Posts Tagged self-awareness

[BLOG POST] Shuffled Neurons, and Other Speed Bumps in The Search for Self-Awareness

By Bill Herrin

Self-awareness after a brain injury

Experiences in life make us who we are – they can intrinsically change who we are for better or worse, sometimes in a temporary way, and sometimes for the rest of our lives. There are things that happen that we’ll cherish, things we look back on and laugh about, things that we’d rather not think about…and then there are things that we won’t even recall. TBI can be like a thief in the night…slipping away with treasured memories and leaving us with little to work with. But take heart, because as the old saying “time heals all wounds” actually rings true, especially in the realm of brain injury. When a brain is injured, the severity really depends on where the injury occurred, the level of the impact, and to some degree – whether the trauma was over the line of being able to overcome or not…not to mention that every person’s brain is as different as their TBI.

Every TBI is Personal

The different levels of self-awareness that arise from having a TBI can spark debate because everyone’s TBI is personal to them, but their self-awareness will never be exactly like someone else’s…although there will be common similarities. That’s where we should focus – on the broad similarities that we can all relate to, and support each other in. For survivors and their friends, families and beyond, there can be friction – often caused by the survivor saying “I don’t need help, I’ll be fine” to someone telling a survivor “you don’t look injured, you’ll be fine.” That’s a hard pill to swallow, especially when the survivor has isolated themselves or if their family has withdrawn from trying to encourage or help them because of previous resistance.

Self-Awareness Doesn’t Come Easy

Awareness of how you’ve changed after a TBI may be harder to do than many realize. I’ll be referencing some points regarding self-awareness from a Lash & Associates “tip card” (an 8-page brochure that they sell) that is packed with great advice for survivors, therapists, clinicians, families, and caregivers. These excerpts will be highlighted in italics.

Why is Self Awareness Important?

Self-awareness is the ability to view ourselves somewhat objectively. It is also the ability to see ourselves from the perspective of other people. It allows us to use feedback from others as we develop our personal identity. We rely on self-awareness when we…

  • interact socially with others
  • decide what situations or information to share
  • make judgments about ourselves, and
  • act in ways that ensure our personal safety.

Brain injury can impair the critical capacity for self-awareness.”

The previous sentence says so much because impairments in self-awareness come from different causes, and can show up at any time – and every person with a TBI will have different impairments or limitations of varying degrees. Hence, their own ability to assess their self-awareness is negligible in many cases. Damage in different parts of the brain can impair self-awareness in ways other than judgment – such as awareness of paralysis of certain parts of the body, awareness of loss of memory, problem-solving skills, reasoning, or being unable to anticipate consequences of decisions (based, in part, by lack of recall of it happening at a prior point in time, etc.)

“What Helps Unawareness?

Working on awareness can help people make better decisions. Efforts to increase a person’s understanding of abilities/disabilities must be done in a manner that preserves self-esteem. A healthy sense of self is critical for recovery. The two primary methods to address impaired self-awareness are education and structured feedback.

Both require an interpersonal bond between the person delivering information or feedback and the individual with impaired self-awareness. It is also important to have an environment that helps the person learn about strengths and weaknesses while still maintaining hope.”

The deficits of self-awareness can be obvious to family, friends, caregivers, and clinicians, and many times be quite frustrating. Helping a survivor to have a clear vision of their actual cognitive and physical abilities should be addressed with patience, positivity, and prudence.

“The goal of feedback is to orient individuals to the aspects of their performance that they do not accurately perceive. It is very important to balance feedback for problem areas with feedback for strengths.

Regardless of the approach used to help someone increase self-awareness, the person in the role of therapist, coach or caregiver needs to have a positive bond or connection with the individual. In order for a person to accept feedback, the person needs to feel that there is a partnership. The clinical term for this partnership is therapeutic alliance.”

In closing, it’s important to realize that everyone has the potential for unrealistic self-awareness – it’s what the long-running TV show “American Idol” was built upon…people whose self-awareness about their vocal abilities may have been bolstered by false praise, or just delusions of grandeur…many times, the people that go on the show with a humble approach are the ones that blow the judges away!!

Help your friend, colleague, partner, family member achieve a realistic understanding of where they are, but help foster a vision for them that will lead them to further improvements through encouragement, suggestions, positivity, strong communication, realistic goals, and love. Dealing with a huge change in self-awareness is complex and there is no “set route” to get to the next level. Understanding this helps both the caregiver and the survivor to make progress on the best terms possible.

The tip card “Changes in Self Awareness” is written by written by McKay Moore Sohlberg, Ph.D. and is available for just $1.00 at www.lapublishing.com/brain-injury-self-awareness-survivor/  – it’s a great resource for families or clinicians.

via Shuffled Neurons, and Other Speed Bumps in The Search for Self-Awareness

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[BLOG POST] A Brain Injury Life – formerly TBI to LIFE

Perception of Self after Brain Injury

Lately I’ve been wondering whether brain injury really changed the person I am or if it just added a new layer to my old self.  It may be impossible to articulate and probably unanswerable. Obviously, an injury physically changes how the brain works and directly causes a host of problems—physical pain, cognitive deficits, and the loss of identity (e.g. the tendency to ask existential questions like this). But cause and effect are not always clear. There are many problems that could be organic or could just as well be new incarnations of innate character traits.

I’ve gotten used to the idea that everything different in my life since my TBI has either been caused by the brain injury or what I learned in my neuropsychological rehabilitation. But what if there are fewer changes than I imagined? Am I still who I was but with some parts missing? That would explain the feeling of being lost in a foreign land.

For example, I used to think I was always right. But if brain injury has altered me functionally (it has, now I am often wrong), while leaving my sense of self intact (i.e. I still see myself as in the right), my perception would contradict reality. Since I’m nothing if not logical, one or the other would have to give. The belief of always being right could, unconsciously, be directed somewhere else. So instead of being convinced that my answers were better, I’d think I was wiser because I’d learned the best strategies, and was convinced that I could recognize a brain injury—or deficit—intuitively and in the moment. Which I am.

Does that make any sense? One more try:

If brain injury changed the life I lived—the structure, productivity, and satisfaction—but not who I think I am in life, it would explain why I feel rudderless. I keep trying to find my place in the world, a goal I can realistically accomplish and the initiation to follow through. Instead, I feel like I have no purpose. I come up with labels to define myself like an advocate (really?), a leader in the community (since when—6 years ago?), or educating people about brain injury (who am I teaching?). So what’s up with that?

All I can say with certainty is that the feeling of being unmoored seems to grow deeper as time passes.

via A Brain Injury Life – formerly TBI to LIFE

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[Abstract] Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.

Abstract

Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).

Design: Observational. Setting: Outpatient rehabilitation hospital.

Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.

Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.

Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>−2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<−2 z cognitive composite).

Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness.

This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

via PsycNET Record Display – PsycNET

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[THESIS] Bridge/Adapt: A Systematic Cognitive Rehabilitation Curriculum -Full Text PDF

Abstract

Cognitive impairment, including deficits in memory, attention, visual perception, executive functioning, and self-awareness, is a common consequence of acquired brain injury (ABI). Subsequently, these cognitive impairments result in functional impairments in daily life activities for clients with ABI.

Rehabilitation efforts are categorized under two broad approaches: remediation and adaptation. Computer-assisted cognitive retraining (CACR) is a remediation approach using a computer platform to deliver cognitive exercises. CACR therapy can lead to improvements in memory and attention for adults with chronic ABI. However, memory and attention improvements from CACR may not carry over to functional improvements in occupational performance. Research suggested that therapy using an adaptive approach can yield functional improvements.

The purpose of this project was to design a systematic cognitive retraining curriculum, Bridge/Adapt, to bridge the gap between memory and attention-skill gains from CACR to functional improvements in occupational performance using adaptive strategies. The Bridge/Adapt curriculum incorporates the cognitive orientation of occupational performance (CO-OP) intervention approach, multicontext approach, and goal oriented attentional self-regulation training.

The curriculum includes eight modules that provide grading options so that occupational therapists can choose which difficulty level best suits the client. Clients practice adaptive strategies during simulations of instrumental activities of daily living (IADL), including financial management, appointment scheduling, and grocery shopping, utilizing the three themes in Bridge/Adapt: salience, context, and hierarchy. Clients use salience to choose meaningful goals to work on at home. Context refers to clients working on goals in varying environments. Lastly, clients work on tasks that increase in complexity with the hierarchical theme.

Full Text PDF

 

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