Impaired self-awareness of everyday task ability following acquired brain injury (ABI) presents a serious obstacle to progress in rehabilitation. However, there is a lack of consensus about the optimal method of determining awareness level, how best to increase awareness, and even with regard to the very nature of impaired awareness. Awareness level is usually ascertained by comparing self/third party ratings of task performance. A behavioural measure of task performance would circumvent some of the concerns regarding the validity of methods relying solely on verbal report. Three main research questions were identified: 1. Is it possible to measure self-awareness of activity limitation and impairment? 2. Is it possible to increase self-awareness of activity limitation and impairment? 3. What is the nature of impaired awareness of activity limitation and impairment? To address these questions, the research programme had four phases: In phase 1, a cross-sectional design was used, incorporating behavioural observation and quantitative questionnaires, to develop a task battery that could be used as a behavioural measure of self-awareness. The resultant task battery consisted of six everyday tasks. In phase 2, a group comparison design was used to establish the sensitivity of the task battery to impaired self-awareness. Questionnaires were administered to obtain a quantitative measure of awareness - including social skills - in the acquired brain injury (ABI) participants. Eighteen ABI participants, identified as having impaired self-awareness, were compared with three comparison groups. The task battery was found to be sensitive to impaired awareness of everyday task ability. In phase 3, a single-case, experimental design methodology was attempted in two ABI participants to determine the effectiveness of interventions designed to increase awareness. Four ABI participants were followed up longitudinally, as natural history case studies, to ascertain changes in awareness over time, and critical incidents contributing to change. The intervention programmes were not found to be effective. Phase 4 included two qualitative studies to explore the nature of impaired awareness. In study 1, interview scripts from thirty-six clinicians were analysed thematically. In study 2, interview data from phase 3 were re-examined to explore 'objects' of awareness and factors contributing to fluctuations in awareness. Both phase 4 studies indicated that manifestations of impaired self-awareness were very varied in terms of 'objects' of awareness, severity of the awareness impairment, and the number of factors contributing. Impaired self-awareness is complex in nature, necessitating repeated measures, of verbal report and behaviour within variolls functional domains, to determine awareness level. Detailed examination of further single cases could help identify profiles of impaired self-awareness for which specific interventions and explanatory models could be developed. It is argued that intervention to address impaired selfawareness within the social skills domain should be prioritised.
Murphy, Maggie M.
Year: 2005
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