Awareness of neurobehavioral deficits and emotional adjustment in acute- and post-acute rehabilitation following traumatic brain injury

by Sawchyn, James Matthew

s dissertation ex -based and emotional individual's self-awareness of newobehavioral deficits following 1). Two studies were completed to ex . acute and post-acute rehabilitation settings using the reports of atient Competency Rating Scale (PCRS) and Selfew were used to assess the patients' awareness of deficit, ef Experiences entory were used to assess emotional adjus ent. Six patients d significant-otherswere followed weekly during the course of inpatient rehabilitation, and were seen approximately one month after their discharge fiom hospital. While individual variability was observed, most patients reported niinor changes in their level of competence and limited emotional distress. The individual perceptions of patients and of significant-others were generally consistent over the course of inpatient care, and variations in patients' emotional adjustment appeared to be reasonable reactions to circumstantial factors. The emotional adjustment of rs varied considerably arnong the individuals assessed, and this variability likely influenced their ratings of the patient. Staff ratings of collected, and identified improvements in functional abilities over time. These results suggest that patient awareness is not a prerequisite for rehabilitation success. A lack of applied or practical experiences may also influence patients' ability to accurately rate their self-competence dwing the acute phase following T Study 2 examined 166 indivi PCRS and the Katz Adjustment Sc ort greater imp significant emotion severity of their inj owledgement of adjustment. General story of moderate and severe T I showed good awareness on PCRS Discrepancy Scores, . . . 111 diffïculties, such that poor emotional adjustment were associated with low ratings of self-competence. On the other hand, the general location of cerebral trauma was not strongly associated wi defich in awareness- s, the nature and severiQ 1 appeared to be less impo an IQ and emotional adju rehabilitation patients, although rnildly injured patients are more likely to report neurobehavioral deficits than moderate or severely injured patients. Strengths and weakness of the self-other discrepancy approach to measuring self-awareness were considered, and a robust approach to awareness assessment, based on multiple measures, ended. Available options include structured interviews, self-report, clinical observation, or objective testing. F appeared to become increasingly salient in the assessment of awareness during the postacute phase, compared to the acute phase of recovery from TBI, where significant-other adjustrnent may be quite relevant.