Occupational therapists' experiences of rehabilitation of patients with limited awareness after stroke

A systematic literature review of the impact of impaired self-awareness on the process of rehabilitation in acquired brain injury

BACKGROUND

Impaired self-awareness (ISA) is common in individuals with an acquired brain injury (ABI) and can lead to reduced awareness of one's difficulties. Previous reviews have found that ISA impacts on functional outcomes in rehabilitation. However, to date there has not been a systematic literature review which examines how ISA impacts on the process of rehabilitation in ABI populations.

METHOD

A literature search was conducted using several databases in May 2024, including Academic Search Premier, CINAHL, MEDLINE, APA PsycARTICLES and APA PsycINFO. Seventeen articles were selected for the review and were analyzed using Narrative Synthesis.

RESULTS

Four themes arose from the findings, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. ISA was found to impact on the value adult ABI participants placed in rehabilitation, which decreased treatment compliance, motivation, and engagement. ISA also impacted on goal setting and behavior and resulted in a longer length of time spent in hospital.

CONCLUSION

This review emphasizes the impact of ISA on various aspects/processes of rehabilitation in ABI and provides considerations of how clinicians might adapt interventions to manage these difficulties.

Analysis of coping capacities and cognitive biases of novice drivers-A questionnaire-based study

Coping capacity is a key aspect of driver-vehicle interaction when drivers observe and make decisions, and is of great importance for drivers. However, different drivers have different self-cognition and assess their driving abilities differently, especially for novice drivers. Based on questionnaire data, this study has investigated the coping capacities of drivers in both static environments and dynamic environments. With the ANOVA analysis method and the structural equation model (SEM), this study has verified the effects of gender and driving factors (driving years, driving frequency, driving time) on drivers' coping capacities based on drivers' self-assessment scores and mutual assessment scores. Drivers' self-assessment scores show significant effects of all factors on drivers' coping capacities, and drivers' mutual assessment scores show significant effects of all factors, excluding driving time, on drivers' coping capacities. Also, it has been found that all drivers in the driving year group have cognitive biases. It seems that first-year drivers are always overconfident with their driving skills, while drivers with a driving experience of more than three years usually score driving skills of themselves and other drivers most conservatively. With increased exposure to various traffic conditions, experienced drivers are more aware of their limitations in dealing with complex traffic situations, while novice drivers do not know their lack of capability to properly respond to any unexpected situation they could encounter.

Changes in older drivers' self-awareness of driving ability over one year

Older drivers' self-awareness of driving ability can prompt self-regulatory behaviors and modifications of their everyday driving performance. To date, studies have yet to examine how older drivers' self-awareness of changes in driving ability over time or identify the characteristics of those who can accurately monitor such changes. 64 older drivers (Age: Mean = 80.0 years, SD = 5.4; male: 70 %) were recruited and categorized into four groups based on the correspondence of changes in their perceived and actual driving ability over one year: 40 % of the participants were accurate in their stable or better driving ability over time, 30 % did not detect their driving performance had worsened and over-estimated their driving ability, and the remainder either accurately detected their performance had worsened or under-estimated their driving performance. No demographic or clinical factors were associated with older drivers' self-awareness of changes in driving ability over time, except the mental processing and executive functioning measured using the Trail Making Tests Part B, showed a marginal effect. Implications for clinical importance are discussed.

Personal and Clinical Factors Associated with Older Drivers' Self-Awareness of Driving Performance

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers' self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.