Awareness and perceptions of outcomes after traumatic brain injury

Awareness or insight has been identified as a major factor in successful rehabilitation after traumatic brain injury (TBI). Anecdotal evidence suggests people with TBI are more likely to be aware of residual physical disabilities, perhaps focusing on these to the exclusion of other issues in the psychosocial and cognitive domains, for example. To investigate this more accurately, recovery and outcome questionnaires were administered to people with TBI and their nominated significant others, and, as appropriate, an assessment of their level of functioning was also recorded. Two- and three-way analyses (t-tests, Kendall's and Wilcoxon's) comparing these perceptions were then conducted. The results indicated a high level of agreement for basic demographic data and broad outcomes. It was found the subjects reported a lower rate of physical impairment and disability than the significant other or the author, suggesting that, as a group, they do not fixate on physical issues. Other areas of difference were found, such as a tendency for the significant other to perceive the subject as being more dependent in mobility and self-care tasks, possibly because of their close involvement. Also the author reported more impairments, using clinical language and assessment that did not necessarily have meaning or significance for the other groups. There was also evidence to support the notion that there is an inherent hierarchy of needs ranging from the lower-order, physiological or survival skills through to higher-order, self-actualizing areas. Because of the differing awareness and perceptions, care must be taken in service provision to identify the personal needs and values of each individual involved.