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Chapter 19. Awareness of Deficits

Laura A. Flashman, Ph.D.; Xavier Amador, Ph.D.; Thomas W. McAllister, M.D.
DOI: 10.1176/appi.books.9781585624201.679544

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Excerpt

Individuals who experience a traumatic brain injury (TBI) may have multiple medical, physical, and cognitive limitations. They may also have reduced awareness of these deficits. Up to 45% of individuals with moderate to severe TBI demonstrate awareness deficits (Freeland 1996; Hart et al. 2009). Deficits that are clearly evident to family or therapists are often not "seen" by the individual, are judged to be inconsequential, or are discounted. Such unawareness is often permanent and can be an enormous impediment to successful rehabilitation and a significant indicator of failure to return to work (Shames et al. 2005). Furthermore, deficits in awareness can be function specific. Some individuals with TBI can accurately assess their physical status (e.g., hemiplegia) but are less reliable in their assessment of their capacity for sound judgment, cognitive skills, interpersonal skills, and other aspects of social behavior (Trahan et al. 2006). In fact, this lack of awareness of neurobehavioral sequelae is commonly observed in moderate to severe TBI, and the resulting behavior is frequently the most troublesome to families and caregivers and presents the most significant barrier to returning to a more normalized existence after an injury.

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Table 19–1. Terms and definitions used when describing lack of awareness
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Table 19–2. Rating scales frequently used to assess unawareness of illness in traumatic brain injury
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Table 19–3. Studies investigating the relationship between impaired awareness and functional outcome after TBI
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Table 19–4. Putative brain circuitry associated with components of unawareness
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Table 19–5. Treatment approaches for brain injury rehabilitation
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Table 19–6. Components of the treatment process

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