Early impaired self-awareness after traumatic brain injury

Sherer M, Hart T, Nick TG, Whyte J, Thompson RN, Yablon SA. Early impaired self-awareness after traumatic brain injury. 2003;84:168-76. Objectives: To evaluate predictors of early impaired self-awareness after traumatic brain injury (TBI); to examine interrelationships of the perceptions of patient, clinician, family, and significant other of how patients are functioning after TBI; and to determine how early impaired self-awareness helps to predict employability at rehabilitation discharge. Design: Inception cohort. Setting: Two inpatient rehabilitation programs. Participants: A total of 129 patients with TBI seen for inpatient rehabilitation at 1 of 2 rehabilitation centers. All subjects had emerged from posttraumatic amnesia before being assessed for this study. Interventions: Not applicable. Main Outcome Measures: Impaired self-awareness as measured by the Awareness Questionnaire (patient self-ratings, clinician ratings) and employability (rated on the Disability Rating Scale) at discharge from inpatient rehabilitation. Results: Regression analysis revealed that early impaired self-awareness was predicted by age and functional status (FIM[trade ] instrument total score) at admission to inpatient rehabilitation. Spearman correlation coefficients revealed that clinician, family, and significant other ratings of patient functioning were related (rs =.42, P[lt ].001), but were not related to patient self-ratings. Multiple logistic regression analysis revealed that early impaired self-awareness was predictive of employability at discharge from inpatient rehabilitation. Clinician ratings of patient functioning showed a positive relation to employability (P =.05), whereas patient self-ratings showed a trend toward a negative relation to employability (P =.09). Conclusions: Our results support the importance of early impaired self-awareness assessment, its predictive value for complex functional activities, and the need for further research to determine if treatment programs for impaired self-awareness enhance functional outcomes. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation