24 Self-awareness of deficits following brain injury: implications for mental capacity and recovery
Authors: Elanjithara Thomas , McIntosh Catriona , Ramos Sara DS , Rogish Miles , Coetzer Rudi 
Published: December 2022

Objectives/Aims

Impaired self-awareness of the executive emotional and physical consequences of moderate to severe brain injuries are reported during the recovery phase. It plays a crucial role in patients’ engagement and utilisation of rehabilitation and adversely affects functional outcomes following a brain injury. We aim to describe disorders of self-awareness after acquired brain injury, including prevalence within a post-acute rehabilitation setting, clinical presentation, association with different types of brain injury, neuropsychological impairments, and functional ability. We then consider its potential impact within the legislative frameworks and summarise possible interventions integrated within a holistic neurobehavioural approach to rehabilitation.

Methods

In a large sample (N=1120 ), the prevalence and severity of self-awareness impairments were captured using Mayo-Portland Adaptability Inventory-4 (MPAI-4) at admission and discharge from our neurobehavioral rehabilitation services. These scores are analysed against a range of neuropsychological parameters and functional outcomes.

Results

79% of the sample had self-awareness deficits that affected their functioning, and in two thirds, to a significant level. The severity of self-awareness impairments across different causes of brain injuries was comparable with no notable differences. Most individuals with mild or no self-awareness deficits were able to engage in restorative rehabilitation, whilst those with severe impairment in self-awareness mainly required scaffolding of their functioning, including some restrictions.

Self-awareness impairment on admission was found to be strongly related with the level of self-awareness on discharge (rs = 0.53, N = 841). Self-awareness was also moderately associated with impairments in problem solving (rs = 0.37, N = 841), memory (rs = 0.30, N = 841), attention (rs = 0.31, N = 841) and money management (rs = 0.35, N = 841).

Abstract 24 Figure 1

Severity of self-awareness impairment by medical diagnosis

Abstract 24 Figure 2

Severity of self-awareness impairment by clinical stream

Abstract 24 Table 1

Prevalence and severity of self-awareness impairment by chronicity

Level of self-awareness impairmentTime Since Injury0–6 months
N (%)6–12 months
N (%)13+ months
N (%)0 – None73 (8%)5 (5%)13 (8%)1 – Very mild: does not interfere with activities110 (13%)13 (12%)17 (11%)2 – Mild174 (20%)24 (23%)31 (20%)3 – Moderate234 (27%)35 (33%)63 (40%)4 – Severe267 (32%)28 (27%)33 (21%)

Conclusions

Disorders of self-awareness are prevalent in people with brain injury and can be persistent. Our data suggest that impaired self-awareness is not exclusively related to the cause/nature of the brain injury, but it is associated with impaired problem solving, memory and attention. The level of self-awareness on admission was also related to social participation and psychological adjustment on discharge. Further studies are required to assess the outcomes of targeted interventions (pharmacological and neurobehavioral) on the executive and emotional deficits that underpins self-awareness.