131 research outputs found
Impaired self-awareness
No full textPersons with neurologie disorders often show impaired ability to accurately pereeive the effeets of their disorders on their physieal, cognitive, and behavioral abilities. For conditions that have a sudden onset such as stroke or traumatic brain injury (TBI) the degree of impairment of this ability is greatest early after onset so that, for example, soon after right hemisphere stroke, the person with stroke may not perceive motor impairment on the left side of the body, but gradually becomes more aware of this impairment as he/she recovers. For progressive conditions such as the various dementias, the degree of impairment of self-aware- ness worsens as the condition progresses so that a person with Alzheimer's disease may be aware of subtle memory impairment in early stages of the disease, but unaware of very severe memory impairment once the disease has progressed. In either case, the perception of impairment is least when the actual impairment is greatest and greatest when the actual impairment is least. Impaired self-appraisal of functioning is referred to as anosognosia in conditions such as the neglect syndrome after right hemisphere stroke or Anton's syndrome (unawareness of cortical blindness) after bilateral posterior cerebral artery strokes where the lack of awareness may be complete. In TBI, this condition is simply called impaired self-aware- ness (ISA) as persons with injury usually have some awareness of their deficits once they recover from the confused state (post-traumatic amnesia). For persons with TBI, severity of ISA is greatest in early recovery. By defi nition, patients in coma or the vegetative state have no self-awareness. Though not directly assessed, minimally conscious patients are assumed to have extremely limited self-awareness. Once patients recover to the confused state, they remain with very severe impairment of self-awareness. Often after resolution of confusion, patients may deny that they have sustained TBI at all and deny any residual effects of the injury. Even when acknowledging injury, we have seen patients insist that their cognitive abilities after severe TBI are much better than they were prior to sustaining TBI. Patients who are unable to walk safely may attempt to remove restraints to leave their beds or wheelchairs to go to the toilet or simply to attempt to leave the room. Patients may refuse therapies because they do not believe that they have impairments that need to be treated. In the post-acute period of recovery, patients may attempt to drive in spite of motor and sensory defi cits or pursue employment or independence goals that are at odds with their current functional limitations. To ensure patient safety, compliance with needed therapies, and the best possible outcomes for patients, neuropsychologists and others treating persons with TBI must assess and, when needed, provide treatment for defi cits in self-awareness. This chapter will: (1) review the nature of ISA after TBI and describe its impact on rehabilitation therapies and patient outcome, (2) describe approaches to assessment of ISA, (3) review the literature on interventions to improve self-awareness in persons with TBI, and (4) provide practical guidance illustrated with clinical cases for intervening with patients with ISA
Dementia Outcomes among Individuals with a History of Traumatic Brain Injury: Differences by Race and Sex
No full textTraumatic brain injury (TBI) is an important public health concern with 20-50% of US adults having sustained a TBI during their lifetime. There is growing evidence to postulate that individuals with a history of TBI may be at greater risk of cognitive decline and dementia in later life, but additional research is needed to better understand this relationship. Research suggests both dementia and TBI outcomes may differ by race/ethnicity and sex/gender suggesting dementia outcomes following TBI may also be impacted by these demographic factors. The purpose of this study was to build upon past literature examining the relationship between TBI history and diagnosis and severity of dementia in later life by focusing on the influence of race/ethnicity and sex in a large, ethnically diverse, civilian sample of older adults with a TBI history while also considering potential contributions from social determinants of health (i.e., income, health insurance, education, etc.). The final sample consisted of 1242 older adults, 261 of whom reported a history of TBI based on the Ohio State University TBI Identification interview, from the Health and Aging Brain Study: Health Disparities (HABS-HD) study database. Outcome variables were dementia diagnosis (Y/N) determined by Clinical Dementia Rating Scale (CDR) sum of boxes score of 2.5 or greater and dementia severity (total sum of boxes). In the full sample, 69 (5.6%) individuals met criteria for dementia diagnosis and among the sub-sample with TBI history, 11 (4.2%) had a dementia diagnosis. Analyses included correlations, chi-squares, t-tests, and regressions to address study aims. The results revealed no significant relationship between TBI history and dementia outcomes. Neither race/ethnicity nor sex significantly predicted dementia outcome. The interaction between race/ethnicity and sex also did not significantly predict either outcome. However, health and sociodemographic factors that significantly contributed to predicting dementia outcomes included income and age with the full sample and history of high blood pressure among individuals with the TBI sample. The low frequency of TBI history and low percentage of people with dementia diagnosis may have impacted these findings. Further study of the relationship between TBI and dementia in later life is required. Future directions and potential mechanisms for the link between TBI and dementia are discussed.Psychology, Department o
Estimating the Burden of Hypertension and Diabetes Among Persons with Traumatic Brain Injury (TBI)
No full textTreating and Collaborating With Family Caregivers in the Rehabilitation of Persons with Traumatic Brain Injury
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Article 8 (NIDRR)Relationship of Preinjury Coping on Outcomes in Adults with Mild Traumatic Brain Injury
No full text*Poster 34: Impact of Traumatic Brain Injury on Quality of Life and Self-Concept: Perspectives of Survivors in an Ethnically Diverse Sample
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