Self-awareness and traumatic brain injury outcome

Abstract

Primary objective: Impaired self-awareness following a traumatic brain injury (TBI) can reduce the effectiveness of rehabilitation, resulting in poorer outcomes. However, little is understood about how the multi-dimensional aspects of self-awareness may differentially change with recovery and impact outcome. Thus, this study examined four self-awareness variables represented in the Dynamic Comprehensive Model of Awareness: metacognitive awareness, anticipatory awareness, error-monitoring and self-regulation.

Research design: This study evaluated change of the self-awareness measures with recovery from TBI and whether the self-awareness measures predicted community re-integration at follow-up.

Methods and procedures: Participants were 90 individuals with moderate-to-severe TBI who were tested acutely following injury and 90 age-matched controls. Forty-nine of the TBI participants and 49 controls were re-tested after 6 months.

Main outcome and results: Results revealed that the TBI group’s error-monitoring performance was significantly poorer than controls at both baseline and follow-up. Regression analyses revealed that the self-awareness variables at follow-up were predictive of community re-integration, with error-monitoring being a unique predictor.

Conclusions: The results highlight the importance of error-monitoring and suggest that interventions targeted at improving error-monitoring may be particularly beneficial. Understanding the multi-dimensional nature of self-awareness will further improve rehabilitation efforts and understanding of the theoretical basis of self-awareness.

• Awareness
• community integration
• outcome
• rehabilitation
• self-awareness
• traumatic brain injury

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. This work was supported by a grant from NINSD R01-NS047690.