Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight

Abstract

The processes of error awareness and sustained attention were investigated in 18 traumatic brain injury (TBI) individuals and 16 matched control participants. In Experiment 1, we found that: (1) in comparison to controls, TBI participants displayed reduced sustained attention and awareness of error during the Sustained Attention to Response Task; (2) degree of error awareness was strongly correlated with sustained attention capacity, even with severity of injury partialed out; and (3) that error feedback significantly reduced errors. We replicated the finding of a correlation between error awareness and sustained attention capacity in Experiment 2 with a separate sample of 19 TBI participants and 20 controls. We conclude that TBI leads to impaired sustained attention and error awareness. The finding of a significant relationship between these two deficits in TBI suggests there may be a link between these two processes. Feedback on error improves sustained attention performance of control and TBI participants.

Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online-awareness

“…Other studies have found similar results to Noe et al (2005) showing that certain measures of executive function and memory predict awareness (McAvinue et al, 2005;Ownsworth et al, 2002;Trudel et al, 1998). The present study only partially replicated some of these findings by showing an association between sustained attention and onlineemergent awareness and online-anticipatory awareness.…”

“…The association between sustained attention, onlineemergent awareness and online-anticipatory awareness may suggest a possible route for rehabilitation, because it has been shown in a study using similar methodology to the present one that the provision of auditory feedback on error led to an improvement in sustained attention performance on the SART for TBI participants. Although it was unclear whether feedback on error enhanced error awareness or general arousal, the possibility that feedback on error may improve online error-monitoring certainly merits further investigation (McAvinue et al, 2005). Despite the small patient sample size (n 5 31) in the present study, the distinct lack of association between the composite scores of metacognitive knowledge and the two online-awareness types, strongly suggests that previous studies may not have examined the whole, multifaceted picture of awareness of deficits following TBI.…”

“…Executive dysfunction has been associated with ISA in many studies (Allen & Ruff, 1990;Noe et al, 2005;Ownsworth et al, 2002), but this association was not found, or only partially replicated in others (Bogod et al, 2003;Trudel et al, 1998). In studies that have found this association, the types of executive functioning that have been associated with aspects of awareness include ability to shift-set or form abstract concepts (Noe et al, 2005), planning abilities (Coben et al, 1995), mental flexibility (Coben et al, 1995;Trudel et al, 1998), idea generation or fluency (Coben et al, 1995;, selfregulation and social interaction skills (Bogod et al, 2003;Ownsworth et al, 2002), sustained attention (McAvinue et al, 2005), and reasoning abilities (Malec et al, 1997;Ownsworth et al, 2002). Memory function including WMS-R General Memory Index (Trudel et al, 1998) and delayed recall (Noe et al, 2005;Trudel et al, 1998) have also been identified in some studies as a significant predictor variable for self-awareness.…”

“…Methods include comparing self-ratings to significant other or clinician ratings, such as the Patient Competency Rating Scale (PCRS) (Fleming et al, 1996;Sherer et al, 1998a), interviews (Fleming et al, 1996;Ownsworth et al, 2000), observation of actual task performance (Hart et al, 1998), comparison of patients' reports to neuropsychological performance (Allen & Ruff, 1990;Anderson & Tranel, 1989), comparison between patients' predictions of performance and actual performance (Gauggel et al, 2002;Fischer et al, 2004a) and more recently onlinemonitoring of errors (McAvinue et al, 2005;O'Keeffe et al, 2004). A number of researchers have highlighted the importance of using a number of different measures to assess the multi-faceted concept of self-awareness of deficits (Fischer et al, 2004a;Fleming et al, 1996).…”

Spider stimuli improve response inhibition

“…Indeed, from the motor perspective, self-reported task-related thoughts elicited after the SART likely reflect awareness of task performance and may even be influenced by performance itself (performance appraisal), e.g., a sportsperson following a match, stewing over a game in which they made many mistakes. McAvinue, O'Keefe, McMackin, & Robertson (2005) observed that people were aware of their SART commission errors 99.1% of the time. People are fully aware of their performance on the task.…”