Knowing me, knowing who? Losing self-awareness after an acquired brain injury is one of the biggest barriers to rehabilitation. What ‘small change, big impact’ can OTs make here?

Reports suggest up to 97 per cent of brain injured people have impaired self-awareness, damaging their potential for successful functioning in everyday life.

Reduced self-awareness also impacts negatively on the outcomes of rehabilitation, including neuro occupational therapy.

Poor motivation, difficulty engaging, unrealistic goals and poor acceptance of compensatory strategies can make rehabilitation goals even harder to reach.

Self-awareness, therefore, plays a significant part in any treatment programme, but how can it be improved?

The force of feedback…

Feedback interventions are those which inform a person of the results of their behaviour or performance.

They can take the shape of verbal, written, audio or visual communications and can be provided in various settings, for individuals or groups, and at different frequencies.

Since the middle of the last century, researchers have been studying the impact of our self-awareness on how we function.

Only this year, a study of 56 patients showed those who took part in a structured intervention programme demonstrated greater improvement in self-awareness and functional outcome than those who did not. (1)

And in a separate review of 15 similar studies of unique interventions (2), all of them reported improvements in measures of everyday living.

The evidence, the researchers concluded, supported the use of intervention that featured elements of:

• Experiential practice and external feedback.
• Guided learning and discussion.
• Metacognitive strategy training, which helps us to understand our own learning process.

Seeing is believing…

Another, earlier study (3) looked more closely at different methods of intervention being used in order to assess their effectiveness.

Over 50 participants from inpatient and rehabilitation settings were asked to perform a meal preparation task on 4 different occasions.

They were assigned to three different feedback groups:

• Video plus verbal feedback.
• Verbal feedback alone.
• Experiential feedback (based on experience and observation).

The researchers then measured improvement in intellectual awareness, self-perception of rehabilitation, and emotional status.

The results showed the most effective outcome came from the combined video/verbal feedback method; if the participants could see it and talk about it, they performed better.

Happily, it was also noted that despite the enhanced self-awareness, there was no accompanying deterioration in the emotional states of any of the participants.

So, if Occupational Therapists are to help people with acquired brain injury successfully achieve their goals, then improving their self-awareness is key.

Further research is vital now to ensure methods of feedback are timely and effective.

Know me, know my story! Find out how timely and effective occupational therapy turned life around for brain injury survivor, Chris:

 Know me, know my story. 

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Further reading

What the experts say - stress and anxiety advice for brain injury survivors during the Covid-19 pandemic. Turn off the news, engage with nature, practice mindfulness, stick to a routine and suss your stressors ...

More resources to help brain injury survivors and their families during Covid-19 here: Krysalis public resources

Over 200 stay at home activities for brain injury survivors and their families ...

Twenty apps to boost brain injury rehabilitation ...

Covid-19 Brain injury and me - Diary of an ABI survivor ...

And so much more on our exclusive talking heads blog ...

References

1. Villalobos, D, et al. Improving Self- Awareness After Acquired brain Injury Leads to Enhancements in Patoents; Daily Living Functionality. s.l. : Brain Impairment, 2019.
2. Engel, L., et al. Optimising activity and participation outcomes for people with self-awareness impairments related to acquired brain injury: an interventions systematic review. s.l. : Neuropsuchological Rehabailition, 2019.
3. Schmidt, J, et al. Feedback Interventions for Impaired Self-Awareness following Brain Injury: A systematic review. . s.l. : Journal of Rehabilitation Medicine, 2011.