Research Reports - Changes in impaired self-awareness after acquired brain injury in patients following intensive neuropsychological rehabilitation

Neuropsychol Rehabil. 2017 Jan;27(1):116-132. Epub 2015 Aug 18.

Smeets SM(1), Vink M(2), Ponds RW(1,)(3), Winkens I(1), van Heugten CM(1,)(4).

The objective of this study was to investigate changes in self-awareness
impairments in outpatients with acquired brain injury (ABI) and the effects these
changes have on rehabilitation. Participants were 78 patients with ABI (8.3 years
post-injury) who followed an intensive outpatient neuropsychological
rehabilitation programme. This longitudinal study comprised pre (T1) and post
(T2) measurements and a one-year follow-up (T3). Thirty-eight patients completed
the study. The main outcome domains were self-awareness, depressive symptoms,
psychological and physical dysfunction, and health-related quality of life
(HRQoL). Patients were divided into three awareness groups: underestimation,
accurate estimation, and overestimation of competencies. Most patients who
underestimated their competencies at the start of treatment accurately estimated
their competencies directly after treatment (9 out of 11 patients). These
patients also exhibited the largest treatment effects regarding depressive
symptoms, psychological and physical dysfunction, and HRQoL. Most patients with
impaired self-awareness (i.e., overestimation of competencies) at the start of
treatment continued to overestimate their competencies after treatment (10 out of
14 patients). These patients exhibited a significant decrease in depressive
symptoms but no other treatment effects. The results indicate that changes in
outcome are related to changes in awareness, which underline the importance of
taking into account different awareness groups with respect to treatment effects. 

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