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Predictors of persistent deficit unawareness in persons with TBI
Abstracts from the 18th Annual Meeting
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gender (F) and income level ( - ) were significantly related to ANS magnitude. Discriminant function analyses were then conducted to examine ANS frequency/magnitude group membership and results yielded ANS magnitude and frequency classification probabilities of 73.6% and 61.5%, respectively. The results may help the clinician select MHI clients likely to respond to treatment techniques focusing on ANS reduction by considering characteristics with predictive utility.
Campodonico, J. Predictors o f Persistent Deficit Unawareness in Persons with TBL Previous studies have shown that brain-injured patients lack awareness of their cognitive, behavioral and physical impairments. Awareness disturbances have been linked to poor rehabilitative outcomes and psychosocial adjustment. Some investigators attribute impaired deficit awareness to neurogenic factors (i.e., lesions of the frontal and/or posterior parietal regions), while others ascribe it to psychogenic factors (i.e., psychological "denial" or defensiveness). Yet, few empirical studies have examined the relative contribution of each factor on impaired deficit awareness. It may be that neurogenic factors lead to an initial alteration in conscious experience, but the prolongation of symptoms may be influenced by psychogenic factors. The purpose of this study was to determine the relative influence of the two factors on deficit awareness in TBI patients. Fifty-two patients (mean age = 29.4 years, SD = 12.6; education = 12.5, SD = 1.8) who sustained a traumatic brain injury (mean coma duration = 14.7 days, SD = 23.6) completed a battery of cognitive tests and psychological inventories on admission to an outpatient braininjury rehabilitation facility. Tests included the WAIS-R, Trail Making Test, Categories Test, and MMPI. Subjects were divided into two groups (low versus high scorers) on each test variable based on a median split of the sample distribution. Subjects completed an extended version of the General Self-Assessment Questionnaire (GSAQ) (McGlynn, Schacter, & Glisky, 1989) approximately 2 years later. This version of the G S A Q consists of 26 items that patients rated, on scale of 0 to 4 (0 = no difficulty, 4 = a great deal of difficulty), indicating the degree to which they experienced difficulties or changes in various aspects of memory, physical, and emotional functioning. Caregivers also rated patients on the GSAQ. A pair of 2 x 2 factorial A N O V A s were computed to assess whether raters (self and other) perceptions on the G S A Q differed between groups (low versus high scorers) on each of the cognitive tests and psychological inventories. For the Trail Making Test (Part B), results revealed a significant main effect for rater (F(1, 46) -5.8, p = .02), a nonsignificant effect for group (F(1, 46) = .06, p = .80), but a significant rater x group interaction (F(1, 46) = 5.34, p = .025). This indicates that patients with worse mental flexibility and simultaneous conceptual tracking at admission were more likely to under-rate their deficits at follow-up, relative to those with less impairment. Similarly, on the MMPI (K scale), there was a significant main effect for rater (F(1, 47) = 8.6, p --- .005), a nonsignificant effect for group (F(1, 47) = 3.7, p = .06), but a significant rater x group interaction (F(1, 47) = 4.6, p < .04). This indicates that patients who displayed more psychological defensiveness early on in their treatment were more likely to under-rate their impairments at follow-up. The rater x group interaction on the WAIS-R FSIQ and Categories Test failed to reach statistical significance. Post-hoc analysis revealed that Trail Making scores, but not K-scale scores, were associated with indices of disease severity. These results suggest that the continuance of impaired deficit awareness (as seen well after recovery) is a function of both deficits in "higher" cognitive functioning, associated with injury severity, and psychological defensiveness. Clinical and theoretical implications are discussed.
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gender (F) and income level ( - ) were significantly related to ANS magnitude. Discriminant function analyses were then conducted to examine ANS frequency/magnitude group membership and results yielded ANS magnitude and frequency classification probabilities of 73.6% and 61.5%, respectively. The results may help the clinician select MHI clients likely to respond to treatment techniques focusing on ANS reduction by considering characteristics with predictive utility.
Campodonico, J. Predictors o f Persistent Deficit Unawareness in Persons with TBL Previous studies have shown that brain-injured patients lack awareness of their cognitive, behavioral and physical impairments. Awareness disturbances have been linked to poor rehabilitative outcomes and psychosocial adjustment. Some investigators attribute impaired deficit awareness to neurogenic factors (i.e., lesions of the frontal and/or posterior parietal regions), while others ascribe it to psychogenic factors (i.e., psychological "denial" or defensiveness). Yet, few empirical studies have examined the relative contribution of each factor on impaired deficit awareness. It may be that neurogenic factors lead to an initial alteration in conscious experience, but the prolongation of symptoms may be influenced by psychogenic factors. The purpose of this study was to determine the relative influence of the two factors on deficit awareness in TBI patients. Fifty-two patients (mean age = 29.4 years, SD = 12.6; education = 12.5, SD = 1.8) who sustained a traumatic brain injury (mean coma duration = 14.7 days, SD = 23.6) completed a battery of cognitive tests and psychological inventories on admission to an outpatient braininjury rehabilitation facility. Tests included the WAIS-R, Trail Making Test, Categories Test, and MMPI. Subjects were divided into two groups (low versus high scorers) on each test variable based on a median split of the sample distribution. Subjects completed an extended version of the General Self-Assessment Questionnaire (GSAQ) (McGlynn, Schacter, & Glisky, 1989) approximately 2 years later. This version of the G S A Q consists of 26 items that patients rated, on scale of 0 to 4 (0 = no difficulty, 4 = a great deal of difficulty), indicating the degree to which they experienced difficulties or changes in various aspects of memory, physical, and emotional functioning. Caregivers also rated patients on the GSAQ. A pair of 2 x 2 factorial A N O V A s were computed to assess whether raters (self and other) perceptions on the G S A Q differed between groups (low versus high scorers) on each of the cognitive tests and psychological inventories. For the Trail Making Test (Part B), results revealed a significant main effect for rater (F(1, 46) -5.8, p = .02), a nonsignificant effect for group (F(1, 46) = .06, p = .80), but a significant rater x group interaction (F(1, 46) = 5.34, p = .025). This indicates that patients with worse mental flexibility and simultaneous conceptual tracking at admission were more likely to under-rate their deficits at follow-up, relative to those with less impairment. Similarly, on the MMPI (K scale), there was a significant main effect for rater (F(1, 47) = 8.6, p --- .005), a nonsignificant effect for group (F(1, 47) = 3.7, p = .06), but a significant rater x group interaction (F(1, 47) = 4.6, p < .04). This indicates that patients who displayed more psychological defensiveness early on in their treatment were more likely to under-rate their impairments at follow-up. The rater x group interaction on the WAIS-R FSIQ and Categories Test failed to reach statistical significance. Post-hoc analysis revealed that Trail Making scores, but not K-scale scores, were associated with indices of disease severity. These results suggest that the continuance of impaired deficit awareness (as seen well after recovery) is a function of both deficits in "higher" cognitive functioning, associated with injury severity, and psychological defensiveness. Clinical and theoretical implications are discussed.