Self-awareness in patients with acquired brain injuryclinical intervention and its impact on patient's functional independence

Resumen

Impaired self-awareness (SA) is a common symptom of patients after suffering acquired brain injury (ABI), affecting the rehabilitation process and achievements in terms of patients’ daily living functionality. This research has the global aim of addressing the concept of SA in ABI patients, and go deeper into the importance of considering the relevance of implementing specific intervention programmes in the context of the global rehabilitation process. It is presented through three independent although related studies. The first one was a systematic review of the literature focused on the role of SA in the rehabilitation of patients with ABI. The review evaluated the state of the literature in three relevant aspects of interest: the relationship between SA and cognitive functioning, specific intervention programs for SA and the relationship between SA status and daily living functionality. The results obtained showed that SA considered as a metacognitive process is linked to other higher order cognitive processes such as executive functions and memory. In addition, it was possible to verify that in the last decades different research had been carried out with the aim of designing and implementing specific intervention programmes on SA, and had proven their effectiveness. Given the need to evaluate the success of an SA intervention in terms of functional improvement, to date some studies have explored this relationship finding significant correlations between SA improvement achieved through intervention programmes, and better functional outcomes in the activities of daily living. The aim of the second study was to develop an intervention programme in SA for patients with ABI, as well as to test its efficacy in a group of patients who were involved in a global rehabilitation process in the National Centre for Brain Injury Treatment (CEADAC). They were compared with a control group, consisted of patients who also received a global rehabilitation but with no specific SA intervention. The results obtained showed that patients who received the specific SA intervention programme exhibited a significant improvement in SA compared to patients in the control group. Likewise, it was found that this improvement was observed in all SA dimensions explored: injury, deficit and disability. Finally, it was observed that patients with a lower initial level of SA before the intervention were those who showed a greater degree of improvement after being involved in the rehabilitation programme. The final goal of any rehabilitation program for patients with ABI should be to make them as independent as possible in their daily living activities. Therefore, the third study focused on this aspect. Results showed that patients receiving the specific intervention programme showed a greater degree of functional independence. The results showed a marginal correlation between the degree of improvement in SA and the degree of improvement in functional independence, so that patients with greater SA improvement (after the intervention programme) might exhibit greater functional improvement after the rehabilitation process. Then, we explored whether patient´s level of SA prior to the intervention programme could influence the relationship between its improvement and functional enhancement. The results showed a significant positive correlation, suggesting that patients with low initial level of SA, even experiencing significant improvements after the intervention programme, do not reach the required level to experience a substantial improvement in their functional outcome. Finally, this relationship was also studied with the whole sample of patients, showing that the enhancement in SA (induced or not by the specific intervention programme) was related to the increase in the degree of functional independence. The present research, despite limitations, allows for improvements and challenges for the future, and implies an extensive and applied approach to SA in patients with ABI. This work allowed us to investigate the main characteristics of those ABI patients who presented impaired SA, especially how to address their difficulties in terms of assessment and specific intervention. Reaching an improvement in SA will have a significant impact on patient´s life and their environment, influencing the rehabilitation process and its results on functional independence in the activities of daily living, with an important effect on their quality of life.