knowledge. The person who is able to demonstrate an understanding of how the problems will affect his/her life is demonstrating good awareness and acceptance.