Impaired self-awareness is a significant barrier to successful rehabilitation. This paper presents a new guideline for practice, entitled Self-awareness Enhancement through Learning and Function (SELF).
Description:
The SELF is a newly developed guideline for practice, which incorporates the latest theoretical information from neuroscience, psychology and computer science regarding self-awareness, learning, cognition and care giving, with evidence of the importance of participation in occupation. The SELF provides clear evaluation and treatment postulates using therapeutic alliance, occupation, belief perspectives, brain education and compensatory strategies to improve self-awareness.
Discussion:
The current approach to the treatment of impaired self-awareness focuses on testing and performance feedback. This approach does not have evidence to support its effectiveness and there is some evidence that the approach actually contributes to emotional distress and increased denial of deficits.
Conclusion:
The SELF integrates the art and the science of occupational therapy to foster self-awareness in an empathetic and dignified manner. Occupational therapists are uniquely qualified, and should be leaders, in the integration of personal factors, environmental elements and occupations to improve self-awareness. The SELF provides occupational therapists with guidelines for using these interrelationships to restore self-awareness in a manner that builds confidence and skills.
AbreuBCSealeGScheibelRSHuddlestonNZhangLOttenbacherKJ (2001) Levels of self-awareness after acute brain injury: How patients‘ and rehabilitation specialists’ perceptions compare. Archives of Physical Medicine and Rehabilitation, 82(1), 49–56.
2.
AckermanSJHilsenrothMJ (2003) A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23(1), 1–33.
3.
AmodioDMFrithCD (2006) Meeting of minds: The medial frontal cortex and social cognition. Neuroscience, 7(4), 268–77.
4.
BanduraA (1989) Social cognitive theory. In: VastaR, ed. Annals of Child Development: Volume 6, Six theories of child development. Greenwich, CT: JAI Press, 1–60.
5.
BlackwellLTrzesniewskiKDweckCS (2007) Implicit theories of intelligence predict achievement across an adolescent transition: A longitudinal study and an intervention. Child Development, 78(1), 246–63.
6.
CavalloMMKayTEzrachiO (1992) Problems and changes after traumatic brain injury: Differing perceptions within and between families. Brain Injury, 6(4), 327–35.
CrossonBBarcoPPVelozoCABolestaMMCooperPVWertsDBrobeckTC (1989) Awareness and compensation in postacute head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4(3), 46–54.
9.
DiretteDK (2002) The development of awareness and the use of compensatory strategies for cognitive deficits. Brain Injury, 16(10), 861–71.
10.
DiretteDKPlaisierB (2007) The development of self-awareness of deficits from 1 week to 1 year after traumatic brain injury: Preliminary findings. Brain Injury, 21(11), 1131–36.
11.
DweckCS (1999) Self-theories: Their role in motivation, personality and development. Philadelphia: Taylor and Francis/Psychological Press.
12.
DweckCS (2008) Can personality be changed? The role of beliefs in personality and change. Current Directions is Psychological Science, 17(6), 391–94.
13.
DweckCSLeggettEL (1988) A social cognitive approach to motivation and personality. Psychological Review, 95(2), 256–73.
14.
EngbergAWTeasdaleTW (2004) Psychosocial outcome following traumatic brain injury in adults: A long-term population-based follow-up. Brain Injury, 18(6), 533–45.
15.
EngsterD (2005) Rethinking care theory: The practice of caring and the obligation to care. Hypatia, 20(3), 50–74.
16.
FischerSGauggelSTrexlerLE (2004) Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries. Brain Injury, 18(6), 547–62.
17.
FlemingJOwnsworthT (2006) A review of awareness interventions in brain injury rehabilitation. Neuropsychological Rehabilitation, 16(4), 474–500.
18.
FlemingJStrongJAshtonR (1996) Self-awareness of deficits in adults with traumatic brain injury: How best to measure?Brain Injury, 10(1), 1–15.
19.
GrantHDweckCS (2003) Clarifying achievement goals and their impact. Journal of Personality and Social Psychology, 85(3), 541–53.
20.
HoofienDGilboaAVakilEBarakO (2004) Unawareness of cognitive deficits and daily functioning among persons with traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 26(2), 278–90.
21.
JohnsonSCBaxterLCWilderLSPipeJGHeisermanJEPrigatanoGP (2002) Neural correlates of self-reflection. Brain, 125(8), 1808–14.
22.
KatzNHartman-MaeirA (1997) Occupational performance and metacognition. Canadian Journal of Occupational Therapy, 64(2), 53–62.
23.
KolitzBPVanderploegRDCurtissG (2003) Development of the Key Behaviors Change Inventory: A traumatic brain injury outcome assessment instrument. Archives of Physical Medicine and Rehabilitation, 84(2), 277–84.
24.
KortteKBWegenerSTChwaliszK (2003) Anosognosia and denial: Their relationship to coping and depression in acquired brain injury. Rehabilitation Psychology, 48(3), 131–36.
25.
LevineBStussDTMilbergWPAlexanderMPSchwartzMMacdonaldR (1998) The effects of focal and diffuse brain damage on strategy application: Evidence from focal lesions, traumatic brain injury and normal aging. Journal of the International Neuropsychological Society, 4(3), 247–64.
26.
LucasSEFlemingJM (2005) Interventions for improving self-awareness following acquired brain injury. Australian Occupational Therapy Journal, 52(2), 160–70.
27.
Lundy-EkmanL (2002) Neuroscience: Fundamentals for rehabilitation. 2nd ed.Philadelphia: WB Saunders.
28.
MangelsJAButterfieldBLambJGoodCDweckCS (2006) Why do beliefs about intelligence influence learning success? A social cognitive neuroscience model. Social Cognitive and Affective Neuroscience, 1(2), 75–86.
29.
MoseyAC (1996) Applied scientific inquiry in the health professions: An epistemological orientation. 2nd ed.Bethesda, MD: American Occupational Therapy Association.
30.
MuellerCMDweckCS (1998) Praise for intelligence can undermine children's motivation and performance. Journal of Personality and Social Psychology, 75(1), 33–52.
31.
NussbaumADDweckCS (2008) Defensiveness versus remediation: Self-theories and modes of self-esteem maintenance. Personality and Social Psychology Bulletin, 34(5), 599–612.
32.
PeloquinSM (2007) The issue is: A reconsideration of occupational therapy's core values. American Journal of Occupational Therapy, 61(4), 474–82.
33.
PortAWillmottCCharltonJ (2002) Self-awareness following traumatic brain injury and implications for rehabilitation. Brain Injury, 16(4), 277–89.
34.
PrigatanoGP (2005) Disturbances of self-awareness and rehabilitation of patients with traumatic brain injury. Journal of Head Trauma Rehabilitation, 20(1), 19–29.
35.
PrigatanoGPKlonoffPK (1998) A clinician's rating scale for evaluating impaired self-awareness and denial of disability after brain injury. Clinical Neuropsychologist, 12(1), 56–67.
36.
PrigatanoGPFordyceDJZeinerHK (1986) Neuropsychological rehabilitation after brain injury. Baltimore, MD: John Hopkins University Press.
37.
PrigatanoGPAltmanIMO'BrienKP (1990) Behavioral limitations that TBI patients tend to underestimate. Clinical Neuropsychologist, 4(2), 163–76.
38.
RollsET (2002) The functions of the orbitofrontal cortex. In: StussDTKnightRT, eds. Principles of frontal lobe function. New York: Oxford University Press, 354–75.
39.
SchonbergerMHumleFTeasdaleTW (2006) The relationship between clients' cognitive functioning and the therapeutic working alliance in post-acute brain injury rehabilitation. Brain Injury, 21(8), 825–36.
40.
ShererMBergloffPBoakeCHighWJrLevinE (1998) The Awareness Questionnaire: Factor structure and internal consistency. Brain Injury, 12(1), 63–68.
41.
ShererMHartTNickTGWhyteJThompsonRNYablonSA (2003) Early impaired self-awareness after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84(2), 168–76.
42.
ShererMEvansCCLeverenzJStouterJIrbyJWLeeJEYablonSA (2007) Therapeutic alliance in post-acute brain injury rehabilitation: Predictors of strength of alliance and impact of alliance on outcome. Brain Injury, 21(7), 663–72.
43.
SilviaPJDuvalTS (2001) Objective self-awareness theory: Recent progress and enduring problems. Personality and Social Psychology, 18(5), 230–41.
44.
StussDTAndersonV (2004) The frontal lobes and theory of mind: Developmental concepts from adult focal lesion research. Brain and Cognition, 55(1), 69–83.
45.
StussDTLevineB (2002) Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401–33.
46.
TeasdaleTWChristensenAWillmesKDelocheGBragaLStachowiakFVendrellJMCastro-CaldasALaaksonenRKLeclercqM (1997) Subjective experience in brain-injured patients and their close relatives: A European Brain Injury Questionnaire study. Brain Injury, 11(8), 543–63.
47.
TogliaJP (2005) A dynamic interactional model to cognitive rehabilitation. In: KatzN, ed. Cognition and occupation across the lifespan. 2nd ed.Bethesda, MD: American Occupational Therapy Association, 29–72.
VanderploegRDBelangerHGDuchnickJDCurtissG (2007) Awareness problems following moderate to severe traumatic brain injury: Prevalence, assessment methods, and injury correlates. Journal of Rehabilitation Research and Development, 44(7), 937–49.
50.
WagarBMThagardP (2004) Spiking Phineas Gage: A neurocomputational theory of cognitive-affective integration in decision making. Psychological Review, 111(1), 67–79.
51.
WillerBRozenthalMKreutzerJS (1993) Assessment of community integration following rehabilitation for traumatic brain injury. Journal of Head Trauma Rehabilitation, 8(2), 75–87.
52.
YlvisakerMHanksRJohnson-GreeneD (2002) Perspectives on rehabilitation of individuals with cognitive impairment after brain injury: Rationale for reconsideration of theoretical paradigms. Journal of Head Trauma Rehabilitation, 17(3), 191–209.
