Rehabilitation of Confabulation: The Issue of Unawareness of Deficit

Abstract

Unawareness of deficit is a frequent consequence of brain injury. One striking manifestation of unawareness is confabulation-the spontaneous fabrication of false memories or the temporal displacement of real events, usually associated with frontal lobe impairment. This article outlines an interdisciplinary approach to rehabilitation for confabulation in the treatment of patients with aneurysm of the anterior communicating artery. A three-tiered approach is employed based on published studies on levels of unawareness. Treatment at level 1 is geared toward improving intellectual awareness, the ability to understand that one has an impairment. Level 2 addresses emergent awareness, the ability to recognize a problem when it is occurring. Level 3 of the intervention involves improving the ability to anticipate that a problem (confabulation) is going to occur. The use of this three-tiered program for treatment of confabulation can serve as a model for treatment of various other cognitive impairments often observed after brain injury.