Evaluating late outcome severe closed head injury with emphasis on awareness of disability
Improvements in medical care have lead to increased survival rates for individuals experiencing severe closed head injury (CHI). The sequelae of CHI are typically consistent with diffuse brain damage, and include physical, cognitive, behavioral and psychological impairment. Research indicates that limiting factors in functional CHI recovery include not only physical, cognitive, psychological and behavioral impairments, but also impaired awareness of disability. Neuropsychological factors underlying impaired awareness have been attributed in part to injuries causing integration difficulties, injury to the pre-frontal regions of the frontal system and anosognosia related to a failure in monitoring or inattention/neglect syndromes more commonly associated with right hemisphere lesions. Sixty three participants with severe CHI, in various stages of post-acute rehabilitation, were administered the Scales of Independent Behavior (SIB) for self-rating of Broad Independence with independent staff ratings on this same measure; the Wechsler Adult Intelligence Scale - Revised, the Wechsler Memory Scale - Revised, and the Wisconsin Card Sorting Test. Participants were also classified vocationally and residentially. Therapist SIB scores were compared with participant scores to formulate a discrepancy score indicating impaired awareness of disability, with participants significantly over-rating their functional abilities (502.59 vs. 524.05, t(62) = $-$6.19, p $<$.001). Greater impaired awareness of disability (discrepancy) was associated with lower classification in present vocational status (F(2, 63) = 15.38, p $<$.001) and residential status (F(2, 63) = 17.23, p $<$.001). Participants' degree of lack of awareness of disability was positively correlated with therapist ratings of maladaptive behavior (r(63) =.36, p $<$.01), was negatively correlated with the attention/freedom from distractibility (r(63) = $-$.42, p $<$.001) and was positively correlated with perseverative responses (r(63) =.49, p $<$.001). Stepwise multiple regression analyses indicated that the discrepancy score, indicating degree of impaired awareness, was the best predictor of vocational and residential classification. None of the neuropsychological or behavioral measures administered were significant predictors of vocational status, and only the behavioral measure was a significant predictor of residential status. This study, with a relatively large sample assessed through standardized measures, supports the presence of impaired awareness of disability as a critical factor in post-acute CHI, and highlights the importance of pursuing development and focus on clinical treatment to address awareness in the CHI rehabilitation process.
Trudel, Tina M, "Evaluating late outcome severe closed head injury with emphasis on awareness of disability" (1996). ETD Collection for Fordham University. AAI9628352.