Measuring Self-Awareness after Brain Injury in the Inpatient Rehabilitation Setting and at 6 Months Follow-Up: Comparison of the Functional Self-Assessment Scale and Patient Competency Rating Scale in Understanding Outcome

Objective: Few studies have examined the relationship of self-awareness early in recovery from brain injury to outcome. The Functional Self-Assessment Scale (FSAS) and the Patient Competency Rating Scale (PCRS) were employed to examine the relationship of early self-awareness with later self-awareness along with cognitive and functional status in order to better understand the role of self-awareness in recovery and rehabilitation. Method: Subjects were 70 adult inpatient admissions to a brain injury program. Subjects were administered the FSAS and RBANS and clinicians also completed the FSAS. A Self-Awareness Score (SAS) for each subject was calculated as the difference between subject and staff ratings. The subjects were then divided into good self-awareness (n = 49) and poor self-awareness (n = 21) groups. Thirty-seven subjects were available 6 months later at which time they and family members completed the PCRS and divided into good self-awareness (n = 28) and poor self-awareness (n = 9) groups based on Time 1 assessment. Results: The SAS and cognitive functioning at Time 1 were significantly correlated with PCRS discrepancy scores (difference between subject and family ratings) at Time 2. Step-wise linear regression showed that only the Time 1 SAS predicted Time 2 PCRS discrepancy scores. Impaired awareness was associated with Time 2 functioning in terms of employment and accessing transportaion. Conclusion: Early self-awareness assessment is capable of predicting later awareness. More subjects demonstrated good awareness versus poor awareness, consistent with studies that have noted awareness is not a universal problem after brain injury. Poor self-awareness was a risk factor for poorer outcome regarding employment and supervision needs.