The measurement and magnitude of awareness difficulties after traumatic brain injury: a longitudinal study

J Int Neuropsychol Soc. 2007 Jul;13(4):561-70. doi: 10.1017/S1355617707070713. Epub 2007 May 18.

Abstract

Previous research suggests that reduced self-awareness is common following traumatic brain injury (TBI). However, few studies have examined the magnitude of this problem in a sample representative of hospitalized individuals. In this longitudinal study, individuals with complicated mild to severe TBIs and their significant others (SO) were evaluated at 1 and 12 months postinjury on the Sickness Impact Profile. Awareness was measured by comparing the level of injury-related problems reported by a person with TBI and their SO. Overall, individuals with TBI did not report fewer difficulties than their SO. In contrast, they frequently reported more injury-related difficulties than their SO. As there is no commonly or universally accepted definition for differential awareness, the magnitude of underreporting and over-reporting problems is presented using four different cutoff scores. A minimum discrepancy is proposed for defining awareness difficulties that is based on the standard error of measurement of the test-retest difference of the measure. Reduced self-awareness was inconsistent across both time and functional domains. These results suggest that reduced self-awareness is not the norm at 1 or 12 months postinjury and highlight the need for a more standardized approach to the measurement and classification of self-awareness.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anticonvulsants / therapeutic use
  • Awareness / physiology*
  • Brain Injuries / diagnosis*
  • Brain Injuries / physiopathology*
  • Double-Blind Method
  • Epilepsy / etiology
  • Epilepsy / prevention & control
  • Female
  • Glasgow Coma Scale
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neuropsychological Tests*
  • Retrospective Studies
  • Sickness Impact Profile*
  • Valproic Acid / therapeutic use

Substances

  • Anticonvulsants
  • Valproic Acid