The Role of Awareness in Traumatic Brain Injuries: Interviews with Experts

Approximately 2.8 million US citizens sustain a traumatic brain injury (TBI) annually, with more than 275,000 requiring inpatient rehabilitation (Taylor, Bell & Breiding, 2013). As rehabilitation techniques are refined and adapted to increase the speed of recovery and functional independence following TBIs, there is an ongoing need for better prognostic assessment tools. Research has shown that a lack of self-awareness following TBI is associated with poorer outcomes (e.g. employability, community reintegration) following discharge from inpatient hospitalizations (Cheng & Man, 2006; Robertson & Schmitter, 2016) and can result in decreased motivation (Simmonds & Fleming, 2003), compromised safety, poor community re-integration, and impaired judgment (Hart & Sherer, 2009). The paucity of empirical and objective measurements for a factor strongly correlated with rehabilitative success and prognosis and the lack of consensus about the nature of self-awareness, suggest a need for additional work to develop measures of awareness. Semi-structured interviews were conducted with experts in the field who provided information on their current practices, limitations, and aspirations for the assessment of awareness in those with traumatic brain injuries. Interviews were coded to aid the creation of a universal definition of self-awareness and the development of a meaningful and utilitarian assessment, as well as to identify future directions for the treatment of those with self-awareness deficits following traumatic brain injury. In summary, experts believe awareness should be defined based on the individual’s level of consciousness, awareness of functional limitations, and insight shown. If further assessment if required, experts proposed an approach that engages patients in pre and post-test reflection of their ability to complete a performative task. The discrepancy between their actual performance and their awareness of their performance could be quantified and used to measure current level of self-awareness and improvement over time. This assessment approach could help provide a quantitative measure of treatment efficaciousness