Awareness of Deficits: Introduction | Definition of Lack of Awareness | Dimensions of Awareness | Awareness in Healthy Individuals | Lack of Awareness in Other Neuropsychiatric Disorders | Lack of Awareness After TBI | Measurement of Awareness | Overview of the Neuroanatomical Substrate of Awareness | Relationship of the Typical Profiles of TBI Pathology
to the Circuitry of Awareness | Impact of Lack of Awareness on Treatment and Rehabilitation | Treatment Advances | Key Clinical Points | Recommended Readings | References
Individuals who experience a traumatic brain injury
(TBI) may have multiple medical, physical, and cognitive limitations.
They may also have reduced awareness of these deficits. Up to 45% of
individuals with moderate to severe TBI demonstrate awareness deficits
(Freeland 1996; Hart et al. 2009). Deficits
that are clearly evident to family or therapists are often not "seen" by
the individual, are judged to be inconsequential, or are discounted.
Such unawareness is often permanent and can be an enormous impediment
to successful rehabilitation and a significant indicator of failure
to return to work (Shames et al. 2005). Furthermore,
deficits in awareness can be function specific. Some individuals
with TBI can accurately assess their physical status (e.g., hemiplegia)
but are less reliable in their assessment of their capacity for
sound judgment, cognitive skills, interpersonal skills, and other
aspects of social behavior (Trahan et al. 2006). In
fact, this lack of awareness of neurobehavioral sequelae is commonly
observed in moderate to severe TBI, and the resulting behavior is
frequently the most troublesome to families and caregivers and presents
the most significant barrier to returning to a more normalized existence
after an injury.