title: The measurement and magnitude of awareness difficulties after traumatic brain injury: a longitudinal study.
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 over-reporting 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.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195, USA. farkat@u.washington.edu
authors.forename: Kathleen Farrell
authors.initials: KF
authors.lastname: Pagulayan
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Temkin
authors.forename: Joan E
authors.initials: JE
authors.lastname: Machamer
authors.forename: Sureyya S
authors.initials: SS
authors.lastname: Dikmen
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001364:Awareness / Q000502:physiology*; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D004311:Double-Blind Method; D004827:Epilepsy / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid