title: Treatment of unawareness of deficits in patients with acquired brain injury: a systematic review.
abstract: OBJECTIVE
  To review and evaluate the effectiveness and methodological quality of available treatment methods for unawareness of deficits after acquired brain injury (ABI).
  
  
  METHODS
  Systematic literature search for treatment studies for unawareness of deficits after ABI. Information concerning study content and reported effectiveness was extracted. Quality of the study reports and methods were evaluated.
  
  
  RESULTS
  A total of 471 articles were identified; 25 met inclusion criteria. 16 were uncontrolled or single-case studies. Nine were of higher quality: 2 randomized controlled trials, 5 single case experimental designs, 1 single-case design with pre- and posttreatment measurement, and 1 quasi-experimental controlled design. Overall, interventions consisted of multiple components including education and multimodal feedback on performance. Five of the 9 high-quality studies reported a positive effect of the intervention on unawareness in patients with some knowledge of their impairments. Effect sizes ranged from questionable to large.
  
  
  CONCLUSIONS
  Patients with ABI may improve their awareness of their disabilities and possibly attain a level at which they personally experience problems when they occur. At present, because of lack of evidence, no recommendation can be made for treatment approaches for persons with severe impairment of self-awareness in the chronic phase of ABI. We recommended developing and evaluating theory-driven interventions specifically focused on disentangling the components of treatment that are successful in improving awareness. High-quality intervention studies are urgently needed using controlled designs (eg, single-case experimental designs, randomized controlled trials) based on a theoretic perspective with a detailed description of the content of the intervention and suitable outcome measures.
authors.affiliation: Rehabilitation Centre Adelante, Department of Brain Injury, Hoensbroek (Ms Schrijnemaekers and Drs Rasquin, and Ponds); Adelante knowledge centre, Hoensbroek (Dr Rasquin); School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University (Ms Smeets and Drs Ponds and van Heugten); Department of Medical Psychology, Maastricht University Medical Center (MUMC), Maastricht (Dr Ponds); and Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University (Dr van Heugten), The Netherlands.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Schrijnemaekers
authors.forename: Sanne M J
authors.initials: SM
authors.lastname: Smeets
authors.forename: Rudolf W H M
authors.initials: RW
authors.lastname: Ponds
authors.forename: Caroline M
authors.initials: CM
authors.lastname: van Heugten
authors.forename: Sascha
authors.initials: S
authors.lastname: Rasquin
mesh_terms: D001364:Awareness; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000523:psychology*; D005246:Feedback; D006801:Humans; D009483:Neuropsychological Tests; D010353:Patient Education as Topic; D012054:Reinforcement, Psychology