Sansonetti Danielle, Fleming Jennifer, Patterson Freyr, Lannin Natasha A
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Occupational Therapy Department, Alfred Health, Melbourne, Australia.
Neuropsychol Rehabil. 2022 Sep;32(8):1726-1773. doi: 10.1080/09602011.2021.1924794. Epub 2021 May 19.
Self-awareness is an important consideration in cognitive rehabilitation for clinicians working with individuals following acquired brain injury (ABI), with impaired self-awareness linked to poor outcomes. To appropriately target assessment and intervention for self-awareness, its theoretical foundation and definition must be considered. The aim was to identify the definitions, theoretical models and conceptual frameworks of self-awareness in adults with ABI, and how self-awareness is conceptualized within those models. A qualitative systematic review was completed using search terms related to descriptions of models/frameworks, ABI and self-awareness. Data were analysed by narrative synthesis. Thirty-five papers were included in the review. Within these, 13 models, 12 conceptual frameworks and 2 theories were described. The main themes and subthemes conceptualized in the synthesis were: Clinical presentation of self-awareness (classifications and dimensions of self-awareness), development of self-awareness (knowledge, feedback mechanisms, temporal aspects, self-evaluation, enablers, barriers), understanding (dys)function (cognitive processing mechanisms, neurological foundations, causal factors), and practice guidance (assessment and intervention). This review identified an extensive theoretical basis to support conceptualization of self-awareness following ABI, underpinned by a distinction between intellectual awareness, on-line awareness, and psychological denial. Clinical application of an evaluation process that includes these elements would be beneficial to inform the rehabilitation process.
对于为后天性脑损伤（ABI）患者提供服务的临床医生而言，自我意识是认知康复中一个重要的考量因素，自我意识受损与不良预后相关。为了恰当地针对自我意识进行评估和干预，必须考虑其理论基础和定义。本研究旨在确定ABI成年患者自我意识的定义、理论模型和概念框架，以及自我意识在这些模型中是如何被概念化的。通过使用与模型/框架描述、ABI和自我意识相关的检索词，完成了一项定性系统综述。采用叙述性综合分析法对数据进行分析。该综述纳入了35篇论文。其中描述了13种模型、12种概念框架和2种理论。综合分析中概念化的主要主题和子主题包括：自我意识的临床表现（自我意识的分类和维度）、自我意识的发展（知识、反馈机制、时间维度、自我评估、促进因素和障碍）、对（功能）障碍的理解（认知加工机制、神经学基础、因果因素）以及实践指导（评估和干预）。本综述确定了一个广泛的理论基础，以支持对ABI后自我意识的概念化，其基础是智力意识、在线意识和心理否认之间的区别。包含这些要素的评估过程的临床应用将有助于为康复过程提供信息。
