Awareness of behavioral, cognitive, and physical deficits in acute traumatic brain injury.
OBJECTIVE
To compare awareness of deficit in 3 domains of function (physical, cognitive, behavioral/emotional) in acute traumatic brain injury (TBI), controlling for severity of impairment in the different domains.


METHODS
Inception cohort.


METHODS
Three inpatient rehabilitation programs.


METHODS
People with acute TBI (N=161), tested as soon as feasible after posttraumatic amnesia.


METHODS
Not applicable.


METHODS
Awareness Questionnaire (AQ) completed by the person with TBI and the treating neuropsychologist; and self- and clinician-rating scores calculated in the 3 domains.


RESULTS
For participants who were rated by clinicians as more impaired in at least 1 domain (ie, scored lower on the AQ), self-ratings differed significantly from one another in all 3 domains, with behavioral self-ratings highest, physical self-ratings lowest, and cognitive self-ratings intermediate. In subgroups of participants rated at the same level by clinicians in all 3 domains, physical self-ratings were also lowest, that is, more consonant with clinician ratings. Participants tended to rate themselves as relatively unchanged in cognitive and behavioral domains regardless of the level of clinician ratings on these factors.


CONCLUSIONS
Patterns of discrepant awareness of deficit in different functional areas seen in postacute TBI also appear to be present acutely and are not entirely related to differential severity of deficit. We discuss several possible reasons for discrepant awareness of deficit, including differences in internal and external feedback, cultural and psychologic factors, and different levels of ambiguity inherent in causal explanations for different types of problems.
Hart
Tessa
T
Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA 19141, USA.
Sherer
Mark
M
Whyte
John
J
Polansky
Marcia
M
Novack
Thomas A
TA
D000203:Activities of Daily Living; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001364:Awareness; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D015984:Causality; D003072:Cognition Disorders / Q000209:etiology; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D020127:Recovery of Function; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014481:United States