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Schmidt J, Fleming J, Ownsworth T, Lannin NA. Maintenance of treatment effects of an occupation-based intervention with video feedback for adults with TBI. NeuroRehabilitation 2015; 36:175-86. [PMID: 25882200 DOI: 10.3233/nre-151205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Video feedback interventions have been found to improve self-awareness and occupational performance to a greater extent than other feedback interventions after traumatic brain injury (TBI). However, it is unclear whether the effects of video feedback are maintained over time. OBJECTIVE To evaluate the maintenance of gains in self-awareness achieved with a video feedback intervention in people with TBI. METHODS There were 32 participants with TBI and impaired self-awareness who had completed a randomized controlled trial with three feedback conditions (video plus verbal, verbal and experiential). Eight to ten weeks after the final feedback intervention session, a follow-up assessment was conducted. The primary outcome was maintenance of gains in online awareness measured by the number of errors made during a meal preparation task. Group outcomes were compared using an unstructured linear mixed regression model. RESULTS The video plus verbal feedback group continued to demonstrate significantly greater gains in online awareness compared to the verbal feedback group (mean difference 20.6, 95% CI 8.8 to 32.3) and the experiential feedback group (mean difference 14.4, 95% CI 3.1 to 25.6). There was no significant impact of the interventions on participants' emotional status at the 8 to 10 week follow-up. CONCLUSIONS A combination of video plus verbal feedback is an effective technique for achieving maintained gains in self-awareness in people with TBI.
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Affiliation(s)
- Julia Schmidt
- School of Allied Health, Australian Catholic University, North Sydney, NSW, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Royal Rehabilitation Centre Sydney, Sydney, NSW, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital Health Service, Brisbane, QLD, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, QLD, Australia
| | - Natasha A Lannin
- Occupational Therapy, La Trobe University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Llorens R, Noé E, Ferri J, Alcañiz M. Videogame-based group therapy to improve self-awareness and social skills after traumatic brain injury. J Neuroeng Rehabil 2015; 12:37. [PMID: 25889914 PMCID: PMC4404289 DOI: 10.1186/s12984-015-0029-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022] Open
Abstract
Background This study determines the feasibility of different approaches to integrative videogame-based group therapy for improving self-awareness, social skills, and behaviors among traumatic brain injury (TBI) victims and retrieves participant feedback. Methods Forty-two adult TBI survivors were included in a longitudinal study with a pre- and post-assessments. The experimental intervention involved weekly one-hour sessions conducted over six months. Participants were assessed using the Self-Awareness Deficits Interview (SADI), Patient Competency Rating Scale (PCRS), the Social Skills Scale (SSS), the Frontal Systems Behavior Scale (FrSBe), the System Usability Scale (SUS). Pearson's chi-squared test (χ2) was applied to determine the percentage of participants who had changed their clinical classification in these tests. Feedback of the intervention was collected through the Intrinsic Motivation Inventory (IMI). Results SADI results showed an improvement in participant perceptions of deficits (χ2 = 5.25, p < 0.05), of their implications (χ2 = 4.71, p < 0.05), and of long-term planning (χ2 = 7.86, p < 0.01). PCRS results confirm these findings (χ2 = 5.79, p < 0.05). SSS results were also positive with respect to social skills outcomes (χ2 = 17.52, p < 0.01), and FrSBe results showed behavioral improvements (χ2 = 34.12, p < 0.01). Participants deemed the system accessible (80.43 ± 8.01 out of 100) and regarded the intervention as interesting and useful (5.74 ± 0.69 out of 7). Conclusions Integrative videogame-based group therapy can improve self-awareness, social skills, and behaviors among individuals with chronic TBI, and the approach is considered effective and motivating.
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Affiliation(s)
- Roberto Llorens
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Joan Ferri
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Univesity of Jaume I, Av. Sos Baynat s/n, 12071, Castellón, Spain.
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Wolfe KR, Bigler ED, Dennis M, Gerhardt CA, Rubin K, Taylor HG, Vannatta K, Yeates KO. Self-awareness of peer-rated social attributes in children with traumatic brain injury. J Pediatr Psychol 2015; 40:272-84. [PMID: 25080604 PMCID: PMC4366444 DOI: 10.1093/jpepsy/jsu060] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study investigated self-awareness of peer-rated social attributes and its relations to executive function (EF), theory of mind (TOM), and psychosocial adjustment in children with traumatic brain injury (TBI). METHODS Self- and peer perceptions of classroom social behavior were assessed for 87 children 8-13 years of age: 15 with severe TBI, 40 with complicated mild/moderate TBI, and 32 with orthopedic injury. Participants completed measures of EF and TOM, and parents rated children's psychosocial adjustment. RESULTS Self-ratings of classroom social behavior did not differ between injury groups. Self- and peer ratings generally agreed, although children with severe TBI rated themselves as less rejected/victimized than did their peers. Higher EF predicted better self- and peer ratings and smaller self-peer discrepancies, which in turn predicted better adjustment. CONCLUSIONS Children with TBI show variable social self-awareness, which relates to EF and adjustment. Future studies should identify additional factors that contribute to limited insight.
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Affiliation(s)
- Kelly R Wolfe
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Erin D Bigler
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Maureen Dennis
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Cynthia A Gerhardt
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Kenneth Rubin
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - H Gerry Taylor
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Kathryn Vannatta
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
| | - Keith Owen Yeates
- Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital Department of Psychology, Nationwide Children's Hospital, Departments of Pediatrics and Psychology, The Ohio State University, Department of Psychology, Brigham Young University, Department of Psychiatry, University of Utah, Program in Neuroscience & Mental Health, The Hospital for Sick Children, Department of Surgery, University of Toronto, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Department of Human Development and Quantitative Methodology, University of Maryland, Department of Pediatrics, Case Western Reserve University, and Department of Pediatrics, Rainbow Babies and Children's Hospital
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Gasquoine PG. Blissfully unaware: Anosognosia and anosodiaphoria after acquired brain injury. Neuropsychol Rehabil 2015; 26:261-85. [DOI: 10.1080/09602011.2015.1011665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Krasny-Pacini A, Limond J, Evans J, Hiebel J, Bendjelida K, Chevignard M. Self-awareness assessment during cognitive rehabilitation in children with acquired brain injury: a feasibility study and proposed model of child anosognosia. Disabil Rehabil 2015; 37:2092-106. [DOI: 10.3109/09638288.2014.998783] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schmidt J, Fleming J, Ownsworth T, Lannin NA. An occupation-based video feedback intervention for improving self-awareness: Protocol and rationale. The Canadian Journal of Occupational Therapy 2014; 82:54-63. [DOI: 10.1177/0008417414550999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Impaired self-awareness can limit rehabilitation outcomes for people with traumatic brain injury (TBI). Video feedback on occupational performance has been found to improve self-awareness after TBI when delivered according to specific principles. Purpose. The purpose of this article is to describe an occupation-based video feedback intervention found to be effective in a randomized controlled trial to assist with translation into clinical practice. Key Issues. The intervention uses therapist-mediated video feedback on clients’ occupational performance, aiming to facilitate self-reflection on performance and improve self-awareness. This paper describes the theoretical background, intervention principles, and protocol of the intervention. Implications. Therapists can use video feedback intervention, incorporating the principles in this article, to improve people’s intellectual awareness and ability to recognize and correct errors during task performance after TBI without a negative impact on emotional status.
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Richardson C, McKay A, Ponsford JL. Does feedback influence awareness following traumatic brain injury? Neuropsychol Rehabil 2014; 25:233-53. [DOI: 10.1080/09602011.2014.936878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part III. J Head Trauma Rehabil 2014; 29:338-52. [DOI: 10.1097/htr.0000000000000068] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Challenging Behaviours, Co-morbidities, Service Utilisation and Service Access among Community-dwelling Adults with Severe Traumatic Brain Injury: A Multicentre Study. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine patterns, predictors and unmet needs of service utilisation and access to mental health and/or drug and alcohol services among community-dwelling adults with severe traumatic brain injury, and compare those who displayed challenging behaviours with those not displaying challenging behaviour.Design: Retrospective multicentre study.Subjects: All active clients (n= 507) of the New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP) community rehabilitation teams.Methods: Clinician-rated data were collected on client challenging behaviours, mental health and functional status, service utilisation and unmet needs. Between-groups analyses (challenging behaviour versus no challenging behaviours) were conducted to examine patterns of service utilisation and unmet needs. Predictors for service utilisation were tested by multiple linear regression.Results: Challenging behaviours were associated with higher use of BIRP and non-BIRP services and greater levels of unmet needs. Challenging behaviour was an independent predictor of higher levels of service utilisation, in conjunction with pre- and post-injury mental health and drug and alcohol co-morbidities and geographic location. Only 15.3% of the 111 clients with challenging behaviours and co-morbid drug and alcohol problems accessed a drug and alcohol service, while another 32.4% had unmet needs for such services.Conclusion: Challenging behaviours make an independent contribution to increased levels of service utilisation after severe traumatic brain injury.
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Taylor GH, Broomfield NM. Cognitive Assessment and Rehabilitation Pathway for Stroke (CARPS). Top Stroke Rehabil 2013; 20:270-82. [PMID: 23841975 DOI: 10.1310/tsr2003-270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Complex cognitive impairments are common after stroke and they can significantly impede individuals' progress in rehabilitation. Treatment strategies that allow patients to compensate for such deficits are therefore an important part of multidisciplinary rehabilitation, as acknowledged by various clinical guidelines. In part due to the heterogeneity of poststroke cognitive impairments, the evidence base for treatments in this area is often unclear or inconsistent. There are no straightforward clinical tools or guidelines available to facilitate poststroke cognitive rehabilitation across cognitive domains. The present article proposes a cognitive assessment and rehabilitation pathway for stroke (CARPS), which aims to provide a structure to guide stroke rehabilitation teams in this difficult area of clinical practice. Practical treatment strategies are also discussed in some detail. Finally, the limitations of the proposed pathway are acknowledged, as is the importance of further research.
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Affiliation(s)
- Gavin H Taylor
- Department of Clinical Health Psychology, Western Infirmary General, Glasgow, UK
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Hamonet-Torny J, Fayol P, Faure P, Carrière H, Dumond JJ. Traumatic brain injury rehabilitation, the programs applied in French UEROS units, and the specificity of the Limoges experience. Ann Phys Rehabil Med 2013; 56:174-92. [DOI: 10.1016/j.rehab.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
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Lindström AC, Eklund K, Billhult A, Carlsson G. Occupational therapists' experiences of rehabilitation of patients with limited awareness after stroke. Scand J Occup Ther 2013; 20:264-71. [DOI: 10.3109/11038128.2012.758778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schmidt J, Fleming J, Ownsworth T, Lannin NA. Video Feedback on Functional Task Performance Improves Self-awareness After Traumatic Brain Injury. Neurorehabil Neural Repair 2012; 27:316-24. [DOI: 10.1177/1545968312469838] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Feedback is used in rehabilitation to improve self-awareness in people with traumatic brain injury (TBI), but there have been no comparisons of the different methods of providing feedback. Objective. To compare the effect of different methods of feedback on impaired self-awareness after TBI. Method. This was a randomized, assessor-blinded trial with concealed allocation. A total of 54 participants with TBI and impaired self-awareness (85% male) were recruited from inpatient and community rehabilitation settings. Participants performed a meal preparation task on 4 occasions and were randomly assigned to 1 of 3 feedback intervention groups: video plus verbal feedback, verbal feedback, or experiential feedback. The primary outcome was improvement in online awareness measured by the number of errors made during task completion. Secondary outcomes included level of intellectual awareness, self-perception of rehabilitation, and emotional status. Results. Receiving video plus verbal feedback reduced the number of errors more than verbal feedback alone (mean difference = 19.7 errors; 95% confidence interval [CI] = 9.2-30.1) and experiential feedback alone (mean difference = 12.4 errors; 95% CI = 1.8-23.0). Conclusion. The results suggest that the video plus verbal feedback approach used in this study was effective in improving self-awareness in people with TBI. The results also provide evidence that improvement in self-awareness was not accompanied by deterioration in emotional status.
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Affiliation(s)
- Julia Schmidt
- Royal Rehabilitation Centre, Sydney, Australia
- The University of Queensland, Brisbane, Australia
- Metro South Health Services District, Brisbane, Australia
| | - Jennifer Fleming
- The University of Queensland, Brisbane, Australia
- Metro South Health Services District, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | | | - Natasha A. Lannin
- Alfred Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
- Rehabilitation Studies Unit, The University of Sydney, Sydney, Australia
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Hufford BJ, Williams MK, Malec JF, Cravotta D. Use of behavioural contracting to increase adherence with rehabilitation treatments on an inpatient brain injury unit: A case report. Brain Inj 2012; 26:1743-9. [DOI: 10.3109/02699052.2012.698791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schuurs A, Green HJ. A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life. Psychooncology 2012; 22:1043-9. [PMID: 22570263 DOI: 10.1002/pon.3102] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This research aimed to address the gap in evidence-based treatment available for cancer survivors who are experiencing cognitive dysfunction, through piloting a novel treatment intervention. The overall research question was whether a group cognitive rehabilitation intervention would be feasible for improving cognitive function and quality of life for people who have completed cancer treatment. METHODS Three groups of adults were recruited as follows: an intervention group of 23 cancer survivors who completed a 4-week group cognitive rehabilitation treatment, a comparison group of nine cancer survivors, and a community sample of 23 adults who had never experienced cancer. Measures of objective and subjective cognitive function, quality of life, psychosocial distress, and illness perceptions were used. The research design was non-randomised. RESULTS The results indicated that the intervention was effective in improving overall cognitive function, visuospatial/constructional performance, immediate memory, and delayed memory beyond practice effects alone. It was helpful in reducing participants' perceptions of cognitive impairment and psychosocial distress, as well as promoting social functioning and understanding of cognition. The improvements were maintained at 3 months after the intervention. Participants reported a high level of satisfaction with the treatment. CONCLUSIONS The results provided evidence for the feasibility of a brief group-based cognitive rehabilitation intervention to treat cognitive problems experienced by cancer survivors.
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Affiliation(s)
- Alana Schuurs
- Behavioural Basis of Health Program, Griffith Health Institute and School of Applied Psychology, Griffith University, Gold Coast, Australia
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Schmidt J, Fleming J, Ownsworth T, Lannin N, Khan A. Feedback interventions for improving self-awareness after brain injury: a protocol for a pragmatic randomised controlled trial. Aust Occup Ther J 2012; 59:138-46. [PMID: 22448994 DOI: 10.1111/j.1440-1630.2012.00998.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Occupational therapists working in brain injury rehabilitation use functional tasks as a means of providing feedback to improve self-awareness of people who have a brain injury and ultimately improve their occupational performance. PURPOSE To compare the effectiveness of video, verbal and experiential feedback for improving self-awareness in people with traumatic brain injury. METHODS A randomised controlled trial will be conducted to compare the efficacy of video and verbal feedback during occupational therapy. Fifty-four participants with traumatic brain injury will be randomly allocated into three intervention groups: (i) video plus verbal feedback, (ii) verbal feedback and (iii) experiential feedback (control condition). Participants will receive the allocated intervention based on performance of a meal preparation task. The intervention sessions will occur four times during a two-week period. Blinded assessment will occur at baseline, post-intervention, and two months follow up. The primary outcome will be a measure of on-line self-awareness (number of self-corrected and therapist corrected errors). Secondary outcomes to be assessed include levels of intellectual self-awareness, emotional distress, and acceptance of disability. Data will be analysed using an intention to treat approach. Linear mixed effects models will be used to investigate the intervention effects. FINDINGS AND IMPLICATIONS Results will contribute to evidence-based guidelines to support therapists to choose the most effective form of feedback for people with decreased self-awareness after traumatic brain injury.
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Affiliation(s)
- Julia Schmidt
- Royal Rehabilitation Centre Sydney, Ryde, New South Wales, Australia.
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Coetzee N, Andrewes D, Khan F, Hale T, Jenkins L, Lincoln N, Disler P. Predicting Compliance With Treatment Following Stroke: A New Model of Adherence Following Rehabilitation. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.9.2.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground and purpose: Adherence to medication is fundamental to optimal health recovery yet compliance to medication rates are lower than 50% in most studies. This study aimed to investigate the correlates of adherence in stroke patients. Method: Twenty-six stroke patients and 29 amputee patients who had completed a rehabilitation program at Melbourne Rehabilitation Centre were investigated. Medical adherence was determined from computed adherence metrics based on pill counts and subjective reports of patient knowledge of medication use. Model components that were believed to contribute to poor adherence, included emotional and cognitive dysfunction, beliefs about medication, and social support. These factors were assessed by patient and partner self-rating questionnaires. Results: Stroke patients showed a lower level of adherence compared to amputee patients. Cognitive and emotional dysfunction, beliefs about medication, and the level of care were significantly associated with low adherence to medicine regimes in stroke patients. Level of cognitive impairment and emotional impairment were significantly associated with low adherence to medicines in amputee patients. Emotional dysfunction was the best predictor of poor adherence in both patient groups. Conclusion: The findings are in keeping with past adherence studies with other patient groups and support the position that emotional, cognitive, and social factors are important factors in adherence. The specific nonadherence profile for this brain-damaged group is modeled and the application for outpatients following rehabilitation is discussed.
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Liddle J, Fleming J, McKenna K, Turpin M, Whitelaw P, Allen S. Adjustment to loss of the driving role following traumatic brain injury: A qualitative exploration with key stakeholders. Aust Occup Ther J 2011; 59:79-88. [DOI: 10.1111/j.1440-1630.2011.00978.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doering BK, Conrad N, Rief W, Exner C. Life goals after brain injury in the light of the dual process approach: Empirical evidence and implications for neuropsychological rehabilitation. Neuropsychol Rehabil 2011; 21:515-38. [DOI: 10.1080/09602011.2011.583500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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71
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Kortte KB, Hillis AE. Recent trends in rehabilitation interventions for visual neglect and anosognosia for hemiplegia following right hemisphere stroke. FUTURE NEUROLOGY 2011; 6:33-43. [PMID: 21339836 DOI: 10.2217/fnl.10.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article highlights the most recent findings regarding the rehabilitation interventions for the syndromes of visual neglect and anosognosia for hemiplegia that occur following right hemisphere stroke. We review papers published in the past 4 years pertaining to therapeutic approaches for these two syndromes in order to identify the trends in the development of effective interventions. Overall, it appears well recognized that visual neglect syndromes and awareness syndromes frequently co-occur and both include complex, multifaceted impairments leading to significant difficulties in daily life functioning following stroke. Thus, the interventions for these syndromes must be multifaceted in order to address the complex interplay of cognitive-behavioral-emotional components. There appears to be a trend for using combination therapeutic interventions that address these components.
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Affiliation(s)
- Kathleen B Kortte
- Johns Hopkins University School of Medicine, Department of Physical Medicine & Rehabilitation, 600 North Wolfe Street, Phipps 174, Baltimore, MD 21205, USA
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72
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Lundqvist A, Linnros H, Orlenius H, Samuelsson K. Improved self-awareness and coping strategies for patients with acquired brain injury--a group therapy programme. Brain Inj 2010; 24:823-32. [PMID: 20377345 DOI: 10.3109/02699051003724986] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE This study evaluates the effects of a group therapy programme for anticipatory self-awareness and coping strategies. DESIGN The study includes methodological triangulation using three methods to gather data: an overall self-report questionnaire, Self Regulation Skills Interview (SRSI) and focus group interview. SUBJECTS Twenty-one individuals with acquired brain injury participated in a group therapy programme. METHODS A self-report questionnaire developed and used especially for evaluation of the described intervention was used at the end of the last session of the group therapy programme. The Self Regulation Skills Interview-SRSI, was used within 2 weeks before and after the subjects participated in one group program. Three Focus groups were used as a third method for data collection. The Focus group interviews were accomplished 1 month after each group programme. RESULTS The individuals increased their self-awareness and strategy behaviour significantly. Participating in the group therapy programme had had an effect on their life and work situation and on their self-confidence. CONCLUSIONS A structured group therapy programme helps patients with acquired brain injury understand the consequences of their neuropsychological deficits, helps them improve awareness of their impairments and helps them develop coping strategies.
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Affiliation(s)
- Anna Lundqvist
- Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping, Sweden.
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73
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Medley AR, Powell T. Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review. Neuropsychol Rehabil 2010; 20:481-508. [DOI: 10.1080/09602010903529610] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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74
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Dirette D. Self-Awareness Enhancement through Learning and Function (SELF): A Theoretically Based Guideline for Practice. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12759925544344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Impaired self-awareness is a significant barrier to successful rehabilitation. This paper presents a new guideline for practice, entitled Self-awareness Enhancement through Learning and Function (SELF). Description: The SELF is a newly developed guideline for practice, which incorporates the latest theoretical information from neuroscience, psychology and computer science regarding self-awareness, learning, cognition and care giving, with evidence of the importance of participation in occupation. The SELF provides clear evaluation and treatment postulates using therapeutic alliance, occupation, belief perspectives, brain education and compensatory strategies to improve self-awareness. Discussion: The current approach to the treatment of impaired self-awareness focuses on testing and performance feedback. This approach does not have evidence to support its effectiveness and there is some evidence that the approach actually contributes to emotional distress and increased denial of deficits. Conclusion: The SELF integrates the art and the science of occupational therapy to foster self-awareness in an empathetic and dignified manner. Occupational therapists are uniquely qualified, and should be leaders, in the integration of personal factors, environmental elements and occupations to improve self-awareness. The SELF provides occupational therapists with guidelines for using these interrelationships to restore self-awareness in a manner that builds confidence and skills.
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75
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Ownsworth T, Quinn H, Fleming J, Kendall M, Shum D. Error self-regulation following traumatic brain injury: A single case study evaluation of metacognitive skills training and behavioural practice interventions. Neuropsychol Rehabil 2010; 20:59-80. [DOI: 10.1080/09602010902949223] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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76
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77
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Schönberger M, Humle F, Teasdale TW. Subjective outcome of brain injury rehabilitation in relation to the therapeutic working alliance, client compliance and awareness. Brain Inj 2009; 20:1271-82. [PMID: 17132550 DOI: 10.1080/02699050601049395] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the relationship between working alliance, compliance, awareness and subjective outcome of brain injury rehabilitation. Subjects were 86 patients who were clients in an holistic neuropsychological outpatient rehabilitation programme. They had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or some other neurological insult (n = 10). MEASURES The therapeutic alliance, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists. Clients completed the European Brain Injury Questionnaire (EBIQ) at programme start and end. Clients and therapists rated the overall success of their collaboration at programme end. RESULTS Clients' experience of a good emotional bond between themselves and therapists in mid-therapy was predictive for the reduction of clients' report of depressive symptoms on the EBIQ depression sub-scale (R = 0.68, n = 43, p < 0.001). Good compliance early in the programme was predictive of changes on the EBIQ. Improvement of awareness was related to the amplification of depressive symptoms (r = -0.27, n = 56, p < 0.05). CONCLUSIONS Brain injury rehabilitation should be seen as a dynamic process that develops between clients and therapists. Future research should further investigate the relationship between process and outcome and how the therapeutic process can be optimized.
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Affiliation(s)
- Michael Schönberger
- Center for Rehabilitation of Brain Injury, University of Copenhagen, Copenhagen, Denmark.
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78
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Wilbur R, Wilk C, Silver R, Parente R. Validity and reliability of self-monitoring indices. Brain Inj 2009; 22:685-90. [DOI: 10.1080/02699050802270014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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79
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Coetzer R. Holistic neuro-rehabilitation in the community: is identity a key issue? Neuropsychol Rehabil 2009; 18:766-83. [PMID: 18654932 DOI: 10.1080/09602010701860266] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many people experience identity change after brain injury. Impaired self-awareness after acquired brain injury is also common and can, along with other factors, affect the identity change a person may experience. Holistic rehabilitation programmes attempt to address both cognitive and emotional difficulties and specifically problems of self-awareness after brain injury. Does identity change require longer-term rehabilitation interventions? This paper describes a community-based neuro-rehabilitation service that has incorporated some principles from more traditional holistic programmes with a view to providing long-term, low-intensity brain injury rehabilitation. Specific reference is made to problems of identity and how these may be addressed during long-term psychotherapeutic follow-up. The potential relevance of the total duration of rehabilitation input rather than simply the number of sessions when working with adjustment and identity change after brain injury in community settings is discussed. The service model is compared to more traditional holistic rehabilitation programmes. A case study and early outcome data are presented to illustrate some of these points and to provide more information about the nature of the programme.
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Affiliation(s)
- Rudi Coetzer
- North Wales Brain Injury Service, Colwyn Bay, Wales, and Bangor University, Wales.
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80
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Ownsworth TL, Turpin M, Andrew B, Fleming J. Participant perspectives on an individualised self-awareness intervention following stroke: A qualitative case study. Neuropsychol Rehabil 2008; 18:692-712. [DOI: 10.1080/09602010701595136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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81
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Kennedy MRT, Coelho C, Turkstra L, Ylvisaker M, Moore Sohlberg M, Yorkston K, Chiou HH, Kan PF. Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations. Neuropsychol Rehabil 2008; 18:257-99. [DOI: 10.1080/09602010701748644] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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82
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Dirette DK, Plaisier BR, Jones SJ. Patterns and Antecedents of the Development of Self-Awareness following Traumatic Brain Injury: The Importance of Occupation. Br J Occup Ther 2008. [DOI: 10.1177/030802260807100202] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to explore the pattern of the development of self-awareness following traumatic brain injury (TBI). Further, the antecedents to change in self-awareness and the use of compensatory strategies were examined. A longitudinal descriptive method was used with 18 adult participants and their significant others. Each pair was interviewed at 1 week, 1 month, 4 months and 1 year post-injury, using the Awareness Questionnaire, the Patient Assessment of Own Functioning Inventory and the Personal Evaluation of Community Integration. Comparative analyses were conducted between the participants and their significant others, as well as among the different levels of severity of brain injury. The participants with mild TBI showed better self-awareness than the participants with moderate/severe TBI. By 1 year post-injury, however, the level of self-awareness for the participants with mild TBI was not significantly different from that for the participants with moderate/severe TBI. The pattern of the development of self-awareness was different between the two groups. The participants with mild TBI initially overestimated deficits, but demonstrated good self-awareness throughout. The participants with moderate/severe TBI significantly underestimated deficits, but demonstrated a gradual increase in self-awareness. The reported antecedents to self-awareness were similar. Both groups primarily used a comparison of their ability to perform familiar occupations after the injury as a means for developing self-awareness. Severity of injury and time post-injury are both significant variables in the pattern of recovery of self-awareness following TBI. Occupational therapists should consider the use of familiar occupations to assist in the recovery process.
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Affiliation(s)
| | | | - Susan J Jones
- Bronson Lifestyle Improvement and Research Centre — Rehabilitation Services, Kalamazoo, MI, USA
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83
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Orfei MD, Robinson RG, Bria P, Caltagirone C, Spalletta G. Unawareness of illness in neuropsychiatric disorders: phenomenological certainty versus etiopathogenic vagueness. Neuroscientist 2007; 14:203-22. [PMID: 18057389 DOI: 10.1177/1073858407309995] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Awareness of illness is a form of self-knowledge concerning information about the pathological state, its functional consequence, and the way it affects the patient and his interaction with the environment. Unawareness of illness has raised much interest for its consequences on compliance with treatment, prognosis, and the patient's quality of life. This review highlights the great complexity of this phenomenon both at phenomenological and etiopathogenic levels in stroke, traumatic brain injury, psychosis, dementias, and mood disorders. In particular, the clinical expression is characterized by failure to acknowledge being ill, misattribution of symptoms, and noncompliance with treatment. Unawareness of illness may also be linked with characteristics that are peculiar to each individual disturbance, such as symptom duration and cognitive impairment. Despite a long-lasting interest in the clinical characteristics of unawareness, only recently has the focus of research investigated pathogenic mechanisms, with sometimes controversial results. The vast majority of studies have pointed out a remarkable involvement of the right hemisphere. Specifically, functional and structural changes of the dorso-lateral prefrontal cortex and some other frontal areas have often been found to be associated with awareness deficit, as well as parieto-temporal areas and the thalamus, although to a lesser extent. These data indicate the present difficulty of localizing a specific cerebral area involved in unawareness and suggest the existence of possible brain circuits responsible for awareness. In conclusion, phenomenological manifestations of poor awareness are well outlined in their complexity, whereas neuroanatomic and neuropsychological findings are still too vague and sparse and need further, greater efforts to be clarified.
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84
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Ownsworth T, Fleming J, Desbois J, Strong J, Kuipers P. A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design. J Int Neuropsychol Soc 2006; 12:54-63. [PMID: 16433944 DOI: 10.1017/s135561770606005x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 09/07/2005] [Accepted: 09/08/2005] [Indexed: 11/07/2022]
Abstract
Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings.
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Affiliation(s)
- Tamara Ownsworth
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
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