Summary – Module 3 Interventions for deficits in awareness and fatigue
Awareness
It is complicated to start a cognitive intervention with a patient if he/she is not aware of his/her own deficits.
Furthermore, the patient will not be motivated to practice, and practice is key to automatize and generalize
behaviors.
Deficits in awareness are a challenge to rehabilitation. A patient that is not aware of his/her limitations can be
a patient in danger; What if the patient wants to resume his/her activities as before?
A patient that is not aware of his/her limitations:
- may choose activities that exceed his/her capabilities which in turn will increase frustration
- will not recognize the need for help
- will need more supervision, also due to safety reasons
- will have low motivation to participate in rehabilitation activities
- may set unrealistic goals
- may be a cause of tension and dilemma for the rehabilitation professional: more resistance and
arguments about his/her needs
- may have poor rehabilitation outcomes
Finally, rehabilitation activities require effort, motivation and persistence and all of them will be very low if
the patient is not aware of his/her deficits.
Anosognosia: a loss of awareness; they don’t know what they don’t know. Part of the progression of
dementia.
Fleming & Ownsworth (2006). A review of awareness interventions in brain injury rehabilitation.
Key learning points:
- Disorders of awareness are a critical issue in all forms of neuropsychological rehabilitation.
- We have already seen that unawareness is a complex construct, and we can distinguish different
causes: neurological, psychological and social-environmental.
- The level of awareness is related to rehabilitation outcomes.
- A disorder of self-awareness refers to a "person's inability to recognize deficits or problem
circumstances caused by neurological injury” (Barco et al., 1991, p. 129).
Awareness/self-awareness is defined as the capacity to perceive the ‘self’ in relatively ‘objective’ terms while
maintaining a sense of subjectivity. An awareness disorder refers to a person’s inability to recognize deficits
or problem circumstances caused by neurological injury. Awareness is a complex construct, it incorporates
neural and cognitive processes, as well as psychological factors. It is suggested that also the social
environment is able to somewhat influence patients’ unawareness.
Unawareness related to brain injury has implications for rehabilitation participation, functional outcomes, and
the emotional well-being of patients. There are a range of awareness interventions, these approaches make a
distinction between unawareness due to neurocognitive factors and due to psychological factors.
However, not all individuals benefit from interventions that enhance awareness, and increased awareness can
be associated with emotional distress.
Samples of the interventions and research evidence in the table below.
,
,
Awareness
It is complicated to start a cognitive intervention with a patient if he/she is not aware of his/her own deficits.
Furthermore, the patient will not be motivated to practice, and practice is key to automatize and generalize
behaviors.
Deficits in awareness are a challenge to rehabilitation. A patient that is not aware of his/her limitations can be
a patient in danger; What if the patient wants to resume his/her activities as before?
A patient that is not aware of his/her limitations:
- may choose activities that exceed his/her capabilities which in turn will increase frustration
- will not recognize the need for help
- will need more supervision, also due to safety reasons
- will have low motivation to participate in rehabilitation activities
- may set unrealistic goals
- may be a cause of tension and dilemma for the rehabilitation professional: more resistance and
arguments about his/her needs
- may have poor rehabilitation outcomes
Finally, rehabilitation activities require effort, motivation and persistence and all of them will be very low if
the patient is not aware of his/her deficits.
Anosognosia: a loss of awareness; they don’t know what they don’t know. Part of the progression of
dementia.
Fleming & Ownsworth (2006). A review of awareness interventions in brain injury rehabilitation.
Key learning points:
- Disorders of awareness are a critical issue in all forms of neuropsychological rehabilitation.
- We have already seen that unawareness is a complex construct, and we can distinguish different
causes: neurological, psychological and social-environmental.
- The level of awareness is related to rehabilitation outcomes.
- A disorder of self-awareness refers to a "person's inability to recognize deficits or problem
circumstances caused by neurological injury” (Barco et al., 1991, p. 129).
Awareness/self-awareness is defined as the capacity to perceive the ‘self’ in relatively ‘objective’ terms while
maintaining a sense of subjectivity. An awareness disorder refers to a person’s inability to recognize deficits
or problem circumstances caused by neurological injury. Awareness is a complex construct, it incorporates
neural and cognitive processes, as well as psychological factors. It is suggested that also the social
environment is able to somewhat influence patients’ unawareness.
Unawareness related to brain injury has implications for rehabilitation participation, functional outcomes, and
the emotional well-being of patients. There are a range of awareness interventions, these approaches make a
distinction between unawareness due to neurocognitive factors and due to psychological factors.
However, not all individuals benefit from interventions that enhance awareness, and increased awareness can
be associated with emotional distress.
Samples of the interventions and research evidence in the table below.
,
,
