Relationship of awareness of deficits and pre-morbid coping skills among rehabilitation clients

Abstract

One of the most striking deficits following brain injury is an unawareness of injury-related impairments (Anosognosia). It has been proposed that lack of awareness of impaired ability may be classified according to whether it has an organic or psychological origin. The purpose of this study was to investigate the utility of a test instrument, the Patient Competency Rating Survey (PCRS), in determining whether the lack of awareness of deficit exhibited by neurorehabilitation clients is organically based Anosognosia or a manifestation of psychological denial. Consenting consecutive patients (n=49) admitted to the neurorehabilitation unit of St. Joseph's General Hospital in Thunder Bay, Ontario were selected as the target sample for this investigation. Each subject was assigned to a brain injured (BI) or a non-brain injured (non-BI) group. The BI group (n=32) consisted of individuals who had sustained central nervous system damage affecting brain activity, and the non-BI group (n=17) consisted of individuals with neurological damage not directly impacting on brain activity. Each subject’s level of awareness of deficits was assessed using the PCRS, and his/her pre-morbid coping techniques were assessed using the Revised Ways of Coping Questionnaire (WOC-R). Comparison of the responses of BI (n=32) and non-BI individuals (n=17) on the PCRS revealed that the relative to the non-brain injured group, the brain injured group overestimated its ability on the following seven critical items; preparing own meals, dressing self, washing dishes, taking care of finances, keeping appointments on time, handling arguments with people well known to the individual, understanding new instructions. Correlations between these critical items and WOC-R coping scales indicated that psychological denial was not responsible for impaired awareness on four of the critical items. These analyses revealed moderate negative associations between; Positive Reappraisal and preparing meals; Positive Reappraisal and washing dishes; Seeking Social Support and washing dishes; Distancing and handling arguments with people well known to the individual. In addition, a moderate positive association was found between Accepting Responsibility and impaired awareness of deficit in taking care of finances. These results provide evidence that the critical items differentiate between organically and psychologically based impairments of awareness.