Assessment and treatment of impaired awareness after brain injury: implications for community re-integration

Impaired self-awareness of deficits is a common finding in patients who have suffered traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to poor outcome. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness. The present article reviews the existing literature on measurement of impaired awareness, characteristics of impaired awareness, the relationship of impaired awareness to functional outcome, possible treatment approaches for impaired awareness and empirical investigations of interventions to improve awareness. The treatment strategies we use to address impaired awareness in our community re-integration program for brain injury survivors are described in detail. These approaches include: establishment of the therapeutic alliance, family interventions, peer feedback, education, roleplaying, videotape feedback, real world experiences, therapeutic milieu and psychotherapy.