Hart Tessa, Sherer Mark, Whyte John, Polansky Marcia, Novack Thomas A
Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA 19141, USA.
Arch Phys Med Rehabil. 2004 Sep;85(9):1450-6. doi: 10.1016/j.apmr.2004.01.030.
To compare awareness of deficit in 3 domains of function (physical, cognitive, behavioral/emotional) in acute traumatic brain injury (TBI), controlling for severity of impairment in the different domains.
Inception cohort.
Three inpatient rehabilitation programs.
People with acute TBI (N=161), tested as soon as feasible after posttraumatic amnesia.
Not applicable.
Awareness Questionnaire (AQ) completed by the person with TBI and the treating neuropsychologist; and self- and clinician-rating scores calculated in the 3 domains.
For participants who were rated by clinicians as more impaired in at least 1 domain (ie, scored lower on the AQ), self-ratings differed significantly from one another in all 3 domains, with behavioral self-ratings highest, physical self-ratings lowest, and cognitive self-ratings intermediate. In subgroups of participants rated at the same level by clinicians in all 3 domains, physical self-ratings were also lowest, that is, more consonant with clinician ratings. Participants tended to rate themselves as relatively unchanged in cognitive and behavioral domains regardless of the level of clinician ratings on these factors.
Patterns of discrepant awareness of deficit in different functional areas seen in postacute TBI also appear to be present acutely and are not entirely related to differential severity of deficit. We discuss several possible reasons for discrepant awareness of deficit, including differences in internal and external feedback, cultural and psychologic factors, and different levels of ambiguity inherent in causal explanations for different types of problems.
比较急性创伤性脑损伤（TBI）患者在功能的三个领域（身体、认知、行为/情感）的缺陷意识，同时控制不同领域损伤的严重程度。
起始队列研究。
三个住院康复项目。
急性TBI患者（N = 161），在创伤后遗忘症后尽快进行测试。
不适用。
由TBI患者和主治神经心理学家完成的意识问卷（AQ）；以及在三个领域计算的自我评分和临床医生评分。
对于临床医生评定至少在一个领域损伤更严重（即AQ得分较低）的参与者，所有三个领域的自我评分彼此之间存在显著差异，行为自我评分最高，身体自我评分最低，认知自我评分居中。在所有三个领域临床医生评定处于同一水平的参与者亚组中，身体自我评分也最低，即与临床医生评分更一致。无论临床医生对这些因素的评分水平如何，参与者倾向于将自己在认知和行为领域的情况评定为相对未变。
急性TBI后不同功能区域存在的缺陷意识差异模式在急性期似乎也存在，并且并不完全与缺陷的不同严重程度相关。我们讨论了缺陷意识差异的几个可能原因，包括内部和外部反馈的差异、文化和心理因素，以及不同类型问题因果解释中固有的不同程度的模糊性。
