Research Reports - Self-awareness and neurobehavioral outcomes, 5 years or more after moderate to severe brain injury

J Head Trauma Rehabil. 2012 Dec 15

Kelley E, Sullivan C, Loughlin JK, Hutson L, Dahdah MN, Long MK, Schwab KA, Poole JH

OBJECTIVE:: To examine self-awareness 5 years or more after traumatic brain
injury (TBI) and its relation to outcomes. PARTICIPANTS:: Sixty-two adults with
moderate to severe TBI and significant other (SO) informants (family or close
friend). SETTING:: Regional veterans medical center. MAIN MEASURES:: TBI
Follow-up Interview, Community Integration Questionnaire, Satisfaction with Life
Scale, and Caregiver Burden Inventory. DESIGN:: Five to 16 years after acute
inpatient rehabilitation, separate staff contacted and interviewed subjects and
SOs. Subject awareness was defined as inverse subject-SO discrepancy scores.
RESULTS:: Subjects significantly underreported neurologic symptoms and
overreported their work and home functioning; their self-ratings of emotional
distress and social functioning did not differ from SO ratings. Employment was
associated with greater self-awareness of cognitive deficits, even after
controlling for injury severity. Subjects' life-satisfaction was associated with
better self-reported neurologic functioning, which frequently did not agree with
SO ratings. Caregiver burden was worse as SOs perceived subjects as having worse
symptoms and poorer work and social integration. CONCLUSIONS:: Impaired
self-awareness remains evident more than 5 years after TBI. People with TBI are
more likely to gain employment when they are aware of their cognitive deficits
and abilities. However, subjective quality of life, for subjects and SOs, was
related to their own perception of the TBI outcomes.

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