Executive Function and Self-awareness of “Real-world” Behavior and Attention Deficits Following Traumatic Brain Injury (TBI).

Past Studies

Past Studies have shown that individuals with moderate and severe TBI are less aware of difficulties with their performance after the injury. This is called “impaired self-awareness” or ISA. According to past research studies individuals with TBI do not always recognize their limitations in the areas of behavior and cognition (perception, memory, attention and reasoning skills). As a result, they may have difficulty accepting feedback or changing their behavior if they do not think it is inappropriate. They are more aware of their physical limitations because these limitations are obvious and have a more straightforward effect on their daily life activities.

Impairments in executive functioning (the ability to organize and maintain behavior and change self-direction) are commonly found in individuals with ISA. Difficulty controlling and adjusting their behavior and addressing difficult situations, using appropriate behaviors in these situations, may be related to ISA. Other studies of individuals with TBI found that neuropsychological tests of executive function predicted difficulty with concentration and attention on tasks, and showed individuals’ inability to be attentive to many tasks at once.

This Study

This Study compared the results of a group of 36 individuals with moderate to severe TBI who had some difficulties recognizing their abilities and problem solving to results from a group of 30 participants (the control group) with similar age, education, gender and race who did not have TBI. The authors thought that measuring and observing the way individuals with TBI operated in everyday “real-world” situations (for example, on the job, in school, in social interactions and stressful situations) would assist with predicting how well they understood how TBI caused them to have difficulties with participation in day-to-day activities.

This study examined the relationship between executive functioning and how aware individuals with TBI were of their behavior and attention problems using eight measures of executive functioning that were combined into one “Executive Composite (EC)”. How well the participants recognized problems with behavior and attention was measured by the participants themselves and also by their significant others using two questionnaires, the Dysexecutive Questionnaire (DEX) and the Cognitive Failures Questionnaire (CFQ).

Results showed that participants with TBI and their significant others reported more difficulties with daily living than reported by the control group on the DEX, but not on the CFQ. Individuals with TBI scored significantly worse on the EC than the control participants and showed more impaired self-awareness (ISA) than the control group. This was also confirmed by the reports of significant others who observed the participants with TBI. Based on these findings, it appears that there is a relationship between executive function and impaired self-awareness in individuals with moderate to severe TBI and that this impacts the way they perform everyday activities and tasks.

Who May Be Affected By this Study

Individuals with traumatic brain injury, caregivers and family members, health professionals, community providers and researchers.

Caveats

This study had a small sample size. Future studies should attempt to use a larger sample of individuals to determine if there is a connection between different populations with different levels of executive functioning and their ability to recognize their limitations as a result of TBI.

Bottom Line

Even with everyday deficits (impairments) that others recognize, individuals with TBI are less likely than uninjured counterparts to acknowledge the extent of their deficits. This study shows a relationship between executive functioning abilities and ISA, but not whether ISA causes difficulties with executive functioning (for example, the ability to plan, prioritize, sequence, self-monitor, self-correct, inhibit or alter behavior).

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