Unawareness after stroke: A review and practical guide to understanding, assessing, and managing anosognosia for hemiplegia

Abstract

How should stroke patients with poor motor awareness be managed? This question is important because unawareness (or anosognosia) is related to poor rehabilitation and prognosis. This narrative review provides a guide for clinicians and (applied) academics to understanding, assessing and managing anosognosia. Questions addressed are: What is anosognosia? What causes anosognosia? How can anosognosia be assessed? And how can anosognosia be managed? We suggest that anosognosia is a multifaceted disorder, with diverse neuroanatomical and psychopathological origins. Assessment should measure various aspects of awareness, and management should be multidimensional to address problems with motor function, awareness, and emotional/motivational disturbance.

Keywords:

• Unawareness
• Anosognosia for hemiplegia
• Assessment
• Treatment
• Rehabilitation

Acknowledgments

The authors thank Sarah Grogan and the two anonymous reviewers for their helpful comments on an earlier version of this manuscript.