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PubMed2000

Self-awareness of traumatically brain injured patients in the acute inpatient rehabilitation setting.

The self-awareness of brain injured patients in an acute inpatient rehabilitation programme was measured using the Functional Self-Appraisal Scale (FSAS), which compares patient and staff ratings of patient performance on tasks relevant for acute rehabilitation and in a format that is easy to administer. There was a significant difference between patients' and staffs ratings near admission, consistent with previous findings in post-acute settings that brain injured patients tend to overestimate their abilities relative to other raters. Patient and staff ratings tended to converge at time of discharge, likely reflecting patients' improvements on rehabilitation tasks rather than increased self-awareness. The average difference between patients' and staffs ratings did not correlate with neuropsychological functioning on admission, supporting evidence that self-awareness early in the recovery process is a unique construct. Future research is outlined, including investigating the relationship of early levels of self-awareness following TBI to functional outcome.

Adolescent↗
PubMed2006

Subjective outcome of brain injury rehabilitation in relation to the therapeutic working alliance, client compliance and awareness.

OBJECTIVE: To investigate the relationship between working alliance, compliance, awareness and subjective outcome of brain injury rehabilitation. Subjects were 86 patients who were clients in an holistic neuropsychological outpatient rehabilitation programme. They had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or some other neurological insult (n = 10). MEASURES: The therapeutic alliance, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists. Clients completed the European Brain Injury Questionnaire (EBIQ) at programme start and end. Clients and therapists rated the overall success of their collaboration at programme end. RESULTS: Clients' experience of a good emotional bond between themselves and therapists in mid-therapy was predictive for the reduction of clients' report of depressive symptoms on the EBIQ depression sub-scale (R = 0.68, n = 43, p < 0.001). Good compliance early in the programme was predictive of changes on the EBIQ. Improvement of awareness was related to the amplification of depressive symptoms (r = -0.27, n = 56, p < 0.05). CONCLUSIONS: Brain injury rehabilitation should be seen as a dynamic process that develops between clients and therapists. Future research should further investigate the relationship between process and outcome and how the therapeutic process can be optimized.

Adult↗
PubMed1996

Road to awareness: an individualized training package for increasing knowledge and comprehension of personal deficits in persons with acquired brain injury.

Research suggests that awareness of one's deficits may be a significant factor in the recovery process after acquired brain injuries (ABI). Various methods have been employed to teach awareness of the potential sequelae of ABI. The present study extended the use of a board game format to teach awareness to adults with ABI who exhibited serious unwanted behaviours. It used an individualized training package in conjunction with a game format in order to more specifically target individual client awareness of personal deficits in two areas: cognition and behaviour. Training focused on the first three levels within Bloom's Cognitive Taxonomy: knowledge, comprehension, and application. Components of both the multiple-baseline and multiple-probe design were used to demonstrate experimental control. All three participants responded favourably to training, as evidenced by increases in percentage of questions answered correctly during the game sessions and in pre/post-generalization probes in both cognitive and behavioural categories.

Adult↗
PubMed1999

Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation.

Apathy and reduced self-awareness are frequent occurring neurobehavioural sequelae following traumatic brain injury (TBI). Apathy, in terms of reduced goal directed activity and lowered motivation, and reduced self-awareness have a negative impact on the rehabilitation process. In this study, 30 patients suffering severe TBI were clinically rated for apathy and monitored for cardiovascular and electrodermal reactivity during baseline, neutral speech and therapeutic interaction. Applying a cut-off score criterion, two thirds of the TBI sample were classified as apathetic. The apathetic patients showed less psychophysiological reactivity from neutral speech to therapeutic interaction, compared to non-apathetic patients. They also reported less perceived emotional discomfort in the therapeutic situation measured with a visual analogue scale. Moreover, reduced self-awareness was associated with low autonomic reactivity. The results suggest that the reduced psychophysiological reactivity in apathetic patients may be a correlate to the lack of emotional responsivity, disengagement, lack of insight and concern about their own situation. Clinically, these results may have implications for psychotherapeutic intervention aimed at improving self-awareness. Recording psychophysiological responses during therapeutic interaction may serve as a method for monitoring emotional involvement during psychotherapy with TBI patients.

Adolescent↗
PubMed2003

How does orthographic knowledge influence performance on phonological awareness tasks?

Three experiments explored the nature of orthographic influences on performance on phonological awareness tasks. Experiment 1 demonstrated that adults find it easier to perform phoneme deletions on items where there is a direct correspondence between letters and target sounds (e.g., take the /r[se text]/ from struggle) than where there is not (e.g., take the /w[see text]/ from squabble). Analogous results were found in a phoneme reversal task. Spelling production ability tended to correlate more strongly with performance on the former type of item than on the latter, suggesting that elevated performance on phonological awareness tasks is associated with the use of orthographic information. Experiment 2 produced similar results in Grade 5 children. Experiment 3 suggested that adults cannot inhibit orthographic activation when it is disadvantageous to them, as they performed no better on items such as squabble when they were presented in pure blocks than when they were presented in mixed blocks. It is concluded that there are substantial automatic orthographic influences on phonological awareness task performance that need to be taken into account in interpreting data concerning the relationship between phonological awareness and reading.

Adult↗
PubMed1998

Reinforcement without awareness: II. Word class.

In a previous study of reinforcement without awareness by Lieberman, Sunnucks, & Kirk (this issue), subjects were told that the experiment was on ESP; two words were presented on every trial, and their task was to choose the word the experimenter was thinking of. In fact, reinforcement was contingent on the loudness of the subjects' voices when responding. They found stronger evidence for reinforcement without awareness than in many previous studies, and they attributed their success in part to the reinforcement of a response to which subjects were unlikely to attend. To explore this factor further, we again used an ESP cover story but reinforced subjects for choosing the word in each pair that contained a double letter. We found evidence of reinforcement without awareness in three experiments and also identified two factors that influence these effects: Learning did not occur if subjects (a) were encouraged to test irrelevant hypotheses, or (b) sat in an uncomfortable chair. We speculate that learning without awareness may be more likely when subjects are relaxed and that hypothesis testing and uncomfortable chairs impair such learning because they prevent relaxation.

Adult↗
PubMed1999

A multifaceted educational approach to increasing awareness and use of physician data query (PDQ).

BACKGROUND: PDQ is a database developed by the National Cancer Institute that provides state-of-the-art information about cancer. A study was conducted to raise healthcare professionals' and patients'/families' awareness and use of PDQ's patient information file (PIF). METHODS: Educational presentations and poster displays were presented for health care staff to inform them of PDQ/PIF's attributes and how to access it. To expand awareness among patients and families, poster displays were presented in high-traffic areas; PDQ/PIF statements were redesigned and displayed in patient information racks. RESULTS: Among health care professionals, a 54% increase was observed in awareness of the PIF. A ninefold increase in the number of PDQ/PIF statements distributed to patients/families was reported. CONCLUSIONS: To maintain a level of awareness among health care professionals, a consistent educational strategy should be implemented. The number of PDQ/PIF statements distributed to patients and families increased, especially those redesigned for visual appeal.

Awareness↗
PubMed2006

Are people with mild cognitive impairment aware of the benefits of errorless learning?

Mild cognitive impairment (MCI) has been described as a memory deficit in the absence of other cognitive dysfunction. It can be thought of as a pre-clinical dementia. Memory impairment in this group is not as severe as in early dementia and thus learning is still possible. We were interested to see if errorless learning, a widely used rehabilitation technique, was of benefit to people with MCI. Since it has been shown that successful rehabilitation is somewhat contingent on awareness of function, we were also interested to see if people with MCI were aware of the benefits of errorless learning. The present study employed an errorless learning procedure on 16 people with MCI and 16 older adult controls to learn two lists of 10 words in errorless and errorful learning conditions. We adopted a metacognitive approach measuring people's memory monitoring through judgements of learning (JOLs) a prediction of future memory performance. The results revealed errorless learning is an effective memory rehabilitation tool for people with MCI, with significant increases in recall performance for both groups relative to errorful learning. Most interestingly participants were aware of the benefits of errorless learning in their JOLs. MCI participants and controls both had significantly higher JOLs for words studied under errorless learning conditions. The learning performance in MCI and theories of metacognitive awareness are discussed.

Aged↗
PubMedDate not supplied

Phonological awareness skills of 4-year-old British children: an assessment and developmental data.

This study reports developmental data for the phonological awareness and processing skills of 57 normally developing Tyneside preschool children, aged between 46 and 58 months. The children were assessed on eight tasks: consistency of word production, phonological variability according to speech production task, non-word imitation, syllable segmentation, rhyme awareness, alliteration awareness, phoneme isolation and phoneme segmentation. The results indicated that girls and boys performed similarly; socio-economic status significantly affected performance on six of the tasks; and age was significantly correlated with performance on tasks targeting alliteration, non-word imitation, phonological variability, and phoneme isolation and segmentation. The older children were more phonologically aware than the younger children.

Awareness↗
PubMed2004

Categorization, deductive reasoning, and self-awareness: association with everyday competence in persons with acute brain injury.

The present study examined the relationship between executive function, self-awareness and everyday functional competence in individuals with brain injuries. Executive function was assessed using measures of categorization and deductive reasoning ability, both of which were shown by multiple regression analysis to make significant contributions to the performance of Instrumental Activities of Daily Living (IADL), suggesting that both measures can serve as predictors of everyday functioning in persons with brain injuries. Self-awareness contributed significantly to functional competence, but its contribution was mediated through categorization ability. Executive function was correlated significantly with posttest performance estimation (self-evaluation of own performance), but not with self-prediction of test performance prior to testing. The results are discussed within the framework of a conceptual model illustrating the multifaceted nature of executive function and its relationship to self-awareness and everyday functional competence. The results of this study indicate that categorization, deductive reasoning, and self-awareness of individuals with brain injury are good predictors of IADL functional performance, and can help in planning better treatment interventions.

Activities of Daily Living↗
PubMed2001

Environmental tobacco smoke exposure of young children--attitudes and health-risk awareness in the Nordic countries.

AIMS: To assess attitudes towards environmental tobacco smoke (ETS) and health-risk awareness regarding the potential hazards of ETS for children among parents of young children in the Nordic countries. Also to investigate to what extent these factors are related to ETS exposure of the children. DESIGN: A cross-sectional community-based survey using an anonymous mailed questionnaire. PARTICIPANTS: Parents of children aged 3 years at the time of selection from a random sample of 5500 households in the Nordic countries (Sweden, Norway, Denmark, Iceland and Finland). MAIN OUTCOME MEASURES: Smoking status of parents, weekly ETS exposure of children within and outside the home, health-risk awareness and attitudes regarding the potential hazards of passive smoking. FINDINGS: Two in three parents who smoked did not recognize the increased risk for an inner ear infection and approximately 50% were not aware of the role of parental smoking in recruiting smokers. One in two smokers tended to agree or agreed that an act should be passed which forbids all indoor smoking in the vicinity of children. After adjustment for covariates, the level of health-risk awareness about ETS was significantly related to no ETS exposure within and outside the home. CONCLUSION: The main findings indicate that educating parents about the established health risks of ETS for their children may significantly reduce children's exposure to ETS. An increased effort is needed to educate parents who smoke on the potential health risks of ETS for their children.

Attitude to Health↗
PubMed2005

Subjective awareness on the Iowa Gambling Task: the key role of emotional experience in schizophrenia.

The key role of emotion in complex decision-making is commonly assessed using the Iowa Gambling Task, and has recently been a substantial research topic in neuropsychology. However, the question of subjective experience on such emotion-based learning measures has yet to be fully investigated, largely because previous studies have focussed primarily on behavioral performance measures. The present study investigated subjective experience on the Gambling Task, using a more systematic and quantitative method than that previously employed: evaluating the ability of participants to 'interrogate' emotion-based learning systems. The study also investigated subjective experience in a population (people with schizophrenia) in whom the question of emotional awareness is of special interest. People with schizophrenia showed learning on the Gambling Task at levels entirely comparable with that of controls. Both groups of participants also showed substantial, and rapidly developing, awareness of which decks were 'good' and 'bad'. Importantly, greater awareness was a significant correlate of good performance on the Gambling Task, for both groups, suggesting that there may be greater conscious awareness of emotion-related information in complex decision-making than had previously been appreciated.

Adult↗
PubMed2004

Awareness, prevalence, medication use, and risk factors of acute mountain sickness in tourists trekking around the Annapurnas in Nepal: a 12-year follow-up.

Acute altitude exposure may lead to acute mountain sickness (AMS). Increased awareness of altitude-related health hazards in trekkers may accompany a decrease in AMS prevalence. We compared awareness and AMS prevalence in trekkers in two cohorts on an altitude trek up to 5400 m and assessed risk factors for AMS by repeating an observational cohort study 12 yr after an initial study. Questionnaires in English were distributed to two cohorts of 500 trekkers in 1986 and 1998. All trekkers over a several day period were asked to participate. Average participation rate was 62% (71% in 1986 and 53% in 1998). We found an increase in AMS awareness in trekkers from 80% to 95%, a decrease in AMS prevalence from 43% to 29%, and significant slower climbing profiles. We found no relationship between AMS and smoking habits, body mass index, oral contraception intake, or training status. By contrast, age was a strong independent risk factor inversely related to AMS. Subjects over 55 yr were 2.6 times less likely to suffer from AMS than subjects under 25 yr. Self-medication, including acetazolamide and analgesics, had increased importantly from 17% to 56%, and contraception intake in women had increased from 19% to 32%. In conclusion, in 1998 as compared to 1986, trekkers were older, climbed more slowly, had better awareness of altitude illness, used more medication, and suffered less from AMS.

Acclimatization↗
PubMed2003

Understanding nutrition communication between health professionals and consumers: development of a model for nutrition awareness based on qualitative consumer research.

BACKGROUND: Consumers have been exposed to nutrition information from a variety of sources, including the family doctor. They are often not aware of their own risk behavior regarding nutrition. OBJECTIVE: This study sought to assess food associations, conversation topics, interest in food topics, and use of information sources by means of qualitative consumer research. Another aim was to provide a hypothetical model for nutrition awareness that could be tested in a quantitative survey. DESIGN: Three focus groups with 30 Dutch consumers altogether were carried out. Qualitative data were analyzed with the computer software program NUD*IST (QSR, Melbourne) by sorting text blocks into categories, and new themes emerged. In addition, a hypothetical model for nutrition awareness was developed. RESULTS: Consumers associated food most often with safe food, and food safety was the topic most often discussed. Tasty food was the most important food conversation topic. The family doctor was the information source most talked about. Furthermore, consumers possibly lacked some nutrition awareness. CONCLUSIONS: Careful analysis revealed new themes (new in the past 10 y), such as concerns about food safety and reconsideration of the roles of family doctors and dietitians. Based on these themes, recommendations for nutrition communication were composed.

Adolescent↗
PubMed2003

Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia.

BACKGROUND: Some studies support the view that meaningful auditory input can be processed by the brain during apparent surgical anaesthesia. Consequently, patients may be able to remember some information implicitly after anaesthesia as well through a 'dream-like process' (subconscious awareness). The aim of this study was to investigate the presence of subconscious awareness during anaesthesia and to examine its relationship to the mid-latency auditory evoked responses (MLAERs). METHODS: We studied 40 patients, ASA I-II, undergoing laparoscopic cholecystectomy. General anaesthesia was induced with thiopental 5 mg kg(-1), fentanyl 3 micro g kg(-1), and vecuronium 0.08 mg kg(-1). For the maintenance of anaesthesia, patients were randomly assigned to one of four anaesthetic regimen groups: sevoflurane+air in oxygen 40%; sevoflurane+nitrous oxide 60%; isoflurane+air in oxygen 40%; and isoflurane+nitrous oxide 60%. MLAERs were recorded before anaesthesia, at 1 MAC of inhaled anaesthetic and then 30 min after awakening. An audiotape with one of four stories was played immediately after intraoperative MLAER recording. Explicit and implicit memory was assessed 24 h after awakening. RESULTS: None of the patients had explicit recall. One of the patients from the isoflurane-air group showed implicit memory of listening to the audiotape. A dream-like process, in which they remembered implicitly the story played during anaesthesia, occurred in one of the patients from the sevoflurane-nitrous oxide group. In the patients with subconscious awareness, MLAERs were similar to that of the awake state with a Pa latency increase of less than 8.87. When there was a marked increase in Pa latency during anaesthesia, no subconscious awareness was observed. No statistically significant differences were found between Pa latency before and after anaesthesia. CONCLUSIONS: MLAERs may help to predict subconscious cerebral processing of auditory inputs during anaesthesia.

Adolescent↗
PubMed1995

Awareness of and memory for arm weakness during intracarotid sodium amytal testing.

The traditional association between anosognosia for hemiplegia and the right hemisphere was investigated in 31 patients with unilateral temporal lobe pathology during intracarotid sodium amytal testing (ISA) before epilepsy surgery. Recall of arm weakness was examined by questioning at the end of the test, when memory for items presented during the hemiplegia was also examined. Significantly more patients were amnesic for left arm weakness than for right. Amnesia for right arm weakness (and speech arrest) was significantly associated with pathology in the temporal lobe on the non-injected side and with impaired recognition of the memory items. Amnesia for left arm weakness was independent of both. Examination of cases where injection was contralateral to a hemisphere without pathology, and which showed normal memory capacity under ISA conditions, revealed that 87% recalled right arm weakness, but only 22% recalled left arm weakness. Awareness of arm weakness during left hemiplegia was examined in nine patients. Five of them were not aware of the weakness. Three of the four others could not subsequently recall it. By inference from the generally unimpaired recall of right arm weakness, following left hemisphere inactivation by amytal, an intact right hemisphere is capable of both recognizing right arm weakness and mediating its subsequent recall. In contrast, the left hemisphere was aware of left arm weakness only in approximately 50% of cases and even when there had been awareness usually could not mediate its subsequent recall. The suggestion is made that the right hemisphere may have a specific mnestic function for arm weakness, and presumably for hemiplegia, additional to the gnostic function.

Adolescent↗
PubMed1999

Differential pupillary constriction and awareness in the absence of striate cortex.

The fact that the pupil constricts differentially to visual stimuli in the absence of changes in light energy makes it a valuable tool for studying normal function as well as residual capacity in hemianopic subjects. When pupillometrically effective stimuli such as equiluminant gratings or coloured patches with an abrupt onset and offset are presented to the 'blind' hemifield, a hemianopic subject with damage largely restricted to striate cortex (V1) sometimes reports being 'aware' of the transient onset/offset, although without 'seeing' as such. The question addressed here is whether the pupil still responds in the condition of blindsight in its strict sense--i.e. discriminative capacity in the absence of acknowledged awareness--when stimuli are deliberately designed to eliminate awareness. This was accomplished by making stimulus onset and offset slow and gradual. The results with a well-studied hemianope, G.Y., demonstrate that there is still a pupillary constriction to isoluminant achromatic gratings and red-coloured stimuli, although reduced in size, in the absence of acknowledged awareness.

Accidents, Traffic↗
PubMed2002

Aware or unaware: assessment of cortical blindness in four men and a monkey.

In four patients and one monkey with unilateral visual field defects caused by retro-geniculate lesions we measured forced-choice localization of square-wave gratings as a function of contrast, and compared results from the patients' absolutely and relatively blind fields. In addition, the patients indicated verbally whether they were aware of the stimuli. We then switched to a signal detection task in which the subjects had to signal a stimulus as in the localization task, by touching it, no matter whether it appeared in the good or bad hemifield, and in addition to signal a blank trial by touching an outlined square now constantly present on the monitor, and designated the no-stimulus response area. In this way, we could compare a non-verbal procedure that we had previously used in hemianopic monkeys with a verbal one commonly used to assess visual awareness. The results showed a close correspondence between the two measures of awareness in the human subjects who signalled 'stimulus' only for targets that also evoked verbal aware responses, validating the non-verbal approach. The hemianopic monkey behaved more like a patient with an absolute rather than a relative defect, and perfectly localized high-contrast stimuli which she nevertheless treated as blanks in the vast majority of presentations in the signal detection task.

Animals↗