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The measurement and magnitude of awareness difficulties after traumatic brain injury: A longitudinal study

Published online by Cambridge University Press:  18 May 2007

KATHLEEN FARRELL PAGULAYAN ,
NANCY R. TEMKIN ,
JOAN E. MACHAMER  and
SUREYYA S. DIKMEN
KATHLEEN FARRELL PAGULAYAN
Affiliation:
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
NANCY R. TEMKIN
Affiliation:
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington Department of Neurological Surgery, University of Washington, Seattle, Washington Department of Biostatistics, University of Washington, Seattle, Washington
JOAN E. MACHAMER
Affiliation:
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
SUREYYA S. DIKMEN
Affiliation:
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington Department of Neurological Surgery, University of Washington, Seattle, Washington
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Abstract

Previous research suggests that reduced self-awareness is common following traumatic brain injury (TBI). However, few studies have examined the magnitude of this problem in a sample representative of hospitalized individuals. In this longitudinal study, individuals with complicated mild to severe TBIs and their significant others (SO) were evaluated at 1 and 12 months postinjury on the Sickness Impact Profile. Awareness was measured by comparing the level of injury-related problems reported by a person with TBI and their SO. Overall, individuals with TBI did not report fewer difficulties than their SO. In contrast, they frequently reported more injury-related difficulties than their SO. As there is no commonly or universally accepted definition for differential awareness, the magnitude of underreporting and overreporting problems is presented using four different cutoff scores. A minimum discrepancy is proposed for defining awareness difficulties that is based on the standard error of measurement of the test–retest difference of the measure. Reduced self-awareness was inconsistent across both time and functional domains. These results suggest that reduced self-awareness is not the norm at 1 or 12 months postinjury and highlight the need for a more standardized approach to the measurement and classification of self-awareness. (JINS, 2007, 13, 561–570.)

Keywords

Impaired self-awarenessSickness Impact ProfilePsychosocial symptomsMeasurementHead injuryConcordance

Information

Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 4 , July 2007 , pp. 561 - 570
Copyright
© 2007 The International Neuropsychological Society

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References

REFERENCES

Allen, C.C. & Ruff, R.M. (1990). Self-rating versus neuropsychological performance of moderate versus severe head injured patients. Brain Injury, 4, 7–17.Google Scholar
Amador, X.F., Flaum, M., Andreason, N.C., Strauss, D.H., Yale, S.A., Clark, S.C., & Gorman, J.M. (1994). Awareness of illness in schizophrenia and schizo-affective and mood disorders. Archives of General Psychiatry, 51, 826–836.Google Scholar
Anderson, S.W. & Tranel, D. (1989). Awareness of disease states following cerebral infarction, dementia, and head trauma: Standardized assessment. Clinical Neuropsychologist, 3, 327–339.Google Scholar
Bergner, M., Bobbitt, R.A., Pollard, W.E., Martin, D.P., & Gilson, B.S. (1976). The Sickness Impact Profile: Validation of a health status measure. Medical Care, 14, 57–67.Google Scholar
Boake, C., Freeland, J.C., Ringholz, G.M., Nance, M.L., & Edwards, K.E. (1995). Awareness of memory loss after severe closed head injury. Brain Injury, 9, 273–283.Google Scholar
Bogod, N.M., Mateer, C.A., & MacDonald, S.W.S. (2003). Self-awareness after traumatic brain injury: A comparison of measures and their relationship to executive functions. Journal of the International Neuropsychological Society, 9, 450–458.Google Scholar
Cavallo, M.M., Kay, T., & Ezrachi, O. (1992). Problems and changes after traumatic brain injury: Differing perceptions within and between families. Brain Injury, 6, 327–335.Google Scholar
Clare, L. (2004). Awareness in early-stage Alzheimer's disease: A review of methods and evidence. British Journal of Clinical Psychology, 43, 177–196.Google Scholar
Dikmen, S.S., Machamer, J., Miller, B., Doctor, J., & Temkin, N.R. (2001). Functional status examination: A new instrument for assessing outcome in traumatic brain injury. Journal of Neurotrauma, 18, 127–140.Google Scholar
Dikmen, S.S., Machamer, J., Winn, H.R., Anderson, G.D., & Temkin, N.R. (2000). Neuropsychological effects of valproate in traumatic brain injury: A randomized trial. Neurology, 54, 895–902.Google Scholar
Ezrachi, O., Ben-Yishay, Y., Kay, T., Diller, L., & Rattok, J. (1991). Predicting employment in traumatic brain injury following neuropsychological rehabilitation. Journal of Head Trauma Rehabilitation, 6, 71–84.Google Scholar
Fischer, S., Trexler, L.E., & Gauggel, S. (2004). Awareness of activity limitations and prediction of performance in patients with brain injuries and orthopedic disorders. Journal of the International Neuropsychological Society, 10, 190–199.Google Scholar
Fleming, J., Strong, J., & Ashton, R. (1996). Self-awareness of deficits in adults with traumatic brain injury: How best to measure? Brain Injury, 10, 1–15.Google Scholar
Fleming, J., Strong, J., & Ashton, R. (1998). Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome. Journal of Head Trauma Rehabilitation, 13, 39–51.Google Scholar
Hart, T., Giovannetti, T., Montgomery, M.W., & Schwartz, M.F. (1998). Awareness of errors in naturalistic action after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13, 16–28.Google Scholar
Hart, T., Sherer, M., Whyte, J., Polansky, M., & Novack, T.A. (2004). Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 1450–1456.Google Scholar
Hoofien, D., Gilboa, A., Vakil, E., & Barak, O. (2004). Unawareness of cognitive deficits and daily functioning among persons with traumatic brain injuries. Journal of Clinical & Experimental Neuropsychology, 26, 278–290.Google Scholar
Katz, M.M. & Lyerly, S.B. (1963). Methods for measuring adjustment and social behavior in the community. I. Rationale, description, discriminative validity and scale development. Psychological Report, 13, 503–535.Google Scholar
Lanham, R.A., Jr., Weissenburger, J.E., Schwab, K.A., & Rosner, M.M. (2000). A longitudinal investigation of the concordance between individuals with traumatic brain injury and family or friend ratings on the Katz Adjustment Scale. Journal of Head Trauma Rehabilitation, 15, 1123–1138.Google Scholar
Machamer, J., Temkin, N.R., & Dikmen, S.S. (2002). Significant other burden and factors related to it in traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 24, 420–433.Google Scholar
Malec, J.F. & Moessner, A.M. (2000). Self-awareness, distress, and postacute rehabilitation outcome. Rehabilitation Psychology, 45, 227–241.Google Scholar
McCrae, R.R., Stone, S.V., Fagan, P.J., & Costa, P.T. (1998). Identifying the causes of disagreement between self-reports and spouse ratings. Journal of Personality, 66, 285–313.Google Scholar
McGlynn, S.M. & Schacter, D.L. (1989). Unawareness of deficits in neuropsychological syndromes. Journal of Clinical & Experimental Neuropsychology, 11, 143–205.Google Scholar
McKinlay, W. & Brooks, D.N. (1984). Methodological problems in assessing psychosocial recovery following severe head injury. Journal of Clinical & Experimental Neuropsychology, 6, 87–99.Google Scholar
Noe, E., Ferri, J., Caballero, M.C., Villodre, R., Sanchez, A., & Chirivella, J. (2005). Self-awareness after acquired brain injury: Predictors and rehabilitation. Journal of Neurology, 252, 168–175.Google Scholar
Olver, J.H., Ponsford, J.L., & Curran, C.A. (1996). Outcome following traumatic brain injury: A comparison between 2 and 5 years after injury. Brain Injury, 10, 841–848.Google Scholar
Port, A., Willmott, C., & Charlton, J. (2002). Self-awareness following traumatic brain injury and implications for rehabilitation. Brain Injury, 16, 277–289.Google Scholar
Prigatano, G.P. (1986). Neuropsychological rehabilitation after brain injury. Baltimore: The Johns Hopkins University Press.
Prigatano, G.P. (1999). Principles of neuropsychological rehabilitation. New York: Oxford University Press.
Prigatano, G.P. (2005). Disturbances of self-awareness and rehabilitation of patients with traumatic brain injury: A 20-year perspective. Journal of Head Trauma Rehabilitation, 20, 19–29.Google Scholar
Prigatano, G.P. & Altman, I.M. (1990). Impaired awareness of behavioral limitations after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 71, 1058–1064.Google Scholar
Prigatano, G.P., Altman, I.M., & O'Brien, K.P. (1990). Behavioral limitations that traumatic-brain-injured patients tend to under-estimate. Clinical Neuropsychologist, 4, 163–176.Google Scholar
Prigatano, G.P., Bruna, O., Mataro, M., Munoz, J.M., Fernandez, S., & Junque, C. (1998). Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury. Journal of Head Trauma Rehabilitation, 13, 29–38.Google Scholar
Prigatano, G.P. & Schacter, D.L. (1991). Awareness of deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press.
Sbordone, R.J., Seyranian, G.D., & Ruff, R.M. (1998). Are the subjective complaints of traumatically brain injured patients reliable? Brain Injury, 12, 505–515.Google Scholar
Sherer, M., Bergloff, P., Boake, C., High, W., & Levin, E. (1998c). The Awareness Questionnaire: Factor structure and internal consistency. Brain Injury, 12, 63–68.Google Scholar
Sherer, M., Bergloff, P., Levin, E., High, W.M., Jr., Oden, K.E., & Nick, T.G. (1998a). Impaired awareness and employment outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation, 13, 52–61.Google Scholar
Sherer, M., Boake, C., Levin, E., Silver, B.V., Ringholz, G., & High, W.M., Jr. (1998b). Characteristics of impaired awareness after traumatic brain injury. Journal of the International Neuropsychological Society, 4, 380–387.Google Scholar
Sherer, M., Hart, T., Nick, T.G., Whyte, J., Thompson, R.N., & Yablon, S.A. (2003). Early impaired self-awareness after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 168–176.Google Scholar
Sneeuw, K., Aaronson, N., de Haan, R., & Limburg, M. (1997). Assessing quality of life after stroke: The value and limitations of proxy ratings. Stroke, 28, 1541–1549.Google Scholar
Sohlberg, M.M., Mateer, C.A., Penkman, L., Glang, A., & Todis, B. (1998). Awareness intervention: Who needs it? Journal of Head Trauma Rehabilitation, 13, 62–78.Google Scholar
Teasdale, G. & Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical scale. Lancet, ii, 81–84.Google Scholar
Temkin, N.R., Dikmen, S.S., Anderson, G.D., Wilensky, A.J., Holmes, M.D., Cohen, W., Newell, D.W., Nelson, P., Awan, A., & Winn, H.R. (1999). Valproate therapy for prevention of posttraumatic seizures: A randomized trial. Journal of Neurosurgery, 91, 593–600.Google Scholar
Wallace, C.A. & Bogner, J. (2000). Awareness of deficits: Emotional implications for persons with brain injury and their significant others. Brain Injury, 14, 549–562.Google Scholar
Williams, D., Levin, H., & Eisenberg, H.M. (1990). Mild head injury classification. Neurosurgery, 27, 422–428.Google Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioral assessment of the dysexecutive syndrome. Bury St. Edmonds, UK: Thames Valley Test Company.
Wyrwich, K.W., Bullinger, M., Aaronson, N., Hays, R.D., Patrick, D.L., Symonds, T., & The Clinical Significance Consensus Meeting Group. (2005). Estimating clinically significant differences in quality of life outcomes. Quality of Life Research, 14, 285–295.Google Scholar