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Article Excerpt
According to the Center for Disease Control (2002), estimates of the number of people who have survived traumatic brain injury range from 2.5 million to 6.5 million, representing two percent of the U.S. population. The average incidence rate is currently 95 people with traumatic brain injury per 100,000 in the population (Center for Disease Control). During the years 1990 to 1995, the mean annual incidence rate of persons with traumatic brain injury, who were hospitalized and survived, was 260,000. Of these 260,000 persons with traumatic brain injury, thirty-five percent experienced the onset of a longterm disability (Center for Disease Control). Consequently, the estimated number of persons with traumatic brain injury who will incur long-term disability each year is estimated to be between 80,000 to 90,000 Americans (Center for Disease Control).
For persons with traumatic brain injury, awareness of deficits and positive perceptions of quality of life are essential prerequisites to successful rehabilitation after the injury (Trudel, Tryon, & Purdum, 1998; Brown, Gordon, & Haddad, 2000). Persons with traumatic brain injury who have low perceptions of quality of life often experience feelings of guilt, failure, and unhappiness, which may lead to depression (Fisher, 2005). Persons with traumatic brain injury who have a lack of awareness of deficits often have lack of insight into planning, lack of social judgment, impulsivity, difficulties adjusting to change and interpersonal problems, and low long-term psychological adjustment (Newman, Garmoe, Beatty, & Ziccardi, 2000; Wallace & Bogner, 2000). A clear understanding of how awareness of deficits and perceptions of quality of life can improve through group intervention can be helpful to rehabilitation professionals. Rehabilitation professionals can assist persons with traumatic brain injury better deal with their lack of awareness of deficits and low quality of life. This may, in turn, allow persons with traumatic brain injury to better adapt to the physical, mental, and emotional losses that they have incurred.
The failure to recognize the existence of a disease and its limitations is known as anosognosia, the absence of emotional concern or distress regarding one's losses or deficits (Giacino & Cicerone, 1998). Persons with traumatic brain injury go through the process of awareness of their deficits in a three-stage process: intellectual awareness, emergent awareness, and anticipatory awareness (Crosson et al., 1989). Intellectual awareness is the ability to understand at a certain level that a function is impaired or to understand the complications of the impairment. Emergent awareness is the ability to recognize a problem when it is occurring, which requires that the person reach a prior level of intellectual awareness before. Anticipatory awareness is the ability to anticipate that a problem will occur as a result of having some type of deficit. The failure for persons with traumatic brain injury to understand and recognize deficits reduces motivation for rehabilitation, leads to setting unattainable goals, unsuccessful community reentry, unsuccessful employment, and a high risk of conflicts with family members (Trudel, et al.).
Quality of life has become a very influential concept within rehabilitation and disability studies. The term 'quality of life' has been operationalized and defined in many ways by researchers. In rehabilitation and disability studies, quality of life includes social, psychological, physical well-being as well as health perceptions and opportunities (Patrick & Erickson, 1993). Physicians have often used the term quality of life to measure the effects of chronic illness in their patients in order to better understand how an illness interferes with a person's day-to-day life (Center for Disease Control, 2002). Similarly, public health professionals use health-related quality of life to measure the effects of numerous disorders, short and long-term disabilities, and diseases in different populations.
Researchers have examined awareness of deficits among persons with traumatic brain injury. Prigatano and Altman (1990) looked at the degree persons with traumatic brain injury underestimate their deficits. Sixty-four persons with traumatic brain injury and their family members were given the Patient Competency Rating Scale. The results showed persons with traumatic brain injury underestimated their deficits on ten out of 14 items on the scale (Prigatano & Altman). Also, the most underestimated deficits were associated with lack of emotional control and minimal social interaction.
Newman et al. (2000) examined persons with traumatic brain injury at eight weeks post-injury and at the time of discharge in the rehabilitation process to gain an understanding about how awareness of deficits changes over time. Participants who were an average of eight weeks post-injury underestimated their deficits compared to staff's perceptions and rated themselves as nearly independent long before independence was demonstrated. Between the two times that participants and staff were rated, the staff showed a marked improvement in rating participants' awareness of deficits over time while participants' awareness of deficits remained the same over time (Newman et al.).
Sherer, Hart, and Nick (2003) also examined the awareness of persons with traumatic brain injury, family members, and clinicians using the Awareness Questionnaire. Using the Wilcoxon's matched paired signed rank tests, clinicians rated the persons with traumatic brain injury as having less awareness of deficits than the persons themselves and family members (medians of 32 and 39, p<0.001). Also, family members' scores were significantly lower than persons with traumatic brain injury (medians of 39 and 48, p<0.001).
Researchers have examined persons with traumatic brain injury and...
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