1
|
Sansonetti D, Fleming J, Patterson F, De Lacy L, Lannin NA. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort. Brain Inj 2024; 38:699-707. [PMID: 38634476 DOI: 10.1080/02699052.2024.2344096] [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: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. OBJECTIVES To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. DESIGN AND METHODS A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. RESULTS Participants were 149 adults (18-70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. CONCLUSION Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.
Collapse
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
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Laura De Lacy
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Salazar-Frías D, Rodríguez-Bailón M, Ricchetti G, Navarro-Egido A, Funes MJ. The Cognitive Awareness Scale for Basic and Instrumental activities of daily living to measure self-awareness after acquired brain injury: Preliminary evidence of its validity. Clin Neuropsychol 2024; 38:1133-1155. [PMID: 37941388 DOI: 10.1080/13854046.2023.2278822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Objective: There is a crucial need for reliable tools to measure impaired self-awareness (ISA) in patients with acquired brain injury (ABI) across cognitive-functional domains. The aim of this study was to assess the psychometric properties of the Cog-Awareness ADL Scale, which is a novel self-proxy discrepancy method for measuring ISA in both basic and instrumental activities of daily living. Methods: This multicenter study included 54 patients (no-low ISA n = 33; severe ISA, n = 21) from four outpatient rehabilitation units in Málaga-Granada, Spain, and 51 healthy controls. The participants and proxy raters completed the Cog-Awareness ADL Scale and the Patient Competency Rating Scale (PCRS). Agreement between both scales was assessed using Spearman's correlations and the Bland-Altman plot. Group comparisons were made on measures of SA, cognitive abilities and demographic variables. Sensitivity and specificity were analysed by ROC curve analysis. Results: Convergent validity was supported by strong correlations with the PCRS and its subscales (rho's ranging from 0.51 to 0.80, p < 0.01 for all). The Bland-Altman plot confirmed measurement agreement (only 3.70% of the scores were outside the 95% limits). External validity was demonstrated by effectively discriminating between healthy controls and ABI patients with no-low and severe ISA on each discrepancy index while controlling for cognitive/demographic variables. The Cog-Awareness ADL Scale showed optimal diagnostic accuracy (AUC = 0.95, sensitivity = 0.90, specificity = 0.90). Conclusions: The Cog-Awareness ADL Scale proved to be a feasible, valid, and clinical tool to assess ISA across different cognitive-functional domains, in Spanish ABI-patients.
Collapse
Affiliation(s)
- Daniel Salazar-Frías
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Rodríguez-Bailón
- Physiotherapy (Occupational Therapy) Department, Health Science School, University of Málaga, Málaga, Spain
| | - Giorgia Ricchetti
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Jesús Funes
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| |
Collapse
|
3
|
Potvin MJ, Tétreault G, Audy J, Roy SJ, Rouleau I. Factors Influencing Objective and Subjective Prospective Memory Measures in Traumatic Brain Injury. Arch Clin Neuropsychol 2024:acae048. [PMID: 38915139 DOI: 10.1093/arclin/acae048] [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: 07/06/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE To accurately assess prospective memory (PM) functioning in patients who sustained a traumatic brain injury (TBI), it is important to use both subjective (questionnaires) and objective (tests) measures. However, which factors have the most significant effect on each PM measure remains unknown. This observational study aims to verify whether TBI severity or psychological status has the most influence on patients' objective and subjective PM measures. METHOD Fifteen healthy control (HC) participants (n = 15), 19 patients with a mild TBI (n = 19) and 30 patients with a moderate-to-severe TBI (n = 30) were recruited during the post-acute phase. For almost every participant, a relative was also recruited (n = 62). The Test écologique de mémoire prospective (TEMP), an objective computerized PM measure consisting of naturalistic stimuli, was administered to all participants along with anxiety (BAI) and depression inventories (BDI). Participants and their relatives also completed a questionnaire, the comprehensive assessment of PM (CAPM), a subjective PM measure assessing everyday failures. RESULTS Results on the objective PM measure were predicted by TBI severity, while psychological symptoms (BAI and BDI) predicted scores on the subjective PM measure. In addition, relatives in the moderate-to-severe TBI group reported more PM failures on the subjective measure and their perception was significantly correlated with results on the objective PM measure, which was not the case for the other two groups of relatives. CONCLUSIONS Objective PM measures are related to TBI severity and appear more robust against the influence of psychological factors than subjective PM measures.
Collapse
Affiliation(s)
- Marie-Julie Potvin
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
- Traumatology Program, Montreal Sacré-Coeur Hospital, CIUSSS Nord-de-l'île-de-Montréal, 5400 Boulevard Gouin West, Montreal, Quebec, H4J 1C5, Canada
| | - Gabrielle Tétreault
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Julie Audy
- Regional Geriatric Ambulatory Program, CISSS de Laval, 1515 Chomedey Boulevard, Laval, Quebec, H7V 3Y7, Canada
| | - Sarah-Jade Roy
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| |
Collapse
|
4
|
Rodríguez G, Azariah A, Ritter AM, Esquenazi Y, Sherer M, Boake C, Fernandez VL, Garcia-Garcia R. Generalized anosognosia, anosodiaphoria, and visual hallucinations with bilateral enucleation after severe bifrontal brain injury: a case report describing similarities with and differences from Anton syndrome. Neurol Sci 2024; 45:2769-2774. [PMID: 38214846 DOI: 10.1007/s10072-024-07323-z] [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: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
Visual anosognosia, associated with confabulations and cortical blindness in the context of occipital lobe injury, is known as Anton syndrome. Patients with this syndrome strongly deny their vision loss and confabulate to compensate for both visual loss and memory impairments. In this article, we present a case of a patient with some similarities to Anton syndrome, however, with several differences in clinical presentation. Bifrontal brain injury, bilateral enucleation, affective indifference (anosodiaphoria), generalized anosognosia, and the conviction that vision will resume mark clear clinical differences with Anton syndrome. Differentiating these findings from Anton syndrome will help occupational therapists, neuropsychologists, speech-language pathologists, physical therapists, and physicians when assessing frontal lobe brain injury with total and partial visual loss. This case demonstrates that visual anosognosia and confabulations can occur without occipital lobe dysfunction or cortical blindness.
Collapse
Affiliation(s)
- Gabriel Rodríguez
- Stroke, Brain Injury & Disorder of Consciousness Programs, TIRR Memorial Hermann Texas Medical Center, Houston, TX, USA.
- Department of Physical Medicine & Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Abana Azariah
- Disorder of Consciousness Program, TIRR Memorial Hermann Texas Medical Center, Houston, TX, USA
- Brain Injury and Stroke Program, TIRR Memorial Hermann Texas Medical Center, Houston, TX, USA
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, Houston, TX, USA
| | | | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School, Houston, TX, USA
| | - Mark Sherer
- TIRR Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Corwin Boake
- TIRR Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Valentina Ladera Fernandez
- Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Universidad de Salamanca, Salamanca, Spain
| | - Ricardo Garcia-Garcia
- Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
5
|
de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:311-338. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
Collapse
Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
Collapse
Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
8
|
Troeung L, Sarunga Raja TL, Mann G, Wagland J, MacLeod C, Martini A. IMproving psYchosocial adjustment to Traumatic Brain Injury from acute to chronic injury through development and evaluation of the myTBI online psychoeducation platform: protocol for a mixed-methods study. BMJ Open 2024; 14:e080030. [PMID: 38508623 PMCID: PMC10953309 DOI: 10.1136/bmjopen-2023-080030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION This protocol describes the myTBI study which aims to: (1) develop an online psychoeducation platform for people with traumatic brain injury (TBI), their family members/caregivers, and healthcare staff to improve psychosocial adjustment to TBI across different phases of injury (acute, postacute, and chronic), and (2) undertake an evaluation of efficacy, acceptability, and feasibility. METHODS AND ANALYSIS A three-stage mixed-methods research design will be used. The study will be undertaken across four postacute community-based neurorehabilitation and disability support services in Western Australia. Stage 1 (interviews and surveys) will use consumer-driven qualitative methodology to: (1) understand the recovery experiences and psychosocial challenges of people with TBI over key stages (acute, postacute, and chronic), and (2) identify required areas of psychosocial support to inform the psychoeducation platform development. Stage 2 (development) will use a Delphi expert consensus method to: (1) determine the final psychoeducation modules, and (2) perform acceptance testing of the myTBI platform. Finally, stage 3 (evaluation) will be a randomised stepped-wedge trial to evaluate efficacy, acceptability, and feasibility. Outcomes will be measured at baseline, postintervention, follow-up, and at final discharge from services. Change in outcomes will be analysed using multilevel mixed-effects modelling. Follow-up surveys will be conducted to evaluate acceptability and feasibility. ETHICS AND DISSEMINATION Ethics approval was granted by North Metropolitan Health Service Mental Health Research Ethics and Governance Office (RGS0000005877). Study findings will be relevant to clinicians, researchers, and organisations who are seeking a cost-effective solution to deliver ongoing psychoeducation and support to individuals with TBI across the recovery journey. TRIAL REGISTRATION NUMBER ACTRN12623000990628.
Collapse
Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Thilaga L Sarunga Raja
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- Oats Street Rehabilitation Centre, Brightwater Care Group, East Victoria Park, Western Australia, Australia
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Colin MacLeod
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
9
|
Prigatano GP, Russell S, Meites TM. Studying lack of awareness of cognitive decline in neurodegenerative diseases requires measures of both anosognosia and denial. Front Aging Neurosci 2024; 15:1325231. [PMID: 38259640 PMCID: PMC10800930 DOI: 10.3389/fnagi.2023.1325231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
The cause(s) of lack of awareness of cognitive decline in neurodegenerative diseases can be multifactorial. Yet neurologically oriented research on anosognosia of cognitive decline almost exclusively assumes that the underlying disturbance of neuro-networks that support various cognitive functions accounts for the reduced self-awareness. Cultural and psychosocial factors, including the person's emotional state, however, can contribute to the underreporting or avoidance of admitting to cognitive impairments in neurodegenerative diseases. Research on the causes of lack of awareness of cognitive decline in neurodegenerative disorders needs to include these variables. We briefly present two case examples of underreporting or "unawareness" of memory difficulties in persons with mild cognitive impairment (MCI) (or minor neurocognitive disorder). One presented with classic anosognosia for memory impairment, while the other initially reported no memory impairment but later admitted to "denying" her memory difficulties secondary to anxiety. Based on these patients' clinical presentations and available research, we suggest three potential screening items that may help identify probable denial of memory impairments when studying anosognosia in MCI.
Collapse
Affiliation(s)
- George P. Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | | | | |
Collapse
|
10
|
Cheng WY, Klonoff PS, Perumparaichallai RK. Components of self-awareness affecting caregiver burden: a long-term follow-up study. Brain Inj 2024; 38:26-31. [PMID: 38258808 DOI: 10.1080/02699052.2024.2304883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. METHODS We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). RESULTS Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 = .33) for caregiver burden. CONCLUSIONS Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden.
Collapse
Affiliation(s)
- Wen-Yu Cheng
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Pamela S Klonoff
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | |
Collapse
|
11
|
Sansonetti D, Fleming J, Patterson F, Lannin NA. Profiling self-awareness in brain injury rehabilitation: A mixed methods study. Neuropsychol Rehabil 2023:1-26. [PMID: 38043114 DOI: 10.1080/09602011.2023.2282656] [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: 07/11/2023] [Accepted: 10/28/2023] [Indexed: 12/05/2023]
Abstract
ABSTRACTImpaired self-awareness impacts outcomes for individuals with brain injury. Self-awareness is a complex construct, with little known about how its presentation differs across diagnostic groups, or how brain injury-related changes are expressed by individuals in the early phase post-brain injury. This study aims to identify differences and similarities in patterns of self-awareness between patients with different brain injury diagnoses, and provide a clinical account of how individuals with ABI describe changes to themselves arising from brain injury. This is a mixed methods retrospective cohort study involving an audit of medical files that included extraction of data from the Self-Awareness of Deficits Interview. Quantitative and qualitative techniques were used to analyse data from 173 participants. Individuals identified a range of brain injury-related impairments across domains, with greatest difficulty noted with linking impairments to functional implications and setting realistic goals. There were similarities and distinct differences in the expression of changes across diagnostic groups. Two main themes that aligned with self-awareness theory were identified from the data: 1/ Development of self-awareness; and 2/ Dimensions of self-awareness. These interrelated themes demonstrated the multifaceted nature of the clinical presentation of self-awareness, and highlight the need for an individualized approach to cognitive rehabilitation.
Collapse
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
| |
Collapse
|
12
|
Henning A, Linden M, Muschalla B. Self- and observer ratings of capacity limitations in patients with neurological conditions. BRAIN IMPAIR 2023; 24:586-600. [PMID: 38167355 DOI: 10.1017/brimp.2022.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the self- and observer ratings of capacity limitations in patients with neurological conditions. Research on this topic is relevant for assessing the patients' ability to participate in work and social life and improving collaborative patient-clinician relationships. METHOD The self- and observer ratings of capacity limitations in a sample of N = 245 patients with neurological conditions from a rehabilitation facility were compared and assessed using the short rating of activity limitations and participation restrictions in mental disorders according to the International Classification of Functioning, Disability and Health (Mini-ICF-APP) and the equivalent self-rating questionnaire (Mini-ICF-APP-S). RESULTS Paired-samples t-tests revealed significant differences between the self- and observer ratings for six out of 13 capacity dimensions. On average, the patients rated the capacity dimensions adherence to regulations, planning and structuring of tasks, professional competency and endurance as significantly less limited, in comparison to the observers (small to medium effect sizes). The self-ratings for limitation of contact with others and self-care were only marginally higher than the observer ratings. CONCLUSIONS The findings show that psychological capacity limitations occur in patients with neurological conditions. In clinical practice, limitations in each capacity dimension and discrepancies in patient- and clinician-ratings should be thoroughly assessed. This is especially relevant in patients with neurological conditions who have a potential tendency to underestimate or deny their disability.
Collapse
Affiliation(s)
- Anne Henning
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
- Brandenburgklinik Berlin-Brandenburg, Bernau bei Berlin, Germany
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Muschalla
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany
- Brandenburgklinik Berlin-Brandenburg, Bernau bei Berlin, Germany
| |
Collapse
|
13
|
Cheng A, Tsow R, Schmidt J. Understanding the Barriers of Implementing a Self-Awareness Assessment in Occupational Therapy Practice within a Brain Injury Population: An Exploratory Study. Occup Ther Int 2023; 2023:3933995. [PMID: 37265857 PMCID: PMC10232193 DOI: 10.1155/2023/3933995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Background Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. Aims (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. Materials and Methods A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. Results 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Conclusion Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.
Collapse
Affiliation(s)
- Anika Cheng
- Graduate Program in Occupational Therapy, University of British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
| | - Rebecca Tsow
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
| |
Collapse
|
14
|
Psychosocial functioning mediates change in motor and cognitive function throughout neurorehabilitation for adults with acquired brain injury (ABI-RESTaRT). Neurol Sci 2023:10.1007/s10072-023-06645-8. [PMID: 36780031 DOI: 10.1007/s10072-023-06645-8] [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: 10/10/2022] [Accepted: 01/24/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the mediational role of change in psychosocial abilities, adjustment and participation on change in motor and cognitive function from admission to discharge from a staged community-based brain injury rehabilitation (SCBIR) service in Western Australia, 2011-2020. METHODS A retrospective cohort study of n = 324 adults with ABI enrolled in SCBIR using routinely collected rehabilitation outcome measures data. Motor and cognitive function were assessed with the UK Functional Independence and Assessment Measure and psychosocial function with the Mayo-Portland Adaptability Inventory-4. Six multilevel mediation regression analyses were conducted to determine whether change in psychosocial function (abilities, adjustment and participation) mediated change in motor and cognitive function from admission to discharge. RESULTS Participants demonstrated clinically significant improvements in both motor (+ 11.8, p < 0.001) and cognitive (+ 9.5, p < 0.001) functioning from admission to discharge. Statistically significant improvements in psychosocial abilities (- 4.8, p < 0.001), adjustment (- 2.9, p = 0.001) and participation (- 2.5, p < 0.001) were also seen but were not clinically significant. Mediation analyses showed that participation accounted for 81% of improvements in motor function at discharge and 71% of cognitive function improvements. Adjustment accounted for 26% and 32% of change in motor and cognitive function, respectively. Abilities accounted for 60% of change in cognitive function but did not significantly influence change in motor function. Changes in psychosocial participation fully mediated change in motor function during neurorehabilitation. CONCLUSIONS Psychosocial function, particularly participation, is an important driver of motor and cognitive recovery throughout neurorehabilitation. Functional rehabilitation programs should target psychosocial improvement as an important mechanism of change.
Collapse
|
15
|
Davies E, Steel L. The psychological responses of British amateur point-to-point jockeys to personal injury. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Previous research has reported significant psychological consequences of injury on rehabilitation success, performance, and wellbeing in athletes, although little is known within horse-based sports. There is a high prevalence of injury reported in point-to-point (P2P) jockeys, but despite this, comparatively little research exists examining the psychological implications resulting from physical trauma within horseracing. The aim of this study was to investigate the psychological responses to personal injury in British amateur P2P jockeys. Five amateur P2P jockeys (two male, three female, x- age 25 years old) were interviewed about their experiences post an injury sustained during racing in the preceding 12 months. Interview questions explored their pre-injury career, the rehabilitation phase, pre-return to racing phase issues and coping strategies used by jockeys. Thematic analysis revealed three higher order themes: emotional responses, coping strategies, and factors affecting recovery. Subjects universally cited negative emotional responses following injury, including grief, a sense of loss, and frustration, and all experienced denial at the onset of injury. Typical coping strategies included strong support networks of family, friends and racing staff, and goal setting. Fear of reinjury was identified by all athletes, particularly on return to the saddle, and the attitudes towards injury management, such as denial, seen in this study may provide opportunities to develop targeted education campaigns for P2P jockeys on injury services. Targeted marketing for P2P jockeys on available injury support is recommended, such as seen for professional jockeys, as well as the creation of career development resources to offer alternative routes for P2P jockeys following injury.
Collapse
Affiliation(s)
- E. Davies
- Hartpury University, Hartpury House, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| | - L. Steel
- Hartpury University, Hartpury House, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| |
Collapse
|
16
|
Smith BG, Tumpa S, Mantle O, Whiffin CJ, Mee H, Solla DJF, Paiva WS, Newcombe VF, Kolias AG, Hutchinson PJ. Remote Follow-Up Technologies in Traumatic Brain Injury: A Scoping Review. J Neurotrauma 2022; 39:1289-1317. [PMID: 35730115 PMCID: PMC9529313 DOI: 10.1089/neu.2022.0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Motivations for outcome data collection in TBI are threefold: to improve patient outcomes, to facilitate research, and to provide the means and methods for wider injury surveillance. Such data play a pivotal role in population health, and ways to increase the reliability of data collection following TBI should be pursued. As a result, technology-aided follow-up of patients with neurotrauma is on the rise; there is, therefore, a need to describe how such technologies have been used. A scoping review was conducted and reported using the PRISMA extension (PRISMA-ScR). Five electronic databases (Embase, MEDLINE, Global Health, PsycInfo, and Scopus) were searched systematically using keywords derived from the concepts of "telemedicine," "TBI," "outcome assessment," and "patient-generated health data." Forty studies described follow-up technologies (FUTs) utilizing telephones (52.5%, n = 21), short message service (SMS; 10%, n = 4), smartphones (22.5%, n = 9), videoconferencing (10%, n = 4), digital assistants (2.5%, n = 1), and custom devices (2.5%, n = 1) among cohorts of patients with TBI of varying injury severity. Where reported, clinical facilitators, remote follow-up timing and intervals between sessions, synchronicity of follow-up instances, proxy involvement, outcome measures utilized, and technology evaluation efforts are described. FUTs can aid more temporally sensitive assessments and capture fluctuating sequelae, a benefit of particular relevance to TBI cohorts. However, the evidence base surrounding FUTs remains in its infancy, particularly with respect to large samples, low- and middle-income patient cohorts, and the validation of outcome measures for deployment via such remote technology.
Collapse
Affiliation(s)
- Brandon G. Smith
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Stasa Tumpa
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Orla Mantle
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Charlotte J. Whiffin
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Harry Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- Division of Rehabilitation Medicine, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Davi J. Fontoura Solla
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Wellingson S. Paiva
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
17
|
Alderman N, Williams C, Wood RL. Using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) to determine prevalence and predictors of neurobehavioural disability amongst survivors with traumatic brain injury in the community. Neuropsychol Rehabil 2022; 32:2342-2369. [PMID: 34180770 DOI: 10.1080/09602011.2021.1946092] [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: 12/27/2022]
Abstract
Studies using the St Andrew's - Swansea Neurobehavioural Outcome Scale (SASNOS) confirm neurobehavioural disability (NBD) is highly prevalent in inpatient Neurobehavioural Rehabilitation and Stroke samples. However, a recent study amongst a Danish community sample of acquired brain injury survivors found a relative paucity of NBD symptoms; and when symptoms were present, they tended to be of mild severity. The current observational study employed the SASNOS to explore prevalence of NBD in survivors with traumatic brain injury (TBI) living in the community, the extent of survivors' self-awareness of NBD symptoms, and constructed prediction models of NBD. A de-identified data set was compiled, comprising data for 97 TBI survivors (74.2% men, mean time since injury 2.8 years). In addition to SASNOS self- and proxy-ratings, various demographic, clinical and injury-related characteristics were captured. NBD was found to be highly characteristic, although severity varied depending on subtype. Statistical comparison of self- and proxy-ratings did not support reduced self awareness regarding NBD, whereas treating the problem as one of inter-rater reliability suggested this was an issue. Executive impairment, depressed mood and sex were especially prognostic of NBD. Reasons accounting for differences in NBD between the community samples are discussed and recommendations for future research made.
Collapse
Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
| | - Claire Williams
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, UK.,Department of Psychology, Swansea University, Swansea, UK
| | | |
Collapse
|
18
|
Mamman R, Cheng A, Tsow R, Schmidt J. Clinician reports of self-awareness after traumatic brain injury: a retrospective chart review. BMC Health Serv Res 2022; 22:1124. [PMID: 36068541 PMCID: PMC9450399 DOI: 10.1186/s12913-022-08444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired self-awareness (i.e., a lack of insight) is experienced by most individuals who have sustained a moderate to severe traumatic brain injury (TBI). During the early recovery period post-injury, these individuals may not be able to recognize their abilities and limitations, hence, negatively impacting their daily life and function. Although there are assessments and interventions to improve self-awareness after TBI, little is known about how clinicians assess and address this impairment in an inpatient rehabilitation setting. OBJECTIVE To examine how clinicians assess, report, and provide interventions for impaired self-awareness after TBI. METHODS A retrospective chart review was conducted on interdisciplinary rehabilitation clinician entries for individuals with TBI (n = 67) who received inpatient rehabilitation within a five-year period (2014-2019). A reflexive thematic analysis was used to identify themes pertaining to self-awareness. RESULTS Three themes were generated to explore clinician responses to their clients' impaired self-awareness: 1) 'recalling and understanding' described clinician observations of client behaviors and expressions of self-awareness, 2) 'applying and analyzing' identified clinicians providing relevant tasks and advice to clients, and 3) 'evaluating and creating' described clinicians actively interacting with clients by providing feedback, guided prompts, and a follow-up plan. CONCLUSION Clinicians produced varied responses to clients' impaired self-awareness after TBI. Findings may help to develop research priorities and integrated knowledge translation initiatives to increase evidence-based practice for impaired self-awareness after TBI.
Collapse
Affiliation(s)
- Rinni Mamman
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada
| | - Anika Cheng
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Graduate Program in Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Rebecca Tsow
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Julia Schmidt
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada. .,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
19
|
Looking Ahead: Traumatic Brain Injury, Ethics, and Discharge Planning. J Head Trauma Rehabil 2021; 37:125-129. [PMID: 34698681 DOI: 10.1097/htr.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Prigatano GP, Braga LW, Johnson SF, Souza LMN. Neuropsychological rehabilitation, neuroimaging and neuroplasticity: A clinical commentary. NeuroRehabilitation 2021; 49:255-265. [PMID: 34397433 PMCID: PMC8543255 DOI: 10.3233/nre-218024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Initial brain imaging studies on recovery of motor functioning after stroke suggested their potential prognostic value in neurorehabilitation. However, the value of brain imaging in documenting brain changes associated with cognitive and behavioral treatment effects seem less likely. Also, neuroimaging studies at that time seem to have little, if any, value for treatment planning. Advances in neuroimaging technology are beginning to challenge these initial impressions. In this clinical commentary, we propose that advances in the field of neuroimaging have relevance for the future development of neuropsychological rehabilitation. Neuropsychological rehabilitation is entering a new era that involves collaboration with neuroimaging and associated studies on neuroplasticity. We recognize that this may seem “aspirational” rather than practical in most rehabilitation settings. However, we provide examples of how this can be achieved as illustrated by collaborative efforts of clinicians and scientists in the SARAH Network of Rehabilitation Hospitals in Brazil. We also review selective papers on neuroplasticity, spontaneous recovery and diaschisis that have relevance for research which will expand and further develop the field of neuropsychological rehabilitation.
Collapse
Affiliation(s)
- George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lucia W Braga
- SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Spring Flores Johnson
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | |
Collapse
|
21
|
Lenzoni S, Baker J, Sumich AL, Mograbi DC. New insights into neural networks of error monitoring and clinical implications: a systematic review of ERP studies in neurological diseases. Rev Neurosci 2021; 33:161-179. [PMID: 34214387 DOI: 10.1515/revneuro-2021-0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/28/2021] [Indexed: 11/15/2022]
Abstract
Error monitoring allows for the efficient performance of goal-directed behaviors and successful learning. Furthermore, error monitoring as a metacognitive ability may play a crucial role for neuropsychological interventions, such as rehabilitation. In the past decades, research has suggested two electrophysiological markers for error monitoring: the error-related negativity (ERN) and the error positivity (Pe), thought to reflect, respectively, error detection and error awareness. Studies on several neurological diseases have investigated the alteration of the ERN and the Pe, but these findings have not been summarized. Accordingly, a systematic review was conducted to understand what neurological conditions present alterations of error monitoring event-related potentials and their relation with clinical measures. Overall, ERN tended to be reduced in most neurological conditions while results related to Pe integrity are less clear. ERN and Pe were found to be associated with several measures of clinical severity. Additionally, we explored the contribution of different brain structures to neural networks underlying error monitoring, further elaborating on the domain-specificity of error processing and clinical implications of findings. In conclusion, electrophysiological signatures of error monitoring could be reliable measures of neurological dysfunction and a robust tool in neuropsychological rehabilitation.
Collapse
Affiliation(s)
- Sabrina Lenzoni
- Department of Psychology, Pontifical University of Rio de Janeiro, 22451-900, Rio de Janeiro, Brazil.,Department of Psychology, Nottingham Trent University, NG1 4FQ, Nottingham, UK
| | - Joshua Baker
- Department of Psychology, Nottingham Trent University, NG1 4FQ, Nottingham, UK.,Institute for Systems Neuroscience, University Hospital Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Alexander L Sumich
- Department of Psychology, Nottingham Trent University, NG1 4FQ, Nottingham, UK.,Department of Psychology, Auckland University of Technology, 1010, Auckland, New Zealand
| | - Daniel C Mograbi
- Department of Psychology, Pontifical University of Rio de Janeiro, 22451-900, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, London, UK
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Prigatano GP, McKnight C, Andrews M, Caplan J. Maladaptive Denial of Severe Pain and Acute Orthopedic Injuries in a Patient With a Schizoaffective Disorder. Front Psychol 2020; 11:574673. [PMID: 33117241 PMCID: PMC7561358 DOI: 10.3389/fpsyg.2020.574673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022] Open
Abstract
Persistent denial of severe and acute pain following orthopedic injuries has not been previously reported. We present a case of a 24-year-old woman with a history of schizoaffective disorder who suffered severe pain secondary to acute orthopedic injuries who insisted, “I am fine! There is nothing wrong with me.” Her maladaptive denial resulted in an initial refusal of necessary medical/surgical care, but she eventually accepted the necessary treatments despite her persistent belief she did not need such care. Her verbalizations and behaviors were characterized by active avoidance and angry reactions when a consulting psychiatrist spoke to her regarding her clinical condition. A modified version of the Conscious Avoidance subscale of the Denial of Illness Questionnaire was useful in measuring the severity level of her denial. This case report suggests that the behavioral features of psychological denial appear different from those associated impaired self-awareness secondary to an underlying brain disorder.
Collapse
Affiliation(s)
- George P. Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
- *Correspondence: George P. Prigatano,
| | - Curtis McKnight
- Department of Psychiatry, Creighton School of Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Megan Andrews
- Department of Internal Medicine, School of Medicine, Creighton University, Omaha, NE, United States
| | - Jason Caplan
- Department of Psychiatry, Creighton School of Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| |
Collapse
|