Review of self-awareness and its clinical application in stroke rehabilitation

Abstract

The objectives of this study were (i) to explore, following a literature review, the concepts of self-awareness, its assessment, and intervention for self-awareness deficits, as well as its clinical significance in stroke rehabilitation; and (ii) to apply the concepts of self-awareness in the context of a rehabilitation program. The search was conducted by the electronic databases Web of Science, Science Direct, MEDLINE, and PsychcInfo. A systematic literature search of publications written in English between 1980 and 2010 was conducted using the keywords, self-awareness or self-regulation. The search was limited to the following keywords: stroke, deficits, assessment, intervention, and rehabilitation. Two important conceptual models, namely, the Pyramid Model of Self-Awareness and the Dynamic Comprehensive Model of Awareness, were reviewed. Suggestions were made to the constraint-induced movement therapy for enhancement of both assessment and treatment of self-awareness deficits. In conclusion, self-awareness is essential for the success of rehabilitation. It is hoped that more studies can be conducted on the effectiveness of awareness enhancement programs incorporated in on-going therapies can be conducted, so that the evidence base can be further built up in this evolving area of practice.

Treatment of Unawareness of Deficits in Patients With Acquired Brain Injury

“…As noted in previous reviews, researchers used different interventions to address impaired self-awareness. 27 The majority of the treatments included a combination of psychoeducation and feedback.…”

“…38,43 In one study, patients were included if they underestimated their memory deficits (incongruence between predicted memory performance and actual performance), 40 and in another study, patients had a SADI score greater than 0 (mean SADI score at baseline was 5). 25 Furthermore, studies reported high SRSI scores (range: 6-10), 42,44 high SADI scores (8), 39 and a large difference score on the AQ (range: [22][23][24][25][26][27][28][29][30] 42 at baseline. In 2 studies, baseline levels of awareness were not specified.…”

“…The objective of this article is to review the available treatment methods for impaired awareness and to provide a comprehensive summary of their effectiveness. The current review differs from previous reviews [26][27][28] in that it has no restriction on the type of brain injury, intervention, study design, and number of participants; it comprises a broad spectrum of research of interventions that aim to improve awareness of deficits. The following questions are addressed: (i) which interventions have been investigated and what are their specific characteristics and (ii) how effective were these interventions?…”

Metacognitive function poststroke: a review of definition and assessment

“…Few studies have explored the relationship between metacognition and stroke location, type and severity, or its clinical application in stroke care and rehabilitation 15 16. Stroke survivors may be particularly susceptible to metacognitive deficits, as neuropsychological disorders such as magnitude estimation deficit,17 anosognosia or anosodiaphoria, spatial neglect, and problems with emotional semantics and abstraction in stroke, are common 15.…”

Physical environments and community reintegration post stroke: qualitative insights from stroke clubs

“…Suggestive of the status and influence of the medical model of disability (Brandon and Pritchard 2011;Schuelka 2015), studies have considered the role of various person-related factors in aiding and/or impeding community reintegration including physical function (Carter et al 2000;Ostir et al 2005), mental health (Carter et al 2000), cognitive ability (robison et al 2009), self-efficacy (Pang, eng, and Miller 2007) and self-awareness (Leung and Liu 2011). Certain factors external to the individual, including social and professional support, have also attracted a degree of attention (Chau et al 2009;ellis-Hill et al 2009;nicholson et al 2013;robison et al 2009;Walsh et al 2014).…”