Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-29T12:59:17.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online-awareness

Published online by Cambridge University Press:  13 December 2006

FIADHNAIT O'KEEFFE ,
PAUL DOCKREE ,
PAULINE MOLONEY ,
SIMONE CARTON  and
IAN H. ROBERTSON
FIADHNAIT O'KEEFFE
Affiliation:
Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland
PAUL DOCKREE
Affiliation:
Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland
PAULINE MOLONEY
Affiliation:
Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland
SIMONE CARTON
Affiliation:
Department of Clinical Neuropsychology, National Rehabilitation Hospital, Dun Laoghaire, Dublin, Ireland
IAN H. ROBERTSON
Affiliation:
Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Recent models of impaired awareness in brain injury draw a distinction between metacognitive knowledge of difficulties and online awareness of errors (emergent and anticipatory). We examined performance of 31 Traumatic Brain Injury (TBI) participants and 31 healthy controls using a three-strand approach to assessing awareness. Metacognitive knowledge was assessed with an awareness interview and discrepancy scores on three questionnaires—Patient Competency Rating Scale, Frontal Systems Behavioral Scale and the Cognitive Failures Questionnaire. Online Emergent Awareness was assessed using an online error-monitoring task while participants performed tasks of sustained attention. Online anticipatory awareness was examined using prediction performance on two cognitive tasks. Results indicated that the TBI Low Self-Awareness (SA) group and High SA group did not differ in terms of severity, chronicity or standard neuropsychological tasks but those with Low SA were more likely to exhibit disinhibition, interpersonal problems and more difficulties in total competency. Sustained attention abilities were associated with both types of online awareness (emergent and anticipatory). There was a strong relationship between online emergent and online anticipatory awareness. Metacognitive knowledge did not correlate with the other two measures. This study highlights the necessity in adopting a multidimensional approach to assessing the multifaceted phenomenon of awareness of deficits. (JINS, 2007, 13, 38–49.)

Keywords

Impaired self-awarenessTraumatic brain injuryNeuropsychological deficitsError-monitoringExecutive functionsBehavior
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 1 , January 2007 , pp. 38 - 49
Copyright
© 2007 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abreu, B.C., Seale, G., Scheibel, R.S., Huddleston, N., Zhang, L., & Ottenbacher, K.J. (2001). Levels of self-awareness after acute brain injury: How patients' and rehabilitation specialists' perceptions compare. Archives of Physical Medicine and Rehabilitation, 82, 49–56.Google Scholar
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
Anderson, S.W. & Tranel, D. (1989). Awareness of Disease States following cerebral infarction, dementia, and head trauma: Standardized assessment. The Clinical Neuropsychologist, 3, 327–339.Google Scholar
Bogod, N.M., Mateer, C.A., & MacDonald, S.W. (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
Boone, K.B., Miller, B.L., Lee, A., Berman, N., Sherman, D., & Stuss, D.T. (1999). Neuropsychological patterns in right versus left frontotemporal dementia. Journal of the International Neuropsychological Society, 5, 616–622.Google Scholar
Broadbent, D.E., Cooper, P.F., FitzGerald, P., & Parkes, K.R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21, 1–16.Google Scholar
Coben, R.A., Boksenbaum, S.I., & Kulberg, A.M. (1995). Cognitive determinants of unawareness of deficits: The importance of specific frontal-mediated executive functions. Archives of Clinical Neuropsychology, 10, 309–310.Google Scholar
Crosson, C., Barco, P.P., Velozo, C., Bolesta, M.M., Cooper, P.V., Werts, D., & Brobeck, T.C. (1989). Awareness and Compensation in postacute head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4, 46–54.Google Scholar
Dockree, P.M., Bellgrove, M.A., O'Keeffe, F., Moloney, P., Aimola, L., Carton, S., & Robertson, I.H. (2006). Sustained Attention in traumatic brain injury (TBI) and healthy controls: Enhanced sensitivity with dual-task load. Experimental Brain Research, 168, 218–229.Google Scholar
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: A Frontal Assessment Battery at bedside. Neurology, 55, 1621–1626.Google Scholar
Enderby, P.M., Wood, V.A., Wade, D.T., & Hewer, R.L. (1987). The Frenchay Aphasia Screening Test: A short, simple test for aphasia appropriate for non-specialists. International Rehabilitation Medicine, 8, 166–170.Google Scholar
Fischer, S., Gauggel, S., & Trexler, L.E. (2004a). Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries. Brain Injury, 18, 547–562.Google Scholar
Fischer, S., Trexler, L.E., & Gauggel, S. (2004b). 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. (1999). A longitudinal study of self-awareness: Functional deficits underestimated by persons with brain injury. The Occupational Therapy Journal of Research, 19, 3–17.Google Scholar
Fleming, J.M., 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
Fontaine, A., Azouvi, P., Remy, P., Bussel, B., & Samson, Y. (1999). Functional anatomy of neuropsychological deficits after severe traumatic brain injury. Neurology, 53, 1963–1968.Google Scholar
Gauggel, S., Hoop, M., & Werner, K. (2002). Assigned versus self-set goals and their impact on the performance of brain-damaged patients. Journal of Clinical & Experimental Neuropsychology, 24, 1070–1080.Google Scholar
Grace, J. & Malloy, P.F. (2002). Frontal Systems Behavior Scale. Professional Manual. Lutz, FL: PAR Inc.
Hart, T. & Sherer, M. (2005). Preface to Special Edition. Journal of Head Trauma Rehabilitation, 20, 285–286.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., Whyte, J., Kim, J., & Vaccaro, M. (2005). Executive Function and Self-awareness of “Real-world” Behavior and Attention Deficits Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 20, 333–347.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 and Experimental Neuropsychology, 26, 278–290.Google Scholar
Lam, C.S., McMahon, B.T., Priddy, D.A., & Gehred-Schultz, A. (1988). Deficit awareness and treatment performance among traumatic head injury adults. Brain Injury, 2, 235–242.Google Scholar
Levine, B., Dawson, D., Boutet, I., Schwartz, M.L., & Stuss, D.T. (2000). Assessment of strategic self-regulation in traumatic brain injury: Its relationship to injury severity and psychosocial outcome. Neuropsychology, 14, 491–500.Google Scholar
Malec, J.F., Machulda, M.M., & Moessner, A.M. (1997). Differing problem perceptions of staff, survivors, and significant others after brain injury. Journal of Head Trauma Rehabilitation, 12, 1–13.Google Scholar
Manly, T., Owen, A.M., McAvinue, L., Datta, A., Lewis, G.H., Scott, S.K., Rorden, C., Pickard, J., & Robertson, I.H. (2003). Enhancing the sensitivity of a sustained attention task to frontal damage: Convergent clinical and functional imaging evidence. Neurocase, 9, 340–349.Google Scholar
Markova, I.S. & Berrios, G.E. (2001). The “object” of insight assessment: Relationship to insight “structure.” Psychopathology, 34, 245–252.Google Scholar
McAvinue, L., O'Keeffe, F., McMackin, D., & Robertson, I.H. (2005). Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight. Neuropsychological Rehabilitation, 15, 569–587.Google Scholar
McGlynn, S.M. & Schacter, D.L. (1989). Unawareness of deficits in neuropsychological syndromes. Journal of Clinical and Experimental Neuropsychology, 11, 143–205.Google Scholar
Mehrabian, A. & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40, 525–543.Google Scholar
Nelson, H.E. (1982). The National Adult Reading Test (NART): Test Manual (1st ed.). Windsor: NFER-Neslon.
Nelson, H.E. & Willison, J. (1991). The National Adult Reading Test Manual (2nd ed.). Windsor: NFER-Nelson.
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 Neurolology, 252, 168–175.Google Scholar
O'Keeffe, F., Dockree, P., & Robertson, I.H. (2004). Poor insight in traumatic brain injury mediated by impaired error processing? Evidence from electrodermal activity. Brain Research. Cognitive Brain Research, 22, 101–112.Google Scholar
Ownsworth, T., Clare, L., & Morris, R. An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer's disease and brain injury. Neuropsychological Rehabilitation (In Press).
Ownsworth, T. & Fleming, J. (2005). The relative importance of metacognitive skills, emotional status, and executive function in psychosocial adjustment following acquired brain injury. Journal of Head Trauma Rehabilitation, 20, 315–332.Google Scholar
Ownsworth, T.L., McFarland, K., & Young, R.M. (2002). The investigation of factors underlying deficits in self-awareness and self-regulation. Brain Injury, 16, 291–309.Google Scholar
Ownsworth, T.L., McFarland, K.M., & Young, R.M. (2000). Development and standardization of the Self-regulation Skills Interview (SRSI): A new clinical assessment tool for acquired brain injury. Clinical Neuropsychology, 14, 76–92.Google Scholar
Prigatano, G.P. (1996). Behavioral limitations TBI patients tend to underestimate: A replication and extension to patients with laterlized cerebral dysfunction. Clinical Neuropsychologist, 10, 191–201.Google Scholar
Prigatano, G.P. (1999). Disorders of self-awareness after brain injury. In G.P. Prigatano (Ed.), Principles of Neuropsychological Rehabilitation (pp. 265–293). 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 Physiology and Medical 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 underestimate. Clinical Neuropsychologist, 4, 163–176.Google Scholar
Prigatano, G.P., Borgaro, S., Baker, J., & Wethe, J. (2005). Awareness and distress after traumatic brain injury: A relative's perspective. Journal of Head Trauma Rehabilitation, 20, 359–367.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. & Fordyce, D.J. (1986). Cognitive dysfunction and psychosocial adjustment after brain injury. In G.P. Prigatano (Ed.), Neuropsychological Rehabilitation after Brain Injury. Baltimore: John Hopkins University Press.
Prigatano, G.P., Fordyce, D.J., & Zeiner, H.K. (1986). Neuropsychological Rehabilitation After Brain Injury. Baltimore: John Hopkins University Press.
Prigatano, G.P., Ogano, M., & Amakusa, B. (1997). A cross-cultural study on impaired self-awareness in Japanese patients with brain dysfunction. Neuropsychiatry Neuropsychology and Behavioral Neurology, 10, 135–143.Google Scholar
Prigatano, G.P. & Schacter, D.L. (1991). Awareness of Deficit after Brain Injury: Clinical and Theoretical Issues. New York: Oxford University Press.
Robertson, I.H., Manly, T., Andrade, J., Baddeley, B.T., & Yiend, J. (1997). “Oops!”: Performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia, 35, 747–758.Google Scholar
Robertson, I.H., Ward, T., Ridgeway, V., & Nimmo-Smith, I. (1996). The structure of normal human attention: The Test of Everyday Attention. Journal of the International Neuropsychological Society, 2, 525–534.Google Scholar
Sawchyn, J.M., Mateer, C.A., & Suffield, J.B. (2005). Awareness, emotional adjustment, and injury severity in postacute brain injury. Journal of Head Trauma Rehabilitation, 20, 301–314.Google Scholar
Schacter, D.L. (1990). Toward a cognitive neuropsychology of awareness: Implicit knowledge and anosognosia. Journal of Clinical and Experimental Neuropsychology, 12, 155–178.Google Scholar
Schmitz, T.W., Rowley, H.A., Kawahara, T.N., & Johnson, S.C. (2006). Neural correlates of self-evaluative accuracy after traumatic brain injury. Neuropsychologia, 44, 762–773.Google Scholar
Sherer, M., Bergloff, P., Boake, C., High, W., Jr., & Levin, E. (1998a). 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. (1998b). Impaired awareness and employment outcome after traumatic brain injury. Journal of Head Trauma and Rehabilitation, 13, 52–61.Google Scholar
Sherer, M., Boake, C., Levin, E., Silver, B., Ringholz, G., & High, W.M., Jr. (1998c). Characteristics of impaired awareness after traumatic brain injury. Journal of the International Neuropsychological Society, 4, 380–387.Google Scholar
Sherer, M., Hart, T., Whyte, J., Nick, T.G., & Yablon, S.A. (2005). Neuroanatomic basis of impaired self-awareness after traumatic brain injury: Findings from early computed tomography. Journal of Head Trauma and Rehabilitation, 20, 287–300.Google Scholar
Sohlberg, M.M., Mateer, C.A., Penkman, L., Glang, A., & Todis, B. (1998). Awareness intervention: Who needs it? Journal of Head Trauma and Rehabilitation, 13, 62–78.Google Scholar
Spreen, O. & Benton, A.L. (1969). Neurosensory Center Comprehensive Examination for Aphasia (NCCEA). Victoria: University of Victoria Neuropsychology Laboratory.
Spreen, O. & Strauss, E. (1998). A Compendium of Neuropsychological Tests. Administration, Norms and Commentary (2nd ed.). New York: Oxford University Press.
Stuss, D.T., Picton, T.W., & Alexander, M.P. (2001). Consciousness, self-awareness and the frontal lobes. In S. Salloway, P. Malloy, & J. Duffy (Eds.), The Frontal Lobes and Neuropsychiatric Illness. Washington, DC: American Psychiatric Press.
Toglia, J. & Kirk, U. (2000). Understanding awareness deficits following brain injury. NeuroRehabilitation, 15, 57–70.Google Scholar
Trudel, T.M., Tryone, W.W., & Purdum, C.M. (1998). Awareness of disability and long-term outcome after traumatic brain injury. Rehabilitation Psychology, 43, 267–281.Google Scholar
Walker, D. (2003). Remembrance of things future: Involuntary and strategic processes in prospective memory reminders. Unpublished PhD, University of Reading, Reading, UK.
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
Wechsler, D., Wycherly, R., Benjamin, L., Crawford, J.R., & Mockler, D. (1998). Wechsler Memory Scale-111 (3rd ed.). London: The Psychological Corporation Limited.
Wise, K., Ownsworth, T., & Fleming, J. (2005). Convergent validity of self-awareness measures and their association with employment outcome in adults following acquired brain injury. Brain Injury, 19, 765–775.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67, 361–370.Google Scholar