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Salazar-Frías D, Rodríguez-Bailón M, Ricchetti G, Navarro-Egido A, Funes MJ. The Cognitive Awareness Scale for Basic and Instrumental activities of daily living to measure self-awareness after acquired brain injury: Preliminary evidence of its validity. Clin Neuropsychol 2024; 38:1133-1155. [PMID: 37941388 DOI: 10.1080/13854046.2023.2278822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Objective: There is a crucial need for reliable tools to measure impaired self-awareness (ISA) in patients with acquired brain injury (ABI) across cognitive-functional domains. The aim of this study was to assess the psychometric properties of the Cog-Awareness ADL Scale, which is a novel self-proxy discrepancy method for measuring ISA in both basic and instrumental activities of daily living. Methods: This multicenter study included 54 patients (no-low ISA n = 33; severe ISA, n = 21) from four outpatient rehabilitation units in Málaga-Granada, Spain, and 51 healthy controls. The participants and proxy raters completed the Cog-Awareness ADL Scale and the Patient Competency Rating Scale (PCRS). Agreement between both scales was assessed using Spearman's correlations and the Bland-Altman plot. Group comparisons were made on measures of SA, cognitive abilities and demographic variables. Sensitivity and specificity were analysed by ROC curve analysis. Results: Convergent validity was supported by strong correlations with the PCRS and its subscales (rho's ranging from 0.51 to 0.80, p < 0.01 for all). The Bland-Altman plot confirmed measurement agreement (only 3.70% of the scores were outside the 95% limits). External validity was demonstrated by effectively discriminating between healthy controls and ABI patients with no-low and severe ISA on each discrepancy index while controlling for cognitive/demographic variables. The Cog-Awareness ADL Scale showed optimal diagnostic accuracy (AUC = 0.95, sensitivity = 0.90, specificity = 0.90). Conclusions: The Cog-Awareness ADL Scale proved to be a feasible, valid, and clinical tool to assess ISA across different cognitive-functional domains, in Spanish ABI-patients.
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Affiliation(s)
- Daniel Salazar-Frías
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Rodríguez-Bailón
- Physiotherapy (Occupational Therapy) Department, Health Science School, University of Málaga, Málaga, Spain
| | - Giorgia Ricchetti
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Jesús Funes
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
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Kajimoto C, Takebayashi T, Okita Y, Fleming J, Shimada S. Development of the Japanese version of the awareness questionnaire for assessment of self-awareness after acquired brain injury: reliability and validity. Top Stroke Rehabil 2024; 31:372-380. [PMID: 37880195 DOI: 10.1080/10749357.2023.2271707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The evaluation of impaired self-awareness (ISA) after brain injury is not widespread in Japan, and there is a lack of Japanese assessments of self-awareness. OBJECTIVES To translate the original version of the Awareness Questionnaire (AQ), an instrument for assessing ISA, into Japanese using a validated method and examine its reliability and validity in inpatients with stroke. METHODS This cross-sectional, prospective study enrolled 130 participants. The double-translation process was used to develop the Japanese version of the AQ. RESULTS Data were collected from 120 patients. High intra-rater reliability was observed for the patient (Cronbach's α = 0.824) and clinician samples (Cronbach's α = 0.933). High intra- and inter-rater reliability were found for all AQ items [interclass coefficient (ICC) (1, 1) = 0.828, ICC (2, 1) = 0.852, ICC (3, 1) = 0.848]; however, the sub-item analysis revealed only moderate reliability. Validity assessment revealed a low but significant positive correlation (r = 0.209; p < 0.05) between the Japanese version of the AQ and the Japanese version of the Self-Regulation Skills Interview and a low but significant negative correlation (r = 0.197; p < 0.05) between the Japanese version of the AQ and the Mini-Mental State Examination. CONCLUSIONS The Japanese version of the AQ was developed and applied to stroke patients, but the concept of post-stroke ISA may differ from ISA after traumatic brain injury, highlighting the need for a stroke-specific version of the AQ.
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Affiliation(s)
- Chinaru Kajimoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Takashi Takebayashi
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Osaka, Japan
| | - Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Eliav R, Nadler Tzadok Y, Segal-Rotenberg S, Kizony R. Efficacy of Intervention of Participation and Executive Functions (I-PEX) for Adults Following Traumatic Brain Injury: A Preliminary Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2024:15459683241231529. [PMID: 38375580 DOI: 10.1177/15459683241231529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Participation restrictions following traumatic brain injury are associated with executive function (EF) deficits (EFDs). The subacute recovery phase's specific characteristics (enhanced brain plasticity and impaired self-awareness) and contextual factors (inpatient setting) warrant adjusting cognitive rehabilitation protocols. The Intervention of Participation and Executive Functions (I-PEX) was designed to improve EFDs during subacute inpatient rehabilitation. OBJECTIVE To investigate the I-PEX's preliminary efficacy to improve EFDs during the performance of complex daily activities and enhance self-awareness, cognitive self-efficacy, participation, and quality of life postdischarge. METHODS A pilot pre-, post-, and follow-up double-blind randomized controlled trial with 25 participants randomly allocated to the I-PEX (n = 13) or treatment-as-usual (n = 12) group. Cognitive assessments were administered pre- and postintervention, and quality of life and participation questionnaires 1-month postdischarge. Data analysis included repeated measures analysis of variance mixed design and independent t-tests, extracting effect sizes. RESULTS Significant group-by-time interaction effect with a medium effect size was found for the primary outcome measure; EFs manifested in complex daily activities, indicating a larger improvement for the experimental group. The group effect was not significant. The experimental group's mean delta score (pre-post improvement) was significantly higher (1.75 ± 2.89; t(23) = 2.52, P = .019), with a large effect size (d = 1.012, 95% confidence interval [0.166-1.840]). We found no significant group and interaction effects for EFs, self-awareness, and cognitive self-efficacy or no significant differences in participation or quality of life postdischarge. CONCLUSIONS Results provide initial evidence for the I-PEX efficacy in treating EFDs in the subacute phase and could help determine effect size for future studies. CLINICAL TRIAL REGISTRY NUMBER ClinicalTrial.gov NCT04292925.
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Affiliation(s)
- Rotem Eliav
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Yael Nadler Tzadok
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shir Segal-Rotenberg
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Depatrment of Occupational Therapy, Sheba Medical Center, Tel-Hashomer, Israel
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Cameron KV, Ponsford JL, McKenzie DP, Stolwyk RJ. When stroke survivors' self-ratings are inconsistent with the ratings of others: a cohort study examining biopsychosocial factors associated with impaired self-awareness of functional abilities. BRAIN IMPAIR 2024; 25:IB23064. [PMID: 38566288 DOI: 10.1071/ib23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
Background Stroke survivors' self-ratings of functional abilities are often inconsistent with ratings assigned by others (e.g. clinicians), a phenomenon referred to as 'impaired self-awareness' (ISA). There is limited knowledge of the biopsychosocial contributors and consequences of post-stroke ISA measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of ISA during subacute rehabilitation (inpatient) and at 4 months post-discharge (community-dwelling). Methods Forty-five subacute stroke survivors participated (Age M (s.d.) = 71.5 (15.6), 56% female), and 38 were successfully followed-up. Self-assessments were compared to those of an independent rater (occupational therapist, close other) to calculate ISA at both time points. Survivors and raters completed additional cognitive, psychological and functional measures. Results Multivariate regression (multiple outcomes) identified associations between ISA during inpatient admission and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close other depression and anxiety. Regression models applied cross-sectionally, including one intended for correlated predictors, indicated associations between ISA during inpatient admission and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping (adjusted R 2 = 0.60). ISA at community follow-up was associated with poorer functional cognition and close other anxiety (adjusted R 2 = 0.66). Conclusions Associations between ISA and poorer outcomes across the rehabilitation journey highlight the clinical importance of ISA and the value of assessment and management approaches that consider the potential influence of numerous biological and psychosocial factors on ISA. Future studies should use larger sample sizes to confirm these results and determine the causal mechanisms of these relationships.
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Affiliation(s)
- Kate V Cameron
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia; and Monash-Epworth Rehabilitation Research Centre, Melbourne, Vic., Australia
| | - Dean P McKenzie
- Epworth HealthCare, Office for Research, Melbourne, Vic., Australia; and School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia; and Monash-Epworth Rehabilitation Research Centre, Melbourne, Vic., Australia
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Cheng WY, Klonoff PS, Perumparaichallai RK. Components of self-awareness affecting caregiver burden: a long-term follow-up study. Brain Inj 2024; 38:26-31. [PMID: 38258808 DOI: 10.1080/02699052.2024.2304883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. METHODS We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). RESULTS Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 = .33) for caregiver burden. CONCLUSIONS Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden.
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Affiliation(s)
- Wen-Yu Cheng
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Pamela S Klonoff
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Yoshida K, Sawamura D, Ogawa K, Mototani T, Ikoma K, Sakai S. Prospective and Retrospective Metacognitive Abilities and Their Association with Impaired Self-awareness in Patients with Traumatic Brain Injury. J Cogn Neurosci 2023; 35:1960-1971. [PMID: 37788321 DOI: 10.1162/jocn_a_02064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Metacognitive impairment often occurs in patients with traumatic brain injury (TBI) and is associated with clinical problems. The aim of this study was to clarify the pathology of metacognitive impairment in TBI patients using a behavioral task, clinical assessment of self-awareness, and lesion-symptom mapping. Metacognitive abilities of TBI patients and healthy controls were assessed using a modified perceptual decision-making task. Self-awareness was assessed using the Patient Competency Rating Scale and the Frontal Systems Behavior Scale. The associations between estimated metacognitive abilities, self-awareness, and neuropsychological test results were examined. The correspondence between metacognitive disabilities and brain lesions was explored by ROI-based lesion-symptom mapping using structural magnetic resonance images. Overall, 25 TBI patients and 95 healthy controls were included in the analyses. Compared with that in healthy controls, the prospective metacognitive ability of TBI patients was lower, with metacognitive evaluations revealing a bias toward overestimating their abilities. Retrospective metacognitive ability showed a negative correlation with self-awareness but not with neuropsychological test results. In the lesion-symptom mapping analysis, the left pFC was associated with lower retrospective metacognitive ability. This study contributes to a better understanding of the pathology of metacognitive and self-awareness deficits in TBI patients and may explain the cause of impaired realistic goal setting and adaptive behavior in these patients.
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Affiliation(s)
- Kazuki Yoshida
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
| | - Daisuka Sawamura
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
| | - Keita Ogawa
- Department of Rehabilitation, Hokkaido University Hospital, Japan
| | - Takuroh Mototani
- Department of Rehabilitation, Hokkaido University Hospital, Japan
| | - Katsunori Ikoma
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Japan
| | - Shinya Sakai
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
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McCabe C, Sica A, Fortune DG. Awareness through relationships in individuals undergoing rehabilitation following acquired brain injury. Neuropsychol Rehabil 2023:1-29. [PMID: 37903181 DOI: 10.1080/09602011.2023.2273578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
AIM This cross-sectional study investigated the association between self-awareness and quality of therapeutic relationships following acquired brain injury (ABI) while controlling for the potential impact of cognitive problems. It also aimed to investigate attachment as a potential moderator. METHOD 83 adults with ABI were recruited alongside a key member of their community neurorehabilitation team. The Scale to Assess Therapeutic Relationships (STAR) was used to measure therapeutic relationship quality and attachment was measured using the Experiences in Close Relationships - Relationship Structure (ECR-RS) questionnaire. Awareness was measured using the Patient Competency Rating Scale (PCRS) and the Mayo-Portland Adaptability Inventory (MPAI-4) provided a measure of cognitive problems. The MPAI-4 also provided an additional measure of awareness. RESULTS A significant association between self-awareness and therapeutic relationships was found in some regression models such that higher-quality relationships were associated with better awareness, after controlling for the impact of cognitive problems. Neither childhood parental attachment nor participants' attachment towards their rehabilitation staff were moderators. CONCLUSION The observed associations between awareness in clients and therapeutic relationships with rehabilitation staff may have importance for rehabilitation in this context. Results highlight the value of continuing to prioritize the therapeutic relational environment in ABI rehabilitation and research.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Co Dublin, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Hoepner JK, Keegan LC. "I Avoid Interactions With Medical Professionals as Much as Possible Now": Health Care Experiences of Individuals With Traumatic Brain Injuries. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:848-866. [PMID: 36346972 DOI: 10.1044/2022_ajslp-22-00103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This study examined the perceptions of health care experiences by individuals with traumatic brain injuries (TBIs) across the recovery continuum, regarding care received by a variety of health care providers following their TBI. It sought to identify whether perceptions differed across mild, moderate, and severe participants, as well as acute, subacute, and chronic recovery. METHOD Eighteen individuals with TBI were interviewed, using the Sydney Psychosocial Reintegration Scale-Second Edition (SPRS-2) and a semistructured interview about health care perceptions. A qualitative investigation employing two methods, interpretive phenomenological analysis (IPA) and Systemic Functional Linguistics (SFL; modality and appraisal analysis), provided a micro and macrolevel discourse analysis. RESULTS IPA analyses of SPRS-2 interviews differed across severity levels but included changes to relationships, identity, and changes to social engagement and activity. IPA results revealed three core themes related to the health care experiences across severity that encompassed (a) frustrations with providers and (b) lack of support in the chronic phase, and (c) that finding support is crucial. SFL results provided insight into how individuals appraised such experiences in light of their identity and personal perspectives. Key differences between individuals with mild, moderate, and severe TBI diagnoses were found, with those who experienced a mild TBI expressing the most discontent with services received. Participants were most satisfied with acute care and least satisfied with chronic phase support. CONCLUSIONS The results of this study have significant implications for health care professionals interacting with individuals who have experienced a TBI. Facilitating improved communication, referrals, increased access to mental health counseling, and resources such as groups to support identity expression could improve the health care experience.
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Zhao F, Lim H, Morrow EL, Turkstra LS, Duff MC, Mutlu B. Designing evidence-based support aids for social media access for individuals with moderate-severe traumatic brain injury: A preliminary acceptability study. Front Digit Health 2022; 4:991814. [PMID: 36606124 PMCID: PMC9808081 DOI: 10.3389/fdgth.2022.991814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/31/2022] [Indexed: 01/07/2023] Open
Abstract
Background Adults with traumatic brain injury (TBI) report significant barriers to using current social media platforms, including cognitive overload and challenges in interpreting social cues. Rehabilitation providers may be tasked with helping to address these barriers. Objectives To develop technological supports to increase social media accessibility for people with TBI-related cognitive impairments and to obtain preliminary data on the perceived acceptability, ease of use, and utility of proposed technology aids. Methods We identified four major barriers to social media use among individuals with TBI: sensory overload, memory impairments, misreading of social cues, and a lack of confidence to actively engage on social media platforms. We describe the process of developing prototypes of support aids aimed at reducing these specific social media barriers. We created mock-ups of these prototypes and asked 46 community-dwelling adults with TBI (24 females) to rate the proposed aids in terms of their acceptability, ease of use, and utility. Results Across all aids, nearly one-third of respondents agreed they would use the proposed aids frequently, and the majority of respondents rated the proposed aids as easy to use. Respondents indicated that they would be more likely to use the memory and post-writing aids than the attention and social cue interpretation aids. Conclusions Findings provide initial support for social-media-specific technology aids to support social media access and social participation for adults with TBI. Results from this study have design implications for future development of evidence-based social media support aids. Future work should develop and deploy such aids and investigate user experience.
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Affiliation(s)
- Fangyun Zhao
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States,Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
| | - Hajin Lim
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Emily L. Morrow
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, United States
| | - Melissa C. Duff
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States,Correspondence: Melissa Duff
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
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Wales L. Conceptual framework of the recovery of self-awareness following a severe traumatic brain injury in childhood. Brain Inj 2022; 37:655-661. [PMID: 36527373 DOI: 10.1080/02699052.2022.2158233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Self-awareness following a TBI in childhood is an under-represented area of research in the pediatric literature. The issue is well described in the adult literature but the theories and practice recommendations in this body of literature are not easily transferable to pediatric neurorehabilitation. Children and young people sustain a TBI at a time when the brain is yet to fully develop. This paper outlines a conceptual framework that incorporates and adapts knowledge from the adult and pediatric literature of self-awareness. METHODS The content and the structure of the framework is constructed from clinical experience, existing literature and the findings from an empirical study. FINDINGS A conceptual framework is presented with 3 key components: self-awareness knowledge, self-awareness in context, self-awareness for the future. The components are explained and the relationship between the concepts is highlighted. CONCLUSION The framework provides a common language for clinicians and academics to explore the concepts that impact self-awareness during recovery. The framework captures the dynamic developmental and recovery trajectory of self-awareness following a TBI in childhood.
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Affiliation(s)
- Lorna Wales
- Research team, The Children’s Trust, Tadworth, Tadworth, UK
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Arora C, Frantz C, Toglia J. Awareness of Performance on a Functional Cognitive Performance-Based Assessment Across the Adult Lifespan. Front Psychol 2021; 12:753016. [PMID: 34803834 PMCID: PMC8602564 DOI: 10.3389/fpsyg.2021.753016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
As people age, their cognitive skills and ability to complete complex instrumental activities of daily living often decline in subtle ways. Older adults who are aware of these slight cognitive and functional changes spontaneously adapt and implement strategies to maximize performance. On the other hand, older adults with limited self-awareness are less likely to adjust performance or initiate compensatory strategies as they may not recognize the need to do so. This places them at higher risk of functional decline and loss of independence. Research on awareness of functional performance in healthy adults is, however, limited, and there is a paucity of assessment tools available to address questions of awareness and strategy use in functional tasks. We used the Weekly Calendar Planning Activity (WCPA) - a performance-based assessment of functional cognition including measures of awareness and strategy use - to investigate differences in performance, awareness, and strategy use across the adult lifespan. The WCPA requires examinees to schedule appointments into a weekly calendar while following rules designed to increase task demands. Healthy adults (n=342) from ages 18-92 were observed for strategy use and error recognition, while a post-test interview probed participants' reported strategy use and estimation of accuracy. The discrepancy between participant estimation and actual accuracy provided a measure of online awareness of performance where a larger estimation discrepancy indicated over-estimation of performance. Performance on the WCPA declined across the adult lifespan. Older adults were less likely to use self-monitoring strategies and used less effective strategies overall. Overestimation was associated with use of fewer strategies and lower accuracy in all age groups. Importantly, twice as many older adults overestimated compared to younger adults. Furthermore, the subset of older adults who had good awareness of performance was more likely to use effective strategies, to recognize errors, and achieved accuracy on par with their younger counterparts. Our results emphasize the importance of examining self-awareness of performance and analyzing the strategies used to perform a complex functional task. This information can provide a foundation for early detection of functional decline in aging and for designing interventions to maximize functional independence in aging.
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Affiliation(s)
- Catherine Arora
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Carina Frantz
- Department of Occupational Therapy, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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