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Sansonetti D, Fleming J, Patterson F, Lannin NA, Toglia J. Online awareness: a concept analysis and review of assessment approaches for adults with neurological conditions. Disabil Rehabil 2024:1-16. [PMID: 38596894 DOI: 10.1080/09638288.2024.2338876] [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: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Self-awareness is a multifaceted phenomenon that comprises two main concepts: general awareness and online awareness. The latter is an emerging concept that requires further consensus on its definition. The aim of this paper is to define the key components of online awareness and identify approaches for measuring this concept for adults with neurological conditions. MATERIALS AND METHODS Concept analysis using Rodgers' evolutionary method was used to systematically review and summarise relevant literature. Papers were included if they provided a definition of online awareness or method for assessing online awareness for an adult neurological population. RESULTS Fifty-six papers were included in this review, with 21 online awareness assessment approaches identified. Online awareness was described to occur within the context of task performance, with the definition framework comprising four main aspects: 1/appraisal; 2/anticipation and prediction; 3/monitoring; and 4/self-evaluation. Self-regulation is a related concept that is considered to sit outside the conceptual boundaries of online awareness. CONCLUSIONS The findings of this analysis highlight the complexity of online awareness and its importance in rehabilitation. Psychometrically robust measures of online awareness that are inclusive of the essential elements of this concept are needed to advance practice in this area.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Natasha A Lannin
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy University, Dobbs Ferry, New York, USA
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2
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Dromer E, Arnould A, Barbot F, Azouvi P. Assessment of impaired self-awareness after moderate-to-severe traumatic brain injury: a comparison of assessment tools. Brain Inj 2024; 38:76-83. [PMID: 38247236 DOI: 10.1080/02699052.2024.2304875] [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: 04/24/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To compare different assessment methods of impaired self-awareness (ISA). METHODS We included 37 patients with moderate-to-severe traumatic brain injury (TBI) at a subacute/chronic stage, and 33 healthy controls. ISA was assessed with three methods: discrepancy scores (comparison between patient and proxy ratings) on three scales (Patient Competency Rating Scale (PCRS), Awareness Questionnaire (AQ) and Dysexecutive Questionnaire (DEX)); clinician rating with the Self-Awareness of Deficits Interview (SADI); and the difference between prediction or estimation of performance and actual performance on two cognitive tasks. RESULTS Clinician-patient discrepancy scores appeared more sensitive than relative-patient discrepancy. The AQ was the most sensitive. The discrepancy scores were strongly correlated one with each other. Correlations with the SADI were weaker. Patients did not overestimate their performance on cognitive tasks, and the prediction did not significantly correlate with other measures of ISA. DISCUSSION/CONCLUSION Results support the multidimensional nature of ISA: discrepancy scores assess meta-cognitive knowledge (understanding that a function/skill is affected), while the SADI takes into account anticipatory awareness (ability to set realistic goals) and estimation of performance assesses anticipatory and situational awareness. Assessment of these different domains may provide a comprehensive overview of an individual's self-awareness.
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Affiliation(s)
- Emilie Dromer
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
| | - Annabelle Arnould
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
| | - Frédéric Barbot
- Centre d'Investigation Clinique, Inserm CIC 1429, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Philippe Azouvi
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
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Ben-Dor Cohen M, Nahum M, Traub Bar-Ilan R, Eldar E, Maeir A. Coping with emotional dysregulation among young adults with ADHD: A mixed-method study of self-awareness and strategies in daily life. Neuropsychol Rehabil 2023:1-25. [PMID: 37971947 DOI: 10.1080/09602011.2023.2279181] [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: 12/28/2022] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emotional dysregulation (ED) impacts functional outcomes among individuals with attention-deficit hyperactivity disorder (ADHD). Self-awareness and strategies may enhance coping with ED yet are rarely studied in ADHD. OBJECTIVES To explore ED-related self-awareness and strategies in daily life of adults with ADHD, and to examine the interrelations between them and their association with symptoms. METHODS Sixty young adults with ADHD participated in a mixed-method study. At baseline, self-awareness and strategies were assessed using the Self-Regulation Skills Interview (SRSI); ADHD symptoms were self-rated using the ASRS symptom checklist. Then, symptoms were rated over 5-days using ecological momentary assessment (EMA). RESULTS Significant challenges in self-awareness and strategies were demonstrated quantitatively and qualitatively. Awareness of ED was associated with variability of ADHD symptoms on EMA yet not with symptom severity. Qualitative content analysis revealed a range of self-awareness levels, which were related to noticing ED-related cues and understanding contextual factors predictive of ED. Self-awareness and strategies were significantly associated. Strategies varied regarding effort, individual preference and temporality. CONCLUSIONS Variability of ADHD symptoms was negatively associated with self-awareness of ED. Strategy selection in daily-life among adults with ADHD may be affected by self-awareness and by a possible trade-off between short-term effort and long-term effectiveness.
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Affiliation(s)
- Maayan Ben-Dor Cohen
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruthie Traub Bar-Ilan
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eran Eldar
- Psychology Department, Faculty of Social Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adina Maeir
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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4
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Steward KA, Kretzmer T. Anosognosia in moderate-to-severe traumatic brain injury: A review of prevalence, clinical correlates, and diversity considerations. Clin Neuropsychol 2022; 36:2021-2040. [PMID: 34429014 DOI: 10.1080/13854046.2021.1967452] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
METHOD A comprehensive search of peer-reviewed articles was conducted from September to November 2020 using Google Scholar and PubMed databases. Key terms included "anosognosia," "self-awareness," "traumatic brain injury," and variants thereof. Our search was restricted to articles published in English within the last 25 years, although a few historical articles were included due to scientific merit. Articles were chosen based on methodological quality, inclusion of solely or predominantly msevTBI sample, and relevance to the current topic. CONCLUSIONS Anosognosia is a multifaceted and domain-specific construct that affects the majority of those with msevTBI. It is related to TBI severity, injuries in right-hemispheric and cortical midline regions, specific aspects of executive function, psychological function, and cultural factors. We offer pragmatic advice for clinicians working with this population and discuss implications for the field regarding "best practices" of anosognosia assessment and intervention.
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Affiliation(s)
- Kayla A Steward
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Tracy Kretzmer
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
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5
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Toglia J, Goverover Y. Revisiting the dynamic comprehensive model of self-awareness: a scoping review and thematic analysis of its impact 20 years later. Neuropsychol Rehabil 2022; 32:1676-1725. [PMID: 35583377 DOI: 10.1080/09602011.2022.2075017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to (1) describe the scope of research related to the Dynamic Comprehensive Model of Awareness (DCMA) (Toglia & Kirk, 2000); (2) identify themes and support for key model postulates; and (3) suggest future research directions related to this model. Using PRISMA scoping guidelines, 366 articles were reviewed, and 54 articles met our inclusion criteria. Selected studies were clustered into three themes: (1) the relationship between general and online self-awareness (50%); (2) interventions based on the model (41%); and (3) factors contributing to self-awareness (9%). Most studies were conducted with participants with acquired brain injury (BI) and traumatic BI (68%), most used a cross-sectional design (50%), and most intervention studies utilized a single-subject design (18%), followed by an experimental design (9%). This review provides evidence for the wide application of the DCMA across varying ages and populations. The need for a multidimensional assessment approach is recognized; however, stronger evidence that supports a uniform assessment of online self-awareness is needed. The intervention studies frequently described the importance of direct experience in developing self-awareness; however, few studies compared how intervention methods to influence general versus online self-awareness, or how cognitive capacity, self-efficacy, psychological factors, and context, influence the development of self-awareness.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
| | - Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, United States
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Fisher O, Berger I, Grossman ES, Maeir A. Online and Intellectual Awareness of Executive Functioning in Daily Life among Adolescents with and without ADHD. J Atten Disord 2022; 26:870-880. [PMID: 34378435 DOI: 10.1177/10870547211031982] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Executive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in "real-time" task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD. METHODS 102 adolescents with (n = 52) and without (n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness. RESULTS Adolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent's ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls (p < .005). CONCLUSIONS Adolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.
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Affiliation(s)
| | - Itai Berger
- The Hebrew University, Jerusalem, Israel.,Ben-Gurion University of the Negev, Beer-Sheva, Southern, Israel
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Bourke NJ, Trender W, Hampshire A, Lai H, Demarchi C, David M, Hellyer P, Sharp DJ, Friedland D. Assessing prospective and retrospective metacognitive accuracy following traumatic brain injury remotely across cognitive domains. Neuropsychol Rehabil 2022; 33:574-591. [PMID: 35168480 DOI: 10.1080/09602011.2022.2034650] [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: 10/19/2022]
Abstract
The ability to monitor one's behaviour is frequently impaired following TBI, impacting on patients' rehabilitation. Inaccuracies in judgement or self-reflection of one's performance provides a useful marker of metacognition. However, metacognition is rarely measured during routine neuropsychology assessments and how it varies across cognitive domains is unclear. A cohort of participants consisting of 111 TBI patients [mean age = 45.32(14.15), female = 29] and 84 controls [mean age = 31.51(12.27), female = 43] was studied. Participants completed cognitive assessments via a bespoke digital platform on their smartphones. Included in the assessment were a prospective evaluation of memory and attention, and retrospective confidence judgements of task performance. Metacognitive accuracy was calculated from the difference between confidence judgement of task performance and actual performance. Prospective judgment of attention and memory was correlated with task performance in these domains for controls but not patients. TBI patients had lower task performance in processing speed, executive functioning and working memory compared to controls, maintaining high confidence, resulting in overestimation of cognitive performance compared to controls. Additional judgments of task performance complement neuropsychological assessments with little additional time-cost. These results have important theoretical and practical implications for evaluation of metacognitive impairment in TBI patients and neurorehabilitation.
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Affiliation(s)
- N J Bourke
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - W Trender
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - A Hampshire
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - H Lai
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - C Demarchi
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - M David
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - P Hellyer
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - D J Sharp
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - D Friedland
- UK Dementia Research Institute: Care, Research & Technology (UK DRI: CR&T), Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
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8
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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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9
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van der Stelt CM, Fama ME, Mccall JD, Snider SF, Turkeltaub PE. Intellectual awareness of naming abilities in people with chronic post-stroke aphasia. Neuropsychologia 2021; 160:107961. [PMID: 34274379 PMCID: PMC8405585 DOI: 10.1016/j.neuropsychologia.2021.107961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.
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Affiliation(s)
- Candace M van der Stelt
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Research Division, MedStar National Rehabilitation Hospital, USA
| | - Mackenzie E Fama
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Department of Speech, Language and Hearing Sciences, George Washington University, USA
| | - Joshua D Mccall
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA
| | - Sarah F Snider
- Department of Neurology, Georgetown University Medical Center, USA
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Research Division, MedStar National Rehabilitation Hospital, USA.
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10
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Sansonetti D, Fleming J, Patterson F, Lannin NA. Conceptualization of self-awareness in adults with acquired brain injury: A qualitative systematic review. Neuropsychol Rehabil 2021; 32:1726-1773. [PMID: 34008481 DOI: 10.1080/09602011.2021.1924794] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-awareness is an important consideration in cognitive rehabilitation for clinicians working with individuals following acquired brain injury (ABI), with impaired self-awareness linked to poor outcomes. To appropriately target assessment and intervention for self-awareness, its theoretical foundation and definition must be considered. The aim was to identify the definitions, theoretical models and conceptual frameworks of self-awareness in adults with ABI, and how self-awareness is conceptualized within those models. A qualitative systematic review was completed using search terms related to descriptions of models/frameworks, ABI and self-awareness. Data were analysed by narrative synthesis. Thirty-five papers were included in the review. Within these, 13 models, 12 conceptual frameworks and 2 theories were described. The main themes and subthemes conceptualized in the synthesis were: Clinical presentation of self-awareness (classifications and dimensions of self-awareness), development of self-awareness (knowledge, feedback mechanisms, temporal aspects, self-evaluation, enablers, barriers), understanding (dys)function (cognitive processing mechanisms, neurological foundations, causal factors), and practice guidance (assessment and intervention). This review identified an extensive theoretical basis to support conceptualization of self-awareness following ABI, underpinned by a distinction between intellectual awareness, on-line awareness, and psychological denial. Clinical application of an evaluation process that includes these elements would be beneficial to inform the rehabilitation process.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Natasha A Lannin
- Occupational Therapy Department, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Monash University, Melbourne, Australia
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11
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Chen MH, Goverover Y. Self-awareness in multiple sclerosis: Relationships with executive functions and affect. Eur J Neurol 2021; 28:1627-1635. [PMID: 33527564 DOI: 10.1111/ene.14762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Deficits in self-awareness can be observed in persons with multiple sclerosis (pwMS). The present study aimed to investigate two types of self-awareness (intellectual and online) among pwMS, which will inform clinical care. Intellectual awareness refers to knowledge of one's own abilities; online awareness refers to real-time monitoring and regulation of one's performance. METHODS The study sample consisted of 95 pwMS and 65 healthy controls (HCs). Intellectual awareness was defined as discrepancy between participant's and informant's reports of participant's functioning. Online awareness was operationalized by change in self-assessment of performance after engaging in a functional task. RESULTS PwMS had significantly worse intellectual awareness than HCs regarding money management (confidence interval [CI] 0.44 to 1.99), task performance (CI -0.01 to 2.5), social interaction (CI 0.29 to 2.45), and problem solving (CI 0.87 to 2.8) abilities, but not sensory symptoms. Executive functioning was positively associated with intellectual awareness in HCs, while depressive and anxiety symptoms were negatively related to intellectual awareness in pwMS. In contrast, online awareness was not significantly different between groups; both groups were able accurately to assess their performance after engaging in a functional task. CONCLUSIONS Intellectual awareness, but not online awareness, is impaired in pwMS. Among pwMS, affective symptomatology may distort their perception of functional status. Persons with MS may benefit from actually performing a functional task during the assessment and treatment process, which may lead to a more accurate estimate of their own abilities.
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Affiliation(s)
- Michelle H Chen
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Yael Goverover
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
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12
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Brown L, Fish J, Mograbi DC, Bellesi G, Ashkan K, Morris R. Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment. Neuropsychol Rehabil 2021; 31:154-188. [PMID: 31642719 DOI: 10.1080/09602011.2019.1680393] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.
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Affiliation(s)
- Laura Brown
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jessica Fish
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daniel C Mograbi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janerio, Brazil
| | - Giulia Bellesi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Robin Morris
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
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13
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Pacella V, Scandola M, Beccherle M, Bulgarelli C, Avesani R, Carbognin G, Agostini G, Thiebaut de Schotten M, Moro V. Anosognosia for theory of mind deficits: A single case study and a review of the literature. Neuropsychologia 2020; 148:107641. [PMID: 33058921 PMCID: PMC7116409 DOI: 10.1016/j.neuropsychologia.2020.107641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
Being aware of one's own ability to interact socially is crucial to everyday life. After a brain injury, patients may lose their capacity to understand others' intentions and beliefs, that is, the Theory of Mind (ToM). To date, the debate on the association between ToM and other cognitive deficits (in particular executive functions and behavioural disorders) remains open and data regarding awareness of ToM deficits are meagre. By means of an ad-hoc neuropsychological battery of tests, we report on a patient who suffers from ToM deficits and is not aware of these disorders, although aware of his other symptoms. The study is accompanied by a review of the literature (PRISMA guidelines) demonstrating that ToM deficits are independent of executive functions. Furthermore, an advanced lesion analysis including tractography was executed. The results indicate that: i) ToM deficits can be specific and independent of other cognitive symptoms; ii) unawareness may be specific for ToM impairment and not involve other disorders and iii) the medial structures of the limbic, monitoring and attentional systems may be involved in anosognosia for ToM impairment.
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Affiliation(s)
- Valentina Pacella
- Social and Cognitive Neuroscience Laboratory, Department of Psychology, Sapienza University of Rome, via dei Marsi 78, 00185, Rome, Italy; NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Maddalena Beccherle
- Social and Cognitive Neuroscience Laboratory, Department of Psychology, Sapienza University of Rome, via dei Marsi 78, 00185, Rome, Italy; NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Cristina Bulgarelli
- Department of Rehabilitation, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Renato Avesani
- Department of Rehabilitation, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Giovanni Carbognin
- Department of Radiology, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, GC, Italy.
| | - Giulia Agostini
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Rue Léo Saignat 146, 33000, Bordeaux, France.
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
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Merchán-Baeza JA, Rodriguez-Bailon M, Ricchetti G, Navarro-Egido A, Funes MJ. Awareness of cognitive abilities in the execution of activities of daily living after acquired brain injury: an evaluation protocol. BMJ Open 2020; 10:e037542. [PMID: 33109646 PMCID: PMC7592290 DOI: 10.1136/bmjopen-2020-037542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION One of the main limitations that can be observed after acquired brain injury (ABI) is the alteration of the awareness of the deficits that can occur in the cognitive skills necessary for performing activities of daily living (ADL). According to the Dynamic Comprehensive Model of Awareness (DCMA), consciousness is composed of offline component, which contains the information stored about characteristics of the tasks and stable beliefs about one's own capabilities and online awareness, which is activated in the context of the performance of a specific task. The main objective of this project was to generate and validate a detailed cognitive assessment protocol within the context of ADL to evaluate the components of DCMA. METHODS AND ANALYSIS The proposed protocol consists of two ecological tools: The Cog-Awareness ADL Scale to measure offline component and the Awareness ADL-task: Basic and Instrumental ADL performance-based test to measure online awareness. The aim is to identify the presence of cognitive deficits and anosognosia in patients with ABI within the context of everyday life activities. These two measures will be administered to a group of patients with ABI. In addition, these participants will complete another series of classic tests on anosognosia and cognitive functions in order to find the convergent validity of the two tests proposed in this protocol. The external validity of the Cog-Awareness ADL Scale and the relationships between awareness components within the same ADL domain will be also analysed. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Biomedical Research of Andalusia, on 13 January /2017 (Proceeding 1/2017). All participants are required to provide written informed consent. The findings from this will be disseminated via scientific publication. TRIAL REGISTRATION NUMBER NCT03712839.
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Affiliation(s)
- Jose Antonio Merchán-Baeza
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic (Barcelona), Spain
| | - Maria Rodriguez-Bailon
- Departament of Physiotherapy (Occupational Therapy), University of Malaga, Malaga, Spain
| | - Giorgia Ricchetti
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
| | - María Jesús Funes
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
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15
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Bivona U, Ciurli P, Ferri G, Fontanelli T, Lucatello S, Donvito T, Villalobos D, Cellupica L, Mungiello F, Lo Sterzo P, Ferraro A, Giandotti E, Lombardi G, Azicnuda E, Caltagirone C, Formisano R, Costa A. The Self-Awareness Multilevel Assessment Scale, a New Tool for the Assessment of Self-Awareness After Severe Acquired Brain Injury: Preliminary Findings. Front Psychol 2020; 11:1732. [PMID: 32793065 PMCID: PMC7393213 DOI: 10.3389/fpsyg.2020.01732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
Self-awareness (SA) is frequently impaired after severe acquired brain injury (sABI) and may lead to reduced subject's compliance to treatment, worse functional outcome, and high caregiver distress. Considering the multifaceted nature of SA, a specific and effective assessment is crucial to address treatment of impairment of SA (ISA). Many tools can currently assess ISA; however, they have some important limits. In the present study, we proposed the Self-Awareness Multilevel Assessment Scale (SAMAS), a new scale for assessment of SA at different levels (i.e., declarative, emergent, and anticipatory) across all domains of functioning. The SAMAS has been designed to be administered by the cognitive/behavioral therapist with the involvement of a patient's relative. Findings showed that the SAMAS allowed specifically assessing SA at a declarative level and on all possible functional domains. More interestingly, it seems also able to assess both emergent and anticipatory SA, thus overcoming some important limits of other current assessment methods. Our findings are consistent with a holistic perspective of the patient with sABI because thanks to the combined use of assessing tools, the SAMAS can provide an accurate diagnosis of ISA, thus better addressing the neurorehabilitation treatment and, accordingly, reducing the possible occurrence of its primary and secondary implications.
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Affiliation(s)
- Umberto Bivona
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Paola Ciurli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giulia Ferri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Tiziana Fontanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Susanna Lucatello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Teresa Donvito
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Dolores Villalobos
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain
| | - Laura Cellupica
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Fabiana Mungiello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Paola Lo Sterzo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Amalia Ferraro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Eleonora Giandotti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giorgio Lombardi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Eva Azicnuda
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Tor Vergata University, Rome, Italy
| | - Rita Formisano
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Alberto Costa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Università Telematica Niccolò Cusano, Rome, Italy
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16
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Toglia J, Chen P. Spatial exploration strategy training for spatial neglect: A pilot study. Neuropsychol Rehabil 2020; 32:792-813. [PMID: 32684100 DOI: 10.1080/09602011.2020.1790394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spatial neglect is a syndrome due to impaired neural networks critical for spatial attention and related cognitive and motor functions. Affected individuals also have impaired self-awareness of their own neglect symptoms. The present randomized controlled study was the first proof-of-concept pilot examining the multi-context treatment approach using a protocol of spatial exploration strategy training in one brief session (20-30 minutes). The therapist provided supportive feedback and semi-structured guidance to promote strategy learning and self-discovery of omission errors. 40 patients with left-sided neglect after right brain stroke were included. The results showed that the treatment reduced lateralized bias toward the ipsilesional side of space but did not improve overall detection performance. Impaired general self-awareness of daily-life spatial difficulties was found independent of treatment outcome. This implies that judgment regarding responsiveness to treatment should not be made based on an awareness interview or the severity of neglect symptoms. Lastly, the treatment showed the potential of improving online contextual self-awareness of spatial abilities. A collaborative and interactive approach that focuses on helping the patient self-discover, monitor and self-manage their errors, appears to have a potential for decreasing neglect symptoms. Future studies are required to examine additional aspects of the multi-context treatment approach.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA.,Rehabilitation Medicine Department, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Peii Chen
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, NJ, USA
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Prigatano GP, Sherer M. Impaired Self-Awareness and Denial During the Postacute Phases After Moderate to Severe Traumatic Brain Injury. Front Psychol 2020; 11:1569. [PMID: 32765359 PMCID: PMC7378811 DOI: 10.3389/fpsyg.2020.01569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more recent observations (i.e., 1999–2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI.
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Affiliation(s)
- George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Mark Sherer
- TIRR Memorial Hermann, Houston, TX, United States
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18
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Grossner EC, Bernier RA, Brenner EK, Chiou KS, Hillary FG. Prefrontal gray matter volume predicts metacognitive accuracy following traumatic brain injury. Neuropsychology 2019; 32:484-494. [PMID: 29809035 DOI: 10.1037/neu0000446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To examine metacognitive ability (MC) following moderate to severe traumatic brain injury (TBI) using an empirical assessment approach and to determine the relationship between alterations in gray matter volume (GMV) and MC. METHOD A sample of 62 individuals (TBI n = 34; healthy control [HC] n = 28) were included in the study. Neuroimaging and neuropsychological data were collected for all participants during the same visit. MC was quantified using an approach borrowed from signal detection theory (Type II area under the receiver operating characteristic curve calculation) to evaluate judgments during a modified version of the 3rd edition of the Wechsler Adult Intelligence Scale's Matrix Reasoning subtest where half of the items were presented randomly and half were presented in the order of increasing difficulty. Retrospective confidence judgments were collected on an item-by-item basis. Brain volumetric analyses were conducted using FreeSurfer software. RESULTS Analyses of the modified Matrix Reasoning task data demonstrated that HCs significantly outperformed TBIs (ordered: d = .63; random: d = .58). There was a significant difference between groups for MC for the randomly presented stimuli (d = .54) but not the ordered stimuli. There was an association between GMV and MC in the TBI group between the right orbital region and MC (R2 = .11). In the HC group, there were associations between the left posterior (R2 = .17), left orbital (R2 = .29), and left dorsolateral (R2 = .21) regions and MC. CONCLUSIONS These results are consistent with those of previous research on MC in the cognitive neurosciences, but this study demonstrates that injury may moderate the regional contributions to MC. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Kathy S Chiou
- Department of Psychology, University of Nebraska Lincoln
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19
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Bivona U, Costa A, Contrada M, Silvestro D, Azicnuda E, Aloisi M, Catania G, Ciurli P, Guariglia C, Caltagirone C, Formisano R, Prigatano GP. Depression, apathy and impaired self-awareness following severe traumatic brain injury: a preliminary investigation. Brain Inj 2019; 33:1245-1256. [PMID: 31304792 DOI: 10.1080/02699052.2019.1641225] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Objective: The primary aim of this study was to determine the frequency of severe impaired self-awareness (ISA) in patients with severe traumatic brain injury (TBI) and the correlates of selected clinical, neuropsychiatric and cognitive variables. The secondary aim of the study was to assess depression and apathy on the basis of their level of self-awareness. Methods: Thirty patients with severe TBI and 30 demographically matched healthy control subjects (HCs) were compared on measures of ISA, depression, anxiety, alexithymia, neuropsychiatric symptoms and cognitive flexibility. Results: Twenty percent of the patients demonstrated severe ISA. Severe post-acute ISA was associated with more severe cognitive inflexibility, despite the absence of differences in TBI severity, as evidenced by a Glasgow Coma Scale (GCS) score lower than 9 in all cases in the acute phase. Patients with severe ISA showed lower levels of depression and anxiety but tended to show more apathy and to have greater difficulty describing their emotional state than patients with severe TBI who showed minimal or no disturbance in self-awareness. Conclusion: These findings support the general hypothesis that severe ISA following severe TBI is typically not associated with depression and anxiety, but rather with apathy and cognitive inflexibility.
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Affiliation(s)
- U Bivona
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - A Costa
- b Unicusano University , Rome , Italy
| | - M Contrada
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - D Silvestro
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - E Azicnuda
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - M Aloisi
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G Catania
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - P Ciurli
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - C Guariglia
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,c Sapienza University , Rome , Italy
| | - C Caltagirone
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,d Tor Vergata University , Rome , Italy
| | - R Formisano
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G P Prigatano
- e Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , AZ , USA
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20
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Postdecisional Processing Delays in Metacognitive Monitoring After Traumatic Brain Injury. J Head Trauma Rehabil 2019; 35:152-159. [PMID: 31246884 DOI: 10.1097/htr.0000000000000509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document the process by which metacognitive judgments ("online" monitoring of one's own cognitive performance during task completion) are made after traumatic brain injury (TBI). PARTICIPANTS Sixteen community-dwelling adults with moderate to severe TBI and 16 matched healthy controls. DESIGN Prospective, cross-sectional design. MEASURES Metacognitive retrospective confidence judgments and reaction times were collected as participants performed a metamemory task. RESULTS Adults with TBI did not differ from healthy peers in metacognitive accuracy; however, they took significantly longer to make retrospective confidence judgments. Retrospective confidence judgment reaction times were not consistently correlated to measures of processing speed in either sample. CONCLUSIONS Adults with TBI engage in different postdecisional processes to make metacognitive judgments compared with healthy controls. Findings suggest that reaction times may be an important dimension of metacognition to assess clinically after TBI.
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21
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Grossner EC, Bernier RA, Brenner EK, Chiou KS, Hong J, Hillary FG. Enhanced default mode connectivity predicts metacognitive accuracy in traumatic brain injury. Neuropsychology 2019; 33:922-933. [PMID: 31094553 DOI: 10.1037/neu0000559] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To examine the role that intrinsic functional networks, specifically the default mode network, have on metacognitive accuracy for individuals with moderate to severe traumatic brain injury (TBI). METHOD A sample of 44 individuals (TBI, n = 21; healthy controls [HCs], n = 23) were included in the study. All participants underwent an MRI scan and completed neuropsychological testing. Metacognitive accuracy was defined as participants' ability to correctly judge their item-by-item performance on an abstract reasoning task. Metacognitive values were calculated using the signal detection theory approach of area under the receiver operating characteristic curve. Large-scale subnetworks were created using Power's 264 Functional Atlas. The graph theory metric of network strength was calculated for six subsystem networks to measure functional connectivity. RESULTS There were significant interactions between head injury status (TBI or HC) and internetwork connectivity between the anterior default mode network (DMN) and salience network on metacognitive accuracy (R2 = 0.13, p = .047) and between the posterior DMN and salience network on metacognitive accuracy (R2 = 0.15, p = .038). There was an interpretable interaction between head injury status and internetwork connectivity between the attention network and salience network on metacognitive accuracy (R2 = 0.13, p = .067). In all interactions, higher connectivity predicted better metacognitive accuracy in the TBI group, but this relationship was reversed for the HC group. CONCLUSION Enhanced connectivity to both anterior and posterior regions within the DMN facilitates metacognitive accuracy postinjury. These findings are integrated into a larger literature examining network plasticity in TBI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Emily C Grossner
- Department of Psychology and Social, Life, and Engineering Imaging Center (SLEIC)
| | - Rachel A Bernier
- Department of Psychology and Social, Life, and Engineering Imaging Center (SLEIC)
| | - Einat K Brenner
- Department of Psychology and Social, Life, and Engineering Imaging Center (SLEIC)
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Yoshida K, Ogawa K, Mototani T, Inagaki Y, Sawamura D, Ikoma K, Sakai S. Flow experience enhances the effectiveness of attentional training: A pilot randomized controlled trial of patients with attention deficits after traumatic brain injury. NeuroRehabilitation 2018; 43:183-193. [PMID: 30040757 DOI: 10.3233/nre-172396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Flow is an optimal psychological state when people engage in a training task, and it is a theory explaining the absorbed state. OBJECTIVE To investigate the additional effect of flow on attention deficits for chronic patients after traumatic brain injury. METHODS Twenty patients were randomly assigned to the flow group (n = 10) or the control group. Patients performed a video game task, one inducing flow (flow group) and the other not (control group) for 4 weeks, and they were assessed with the flow state scale for occupational tasks (FSSOT) regularly and neuropsychological tests at baseline, after intervention, and at 4 weeks after intervention (follow-up). RESULTS Although both groups significantly improved their attentional function after intervention, patients in the flow group tended to show more improvement of attention. The effect size of the neuropsychological test of attention was positive, and its value was small to medium. There was a significant positive correlation between improvement of attention and the FSSOT score. CONCLUSIONS Attention training with induction of the flow was associated with greater improvement of attention. The results of this study may provide provisional evidence of the effectiveness of rehabilitation considering the patient's psychological state.
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Affiliation(s)
- Kazuki Yoshida
- Department of Functioning and Disability, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Keita Ogawa
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan
| | - Takuroh Mototani
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan
| | - Yuji Inagaki
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Sawamura
- Department of Occupational Therapy, School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Katsunori Ikoma
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinya Sakai
- Department of Functioning and Disability, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Castine BR, Albein-Urios N, Lozano-Rojas O, Martinez-Gonzalez JM, Hohwy J, Verdejo-Garcia A. Self-awareness deficits associated with lower treatment motivation in cocaine addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:108-114. [PMID: 30183371 DOI: 10.1080/00952990.2018.1511725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with cocaine use disorder (CUD) often display behaviours that are paradoxically misaligned with their situation. Typical examples include poor treatment motivation and inconsistent self-reported craving. These behaviours may reflect impairments in the awareness of one's own behaviour. OBJECTIVES We examined whether impaired self-awareness of addiction-related frontostriatal dysfunction (i.e., symptoms of apathy, disinhibition, and executive dysfunction) was associated with treatment motivation and craving. METHODS Sixty-five outpatients with CUD (57 male) and their informants (those who knew the patient well) completed parallel self and informant versions of the Frontal Systems Behaviour Scale. Self-awareness was indexed through the discrepancy between self and informant scores in the three sub-scales; apathy, disinhibition and executive dysfunction. The University Rhode Island Change Assessment Scale assessed treatment motivation. Self-reported craving was assessed using a visual analogue scale. Multiple linear regression models examined associations between self-awareness and treatment motivation and craving, adjusting for sociodemographic factors and lifetime drug use. RESULTS We found an inverse relationship between self-awareness of symptoms of disinhibition and treatment motivation maintenance. Although impaired awareness of disinhibition was also correlated with craving, this association was not significant after adjusting for sociodemographic factors and drug use. The apathy and executive dysfunction awareness scores were not associated with treatment motivation or craving. CONCLUSION We show that people with lower insight into their disinhibition problems (e.g., impulsivity, mood instability) have more problems maintaining motivation when initiating treatment. Findings suggest that self-awareness interventions could be useful to prevent premature treatment dropout and improve addiction treatment outcomes.
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Affiliation(s)
- Benjamin R Castine
- a Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton, Melbourne , VIC , Australia
| | | | - Oscar Lozano-Rojas
- c Departamento de Psicología Clínica, Experimental y Social , Universidad de Huelva , Huelva , Spain
| | | | - Jakob Hohwy
- e Department of Philosophy, Faculty of Arts , Monash University , Clayton, Melbourne , VIC , Australia
| | - Antonio Verdejo-Garcia
- a Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton, Melbourne , VIC , Australia
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O'Brien KH, Kennedy MRT. Predicting Remembering: Judgments of Prospective Memory After Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1393-1408. [PMID: 29800086 DOI: 10.1044/2018_jslhr-l-17-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Adults with traumatic brain injuries (TBIs) often struggle with prospective memory (PM), the ability to remember to complete tasks in the future, such as taking medicines on a schedule. Metamemory judgments (or how well we think we will do at remembering) are linked to strategy use and are critical for managing demands of daily living. The current project used an Internet-based virtual reality tool to assess metamemory judgments of PM following TBI. METHOD Eighteen adults with moderate to severe TBI and 20 healthy controls (HCs) played Tying the String, a virtual reality game with PM items embedded across the course of a virtual work week. Participants studied PM items and made two judgments of learning about the likelihood of recognizing the CUE, that is, when the task should be done, and of recalling the TASK, that is, what needed to be done. RESULTS Participants with TBI adjusted their metamemory expectations downward, but not enough to account for poorer recall performance. Absolute difference scores of metamemory accuracy showed that healthy adults were underconfident across PM components, whereas adults with TBI were markedly overconfident about their ability to recall TASKs. CONCLUSIONS Adults with TBI appear to have a general knowledge that PM tasks will be difficult but are poor monitors of actual levels of success. Because metamemory monitoring is linked to strategy use, future work should examine using this link to direct PM intervention approaches.
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Affiliation(s)
- Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, Athens
| | - Mary R T Kennedy
- Communication Sciences and Disorders, Chapman University, Irvine, CA
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25
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FitzGerald MCC, O'Keeffe F, Carton S, Coen RF, Kelly S, Dockree P. Rehabilitation of emergent awareness of errors post traumatic brain injury: A pilot intervention. Neuropsychol Rehabil 2017; 29:821-843. [PMID: 28728461 DOI: 10.1080/09602011.2017.1336102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impaired awareness of errors is common following traumatic brain injury (TBI) and can be a barrier to successful rehabilitation. The objective of this study was to develop and evaluate a computer-based intervention programme aimed at improving error awareness in individuals with TBI. A further aim was to explore its effects on metacognitive awareness and variability of performance. Participants were 11 individuals with TBI and impaired error awareness who performed a sustained attention task twice-weekly for four weeks. The intervention consisted of audio-visual feedback-on-errors during the sustained attention task. Six participants received audio-visual feedback-on-error, five did not receive feedback. Emergent and metacognitive awareness were measured pre- and post-intervention. Between-groups comparisons of emergent awareness from pre- to post-intervention showed that audio-visual feedback-on-error improved emergent awareness compared to no feedback-on-error. Some changes in metacognitive awareness of executive behaviours as a result of feedback were observed. Audio-visual feedback-on-error improved emergent awareness in individuals with TBI following a four-week/eight-session intervention. This improvement was not observed in the no-feedback group. This pilot intervention is not a stand-alone treatment but it has potential to be usefully incorporated into cognitive or clinical rehabilitation programmes to improve emergent awareness.
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Affiliation(s)
- Mary C C FitzGerald
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland.,b Psychology Department , Trinity College Dublin , Dublin , Ireland
| | - Fiadhnait O'Keeffe
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | - Simone Carton
- a Psychology Department , National Rehabilitation Hospital , Dublin , Ireland
| | | | - Simon Kelly
- d School of Electrical and Electronic Engineering , University College Dublin , Dublin , Ireland
| | - Paul Dockree
- b Psychology Department , Trinity College Dublin , Dublin , Ireland
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Lloyd O, Ownsworth T, Fleming J, Zimmer-Gembeck MJ. Development and preliminary validation of the Paediatric Awareness Questionnaire for children and adolescents with traumatic brain injury. Child Neuropsychol 2017; 24:702-722. [DOI: 10.1080/09297049.2017.1332173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Melanie J. Zimmer-Gembeck
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Australia
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Egbert AR. A Framework for Ethical Decision Making in the Rehabilitation of Patients with Anosognosia. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017281057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fitzgerald LM, Arvaneh M, Dockree PM. Domain-specific and domain-general processes underlying metacognitive judgments. Conscious Cogn 2017; 49:264-277. [DOI: 10.1016/j.concog.2017.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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Social Disinhibition: Piloting a New Clinical Measure in Individuals with Traumatic Brain Injury. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Social disinhibition difficulties are common following traumatic brain injury (TBI). However, clinically sensitive tools to objectively assess the difficulties are lacking. This study aimed to pilot a new clinical measure of social disinhibition, the social disinhibition task (SDT). Whether social disinhibition is dependent on the type of social information judgements required and whether disinhibited responses can be adjusted with additional guidance were also examined. Participants were 31 adults (25 Male) with moderate-to-severe TBI and 22 adult (17 Male) healthy control participants. Participants viewed scenes of complex social situations and were asked to describe a character in them (Part A), describe a character while inhibiting inappropriate or negative responses (Part B), and describe a character while not only inhibiting negative responses, but also providing positive responses (Part C). One-half of the items contained a faux pas requiring participants to make inferences about a character's mental state. TBI and control participants responded similarly to Part A, although control participants responded less positively than TBI participants in the faux pas items. TBI participants were significantly impaired on Part B indicating they experienced difficulties in inhibiting automatic responding. TBI participants were however able to adjust their responding in Part C so that they respond similarly to the control participants. Between group differences were not detected in reaction time. Overall, the SDT appears to be suitable to detect social inhibition difficulties in clinical settings and provides a new direction for remediation of the difficulties in individuals with TBI.
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Hendry K, Ownsworth T, Beadle E, Chevignard MP, Fleming J, Griffin J, Shum DHK. Cognitive Deficits Underlying Error Behavior on a Naturalistic Task after Severe Traumatic Brain Injury. Front Behav Neurosci 2016; 10:190. [PMID: 27790099 PMCID: PMC5063844 DOI: 10.3389/fnbeh.2016.00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022] Open
Abstract
People with severe traumatic brain injury (TBI) often make errors on everyday tasks that compromise their safety and independence. Such errors potentially arise from the breakdown or failure of multiple cognitive processes. This study aimed to investigate cognitive deficits underlying error behavior on a home-based version of the Cooking Task (HBCT) following TBI. Participants included 45 adults (9 females, 36 males) with severe TBI aged 18–64 years (M = 37.91, SD = 13.43). Participants were administered the HBCT in their home kitchens, with audiovisual recordings taken to enable scoring of total errors and error subtypes (Omissions, Additions, Estimations, Substitutions, Commentary/Questions, Dangerous Behavior, Goal Achievement). Participants also completed a battery of neuropsychological tests, including the Trail Making Test, Hopkins Verbal Learning Test-Revised, Digit Span, Zoo Map test, Modified Stroop Test, and Hayling Sentence Completion Test. After controlling for cooking experience, greater Omissions and Estimation errors, lack of goal achievement, and longer completion time were significantly associated with poorer attention, memory, and executive functioning. These findings indicate that errors on naturalistic tasks arise from deficits in multiple cognitive domains. Assessment of error behavior in a real life setting provides insight into individuals' functional abilities which can guide rehabilitation planning and lifestyle support.
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Affiliation(s)
- Kathryn Hendry
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Brisbane, QLD, Australia
| | - Elizabeth Beadle
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Brisbane, QLD, Australia
| | - Mathilde P Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Saint Maurice Hospitals, Saint Maurice, Sorbonne Universités, UPMC Université Paris 06, LIB, F-7013 ParisFrance; Groupe de Recherche Clinique Handicap Cognitif et Réadaptation-UPMC Paris 6France
| | - Jennifer Fleming
- Occupational Therapy Department, Princess Alexandra HospitalBrisbane, QLD, Australia; School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, QLD, Australia
| | - Janelle Griffin
- Occupational Therapy Department, Princess Alexandra Hospital Brisbane, QLD, Australia
| | - David H K Shum
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Brisbane, QLD, Australia
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Doig E, Fleming J, Ownsworth T, Fletcher S. An occupation-based, metacognitive approach to assessing error performance and online awareness. Aust Occup Ther J 2016; 64:137-148. [DOI: 10.1111/1440-1630.12322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Emmah Doig
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Jenny Fleming
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
- Occupational Therapy Department; Princess Alexandra Hospital; Brisbane Queensland Australia
- Centre for Functioning and Health Research; Metro South Health District; Queensland Health; Brisbane Queensland Australia
| | - Tamara Ownsworth
- Griffith School of Applied Psychology and Behavioural Basis of Health Program; Griffith Health Institute; Griffith University; Brisbane Queensland Australia
| | - Stephanie Fletcher
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
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Torres IJ, Mackala SA, Kozicky JM, Yatham LN. Metacognitive knowledge and experience in recently diagnosed patients with bipolar disorder. J Clin Exp Neuropsychol 2016; 38:730-44. [PMID: 27144722 DOI: 10.1080/13803395.2016.1161733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Metacognition, which refers to an individual's ability to assess their own cognitive ability or performance, is poorly understood in bipolar disorder. This study was conducted to evaluate two aspects of metacognitive ability in recently diagnosed patients with bipolar disorder: (a) metacognitive knowledge, pertaining to awareness of one's own general cognitive functioning; and (b) metacognitive experience, referring to awareness of one's cognitive performance on a specific, online cognitive task. METHOD Participants consisted of 50 clinically euthymic patients recently diagnosed with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) bipolar I disorder who were within three months of resolution of their first manic episode, and a comparison group of 38 demographically similar healthy volunteers. To assess metacognitive knowledge, participants provided a general rating of their estimated cognitive ability prior to completing a neuropsychological battery, and self-ratings were compared to actual ability based on a composite score of overall cognitive functioning. To assess metacognitive experience, subjects provided a postdiction rating of their perceived memory performance after completing a list learning verbal memory test, and self-ratings were compared to actual memory performance. Measures of both relative and absolute accuracy of ratings were obtained. RESULTS Results indicated that patients showed diminished accuracy in rating their general cognitive ability, implying deficits in metacognitive knowledge. In contrast, patients were accurate in rating their online memory performance, suggesting intact metacognitive experience. CONCLUSIONS Findings suggest that in patients with bipolar disorder, intact task-specific cognitive self-appraisals may fail to generalize to or to modify inaccurate global cognitive self-appraisals. Further research using more comprehensive metacognitive tasks is warranted in bipolar disorder.
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Affiliation(s)
- Ivan J Torres
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.,b BC Psychosis Program: British Columbia Mental Health and Substance Use Services , Vancouver , BC , Canada
| | - Sylvia A Mackala
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Jan-Marie Kozicky
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Lakshmi N Yatham
- a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
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Abstract
PRIMARY OBJECTIVE Impaired self-awareness following a traumatic brain injury (TBI) can reduce the effectiveness of rehabilitation, resulting in poorer outcomes. However, little is understood about how the multi-dimensional aspects of self-awareness may differentially change with recovery and impact outcome. Thus, this study examined four self-awareness variables represented in the Dynamic Comprehensive Model of Awareness: metacognitive awareness, anticipatory awareness, error-monitoring and self-regulation. RESEARCH DESIGN This study evaluated change of the self-awareness measures with recovery from TBI and whether the self-awareness measures predicted community re-integration at follow-up. METHODS AND PROCEDURES Participants were 90 individuals with moderate-to-severe TBI who were tested acutely following injury and 90 age-matched controls. Forty-nine of the TBI participants and 49 controls were re-tested after 6 months. MAIN OUTCOME AND RESULTS Results revealed that the TBI group's error-monitoring performance was significantly poorer than controls at both baseline and follow-up. Regression analyses revealed that the self-awareness variables at follow-up were predictive of community re-integration, with error-monitoring being a unique predictor. CONCLUSIONS The results highlight the importance of error-monitoring and suggest that interventions targeted at improving error-monitoring may be particularly beneficial. Understanding the multi-dimensional nature of self-awareness will further improve rehabilitation efforts and understanding of the theoretical basis of self-awareness.
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Affiliation(s)
- Kayela Robertson
- Department of Psychology, Washington State University , Pullman, WA , USA
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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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Richardson C, McKay A, Ponsford JL. The trajectory of awareness across the first year after traumatic brain injury: The role of biopsychosocial factors. Brain Inj 2014; 28:1711-20. [DOI: 10.3109/02699052.2014.954270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Caldwell SB, Wilson FC, McBrinn J, Carton S, Delargy M, McCann JP, Walsh J, McGuire BE. Self-awareness following acquired brain injury: measurement and relationship to executive functioning. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/03033910.2014.921228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Cognitive dysfunction is the leading cause of disability following traumatic brain injury (TBI). This article provides a review of the cognitive sequelae of TBI, with a focus on deficits of executive functioning and everyday thinking skills. The pathophysiology, assessment, and treatment of TBI-related cognitive problems are also discussed.
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Affiliation(s)
- Amanda R Rabinowitz
- Department of Neurosurgery, University of Pennsylvania School of Medicine, 370 Stemmler Hall, Philadelphia, PA 19104, USA.
| | - Harvey S Levin
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA; and Departments of Psychiatry and Behavioral Sciences, Physical Medicine and Rehabilitation, Pediatrics, and Neurosurgery, Baylor College of Medicine, 6560 Fannin #1144, Houston, TX 77030, USA
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Ham TE, Bonnelle V, Hellyer P, Jilka S, Robertson IH, Leech R, Sharp DJ. The neural basis of impaired self-awareness after traumatic brain injury. ACTA ACUST UNITED AC 2013; 137:586-97. [PMID: 24371217 DOI: 10.1093/brain/awt350] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Self-awareness is commonly impaired after traumatic brain injury. This is an important clinical issue as awareness affects long-term outcome and limits attempts at rehabilitation. It can be investigated by studying how patients respond to their errors and monitor their performance on tasks. As awareness is thought to be an emergent property of network activity, we tested the hypothesis that impaired self-awareness is associated with abnormal brain network function. We investigated a group of subjects with traumatic brain injury (n = 63) split into low and high performance-monitoring groups based on their ability to recognize and correct their own errors. Brain network function was assessed using resting-state and event-related functional magnetic resonance imaging. This allowed us to investigate baseline network function, as well as the evoked response of networks to specific events including errors. The low performance-monitoring group underestimated their disability and showed broad attentional deficits. Neural activity within what has been termed the fronto-parietal control network was abnormal in patients with impaired self-awareness. The dorsal anterior cingulate cortex is a key part of this network that is involved in performance-monitoring. This region showed reduced functional connectivity to the rest of the fronto-parietal control network at 'rest'. In addition, the anterior insulae, which are normally tightly linked to the dorsal anterior cingulate cortex, showed increased activity following errors in the impaired group. Interestingly, the traumatic brain injury patient group with normal performance-monitoring showed abnormally high activation of the right middle frontal gyrus, putamen and caudate in response to errors. The impairment of self-awareness was not explained either by the location of focal brain injury, or the amount of traumatic axonal injury as demonstrated by diffusion tensor imaging. The results suggest that impairments of self-awareness after traumatic brain injury result from breakdown of functional interactions between nodes within the fronto-parietal control network.
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Affiliation(s)
- Timothy E Ham
- 1 C3NL, Centre for Restorative Neuroscience, Division of Brain Sciences, Department of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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FitzGerald MC, Carton S, O'Keeffe F, Coen RF, Dockree PM. Impaired self-awareness following acquired brain injury: current theory, models and anatomical understanding. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/03033910.2012.708898] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
How the brain monitors ongoing behavior for performance errors is a central question of cognitive neuroscience. Diminished awareness of performance errors limits the extent to which humans engage in corrective behavior and has been linked to loss of insight in a number of psychiatric syndromes (e.g., attention deficit hyperactivity disorder, drug addiction). These conditions share alterations in monoamine signaling that may influence the neural mechanisms underlying error processing, but our understanding of the neurochemical drivers of these processes is limited. We conducted a randomized, double-blind, placebo-controlled, cross-over design of the influence of methylphenidate, atomoxetine, and citalopram on error awareness in 27 healthy participants. The error awareness task, a go/no-go response inhibition paradigm, was administered to assess the influence of monoaminergic agents on performance errors during fMRI data acquisition. A single dose of methylphenidate, but not atomoxetine or citalopram, significantly improved the ability of healthy volunteers to consciously detect performance errors. Furthermore, this behavioral effect was associated with a strengthening of activation differences in the dorsal anterior cingulate cortex and inferior parietal lobe during the methylphenidate condition for errors made with versus without awareness. Our results have implications for the understanding of the neurochemical underpinnings of performance monitoring and for the pharmacological treatment of a range of disparate clinical conditions that are marked by poor awareness of errors.
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Electrophysiological markers of cognitive deficits in traumatic brain injury: A review. Int J Psychophysiol 2011; 82:53-60. [DOI: 10.1016/j.ijpsycho.2011.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/22/2010] [Accepted: 01/06/2011] [Indexed: 11/20/2022]
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Donovan NJ, Heaton SC, Kimberg CI, Wen PS, Waid-Ebbs JK, Coster W, Singletary F, Velozo CA. Conceptualizing functional cognition in traumatic brain injury rehabilitation. Brain Inj 2011; 25:348-64. [DOI: 10.3109/02699052.2011.556105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Anderson JW, Schmitter-Edgecombe M. Mild cognitive impairment and feeling-of-knowing in episodic memory. J Clin Exp Neuropsychol 2009; 32:505-14. [DOI: 10.1080/13803390903224944] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hart T, Seignourel PJ, Sherer M. A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury. Neuropsychol Rehabil 2009; 19:161-76. [DOI: 10.1080/09602010802188393] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The objective of this study is to identify the clinical, neuropsychological, neuropsychiatric, and functional variables that correlate with metacognitive self-awareness (SA) in severe traumatic brain injury (TBI) outpatients and to assess the influence of the same variables on the sensory-motor, cognitive, and behavioral-affective indicators of SA. This cross-sectional observational study evaluated 37 outpatients from May 2006 to June 2007 in a neurorehabilitation hospital on the basis of the following inclusion criteria: (1) age 8); (3) posttraumatic amnesia (PTA) resolution; (4) capacity to undergo formal psychometric evaluation despite cognitive and sensory-motor deficits; (5) absence of aphasia; (6) availability of informed consent. A neuropsychological battery was used to evaluate attention, memory, and executive functions. SA was assessed by the awareness questionnaire (AQ), administered to both patients and relatives. Decreased metacognitive self-awareness is significantly correlated with increased problems in some components of executive system, even when the AQ subscales were considered separately. The significant correlation found between some components of executive system and metacognitive self-awareness confirmed the importance of addressing this issue to treat SA contextually in the rehabilitation of executive functions.
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Robertson RH, Knight RG. Evaluation of social problem solving after traumatic brain injury. Neuropsychol Rehabil 2008; 18:236-50. [DOI: 10.1080/09602010701734438] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc 2008; 14:1-22. [PMID: 18078527 DOI: 10.1017/s135561770808017x] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 08/16/2007] [Accepted: 08/16/2007] [Indexed: 01/17/2023]
Abstract
On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion.
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