Posts Tagged self-awareness

[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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