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The contribution of injury severity, executive and implicit functions to awareness of deficits after traumatic brain injury (TBI)

Published online by Cambridge University Press:  25 August 2010

NICHOLAS MORTON*
Affiliation:
Neurorehabilitation Services Tickhill Road Hospital, Doncaster, South Yorkshire
LYNNE BARKER
Affiliation:
Department of Psychology, Sheffield Hallam University, Sheffield, South Yorkshire
*
*Correspondence and reprint requests to: Nicholas Morton, Rotherham, Doncaster and South Humber Mental Health NHS Trust, Tickhill Road Hospital, Doncaster, South Yorkshire, DN4 8QL. E-mail: n.morton@nhs.net

Abstract

Deficits in self-awareness are commonly seen after Traumatic Brain Injury (TBI) and adversely affect rehabilitative efforts, independence and quality of life (Ponsford, 2004). Awareness models predict that executive and implicit functions are important cognitive components of awareness though the putative relationship between implicit and awareness processes has not been subject to empirical investigation (Crosson et al., 1989; Ownsworth, Clare, & Morris, 2006; Toglia & Kirk, 2000). Severity of injury, also thought to be a crucial determinant of awareness outcome post-insult, is under-explored in awareness studies (Sherer, Boake, Levin, Silver, Ringholz, & Walter, 1998). The present study measured the contribution of injury severity, IQ, mood state, executive and implicit functions to awareness in head-injured patients assigned to moderate/severe head-injured groups using several awareness, executive, and implicit measures. Severe injuries resulted in greater impairments across most awareness, executive and implicit measures compared with moderate injuries, although deficits were still seen in the moderate group. Hierarchical regression results showed that severity of injury, IQ, mood state, executive and implicit functions made significant unique contributions to selective aspects of awareness. Future models of awareness should account for both implicit and executive contributions to awareness and the possibility that both are vulnerable to disruption after neuropathology. (JINS, 2010, 16, 1089–1098.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2010

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References

REFERENCES

Alloy, L.B., & Abramson, L.Y. (1979). Judgement of contingency in depressed and nondepressed students: Sadder but wiser? Journal of Experimental Psychology, 108, 441485.CrossRefGoogle ScholarPubMed
Andrés, P., & Van Der Linden, M. (2002). Are central executive functions working in patients with focal frontal lesions? Neuropsychologia, 40, 835845.CrossRefGoogle ScholarPubMed
Banks, S.J., & Weintraub, S. (2009). Generalized and specific-symptom insight in behavioral variant frontotemporal dementia and primary progressive aphasia. Journal of Neuropsychiatry and Clinical Neurosciences, 21, 299306.CrossRefGoogle Scholar
Barker, L.A., Andrade, J., Morton, N., Romanowski, C.A.J., & Bowles, D. (2010). Investigating the ‘latent’ deficit hypothesis: Age at time of head injury, implicit and executive functions and behavioral insight. Neuropsychologia, 48, 25502563.CrossRefGoogle ScholarPubMed
Barker, L.A., Andrade, J., Romanowski, C.A.J., Morton, N., & Wasti, A. (2006). Implicit cognition is impaired and dissociable in a head-injured group with executive deficits. Neuropsychologia, 44, 14131424.CrossRefGoogle Scholar
Barker, L.A., Andrade, J., & Romanowski, C.A.J. (2004). Impaired implicit cognition with intact executive function after extensive bilateral prefrontal pathology: A case study. Neurocase, 10, 233248.CrossRefGoogle ScholarPubMed
Beldarrain, M.G., Grafman, J., de Valesco, I.R., Pascual-Leone, A., & Garcia-Monco, J.C. (2002). Prefrontal lesions impair the implicit and explicit learning of sequences on visuomotor tasks. Experimental Brain Research, 142, 529538.CrossRefGoogle Scholar
Benton, A.L., & Hamsher, K.deS. (1989). Multilingual aphasia examination. Iowa City, Iowa: AJA Associates.Google Scholar
Bogod, N.M., Mateer, C.A., & MacDonald, S.W.S. (2003). Self-awareness after traumatic brain injury: A comparison of measures and their relationship to executive functions. Journal of the International Neuropsychological Society, 9, 450458.CrossRefGoogle ScholarPubMed
Burgess, P.W., & Shallice, T. (1997). The Hayling and Brixton tests. Thurston, Suffolk: Thames Valley Test Company.Google Scholar
Crosson, B.C., Barco, P.P., Velozo, C.A., Bolesta, M.M., Cooper, P.V., Werts, D., et al. . (1989). Awareness and compensation in post-acute head injury rehabilitation. Journal of Head Trauma Rehabilitation, 4, 4654.CrossRefGoogle Scholar
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis Kaplan executive function system. College Station, TX: The Psychological Corporation.Google Scholar
Flashman, L.A., & McAllister, T.W. (2002). Lack of awareness and its impact in traumatic brain injury. Neurorehabilitation, 17, 285296.CrossRefGoogle ScholarPubMed
Forgas, J.P. (1998). On being happy and mistaken: Mood effects on the fundamental attribution error. Journal of Personality and Social Psychology, 75, 318331.CrossRefGoogle ScholarPubMed
Fleming, J.M., & Strong, J. (1999). A longitudinal study of self-awareness functional deficits underestimated by persons with brain injury. Occupational Therapy Journal of Research, 19, 317.CrossRefGoogle Scholar
Fleming, J.M., Strong, J., & Ashton, R. (1998). Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome. Journal of Head Trauma Rehabilitation, 13, 3951.CrossRefGoogle ScholarPubMed
Fleming, J., Strong, J., & Ashton, R. (1996). Self-awareness of deficits in adults with traumatic brain injury. Brain Injury, 10, 115.Google ScholarPubMed
Frith, C.D., & Frith, U. (2008). Implicit and explicit processes and social cognition. Neuron, 60, 503510.CrossRefGoogle ScholarPubMed
Godfrey, H.P.D., Partridge, F.M., Knight, R.G., & Bishara, S. (1993). Course of insight disorder and emotional dysfunction following closed head injury: A controlled cross sectional follow-up study. Journal of Clinical and Experimental Neuropsychology, 15, 503515.CrossRefGoogle ScholarPubMed
Hart, T., Whyte, J., Kim, J., & Vaccaro, M. (2005). Executive function and self awareness of “real world” behaviour and attention deficits following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20, 333347.CrossRefGoogle ScholarPubMed
Hart, T., Seignourel, P.J., & Sherer, M. (1999). A longitudinal study of awareness of deficits after moderate to severe traumatic brain injury. Neuropsychological Rehabilitation, 19, 161176.CrossRefGoogle Scholar
Kihlstrom, J.F., & Tobias, B.A. (1991). Anosognosia, consciousness and the self. In Prigatano, G.P., & Schacter, D.L. (Eds.), Awareness of deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press.Google Scholar
King, N. (1997). Mild head injury: Neuropathology, sequelae measurement and recovery. British Journal of Clinical Psychology, 36, 161184.CrossRefGoogle ScholarPubMed
Kouider, S., & Dehaene, S. (2007). Levels of processing during non-conscious perception: A critical review of visual masking. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences 362, 857875.CrossRefGoogle ScholarPubMed
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.), New York: Oxford University Press.Google Scholar
Lieberman, M.D. (2000). Intuition: A social cognitive neuroscience approach. Psychological Bulletin, 126, 109137.CrossRefGoogle ScholarPubMed
Mattson, A.J., & Levin, H.S. (1990). Frontal lobe dysfunction following closed head injury: A review of the literature. Journal of Nervous Mental Disorders, 178, 282312.CrossRefGoogle ScholarPubMed
Mild Traumatic Brain Injury Committee of the head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8, 8687.CrossRefGoogle Scholar
Miyake, A., Friedman, N.P., Emerson, M.J., Witski, A.H., Howerter, A., & Wager, T.D. (2000). The unity and diversity of executive functions and their contribution to complex ‘frontal lobe’ tasks: A latent variable analysis. Cognitive Psychology, 40, 49100.CrossRefGoogle Scholar
Morris, R.G., & Hannesdottir, K. (2004). Loss of “awareness” in Alzheimer’s disease. In Morris, R.G., & Becker, J.T. (Eds.), Cognitive neuropsychology of Alzheimer’s disease. Oxford: Oxford University Press.CrossRefGoogle Scholar
Nissen, M.J., & Bullemer, P. (1987). Attentional requirements of learning: Evidence from performance measures. Cognitive Psychology, 19, 132.CrossRefGoogle Scholar
Oddy, M., Coughlan, T., Tyerman, A., & Jenkins, D. (1985). Social adjustment after head injury: A further follow-up seven years after injury. Journal of Neurology, Neurosurgery, and Psychiatry, 48, 564568.CrossRefGoogle ScholarPubMed
O’Keeffe, F., Dockree, P., Moloney, P., Carton, S., & Robertson, I.H. (2007). Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online awareness. Journal of the International Neuropsychological Society, 13, 3849.Google ScholarPubMed
Ownsworth, T., Desbois, J., Grant, E., Fleming, J., & Strong, J. (2006). The associations among self-awareness, emotional well-being, and employment outcome following acquired brain injury: A 12-month longitudinal study. Rehabilitation Psychology, 51, 5059.CrossRefGoogle Scholar
Ownsworth, T., Clare, L., & Morris, R. (2006). An integrated biopsychosocial approach to understanding awareness deficits in Alzheimer’s disease and brain injury. Neuropsychological Rehabilitation, 16, 415438.CrossRefGoogle ScholarPubMed
Ownsworth, T.L., & Fleming, J. (2005). The relative importance of meta-cognitive skills, emotional status, and executive function in psychosocial adjustment following acquired brain injury. Journal of Head Trauma Rehabilitation, 20, 315332.CrossRefGoogle Scholar
Ownsworth, T.L., McFarland, K., & Young, R. (2000). Development and standardization of the Self-Regulation Skills Interview (SRSI): A new clinical assessment tool for acquired brain injury. The Clinical Neuropsychologist, 14, 7692.CrossRefGoogle ScholarPubMed
Ponsford, J. (2004). Cognitive and behavioral rehabilitation: From neurobiology to clinical practice. London: The Guildford Press.Google Scholar
Petrides, M., & Milner, B. (1982). Deficits on subject ordered tasks after frontal and temporal-lobe lesions in man. Neuropsychologia, 20, 263274.CrossRefGoogle ScholarPubMed
Prigatano, G.P., & Schacter, D.L. (Eds.). (1991). Awareness of deficit after brain injury: Clinical and theoretical issues. New York: Oxford University Press.Google Scholar
Prigatano, G.P. (2010). Advances in the study of anosognosia. New York: Oxford University Press.Google Scholar
Reber, A.S. (2002). Prologue in French, R.M. & Cleeremans, A. (Eds.), Implicit learning and consciousness: An empirical, philosophical and computational consensus in the making. London. Psychology Press.Google Scholar
Rich, J.B., Blysma, F.W., & Brandt, J. (1996). Self-ordered pointing performance in Huntington’s disease patients. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 9, 99106.Google Scholar
Rosen, H.J., Alcantar, O., Rothlind, J., Sturm, V., Kramer, J.H., Weiner, M., & Miller, B.L. (2010). Neuroanatomical correlates of cognitive self-appraisal in neurodegenerative disease. Neuroimage, 49, 33583364.CrossRefGoogle ScholarPubMed
Schacter, D.L. (1990). Toward a cognitive neuropsychology of awareness: Implicit knowledge and anosognosia. Journal of Clinical and Experimental Neuropsychology, 12, 155178.CrossRefGoogle Scholar
Schmitz, T.W., Rowley, H.A., Kawahara, T.N., & Johnson, S.C. (2006). Neural correlates of self-evaluative accuracy after traumatic brain injury. Neuropsychologia, 44, 762773.CrossRefGoogle ScholarPubMed
Seger, C.A. (1997). Two forms of sequential implicit learning. Consciousness and Cognition, 6, 108131.CrossRefGoogle ScholarPubMed
Seidler, R.D., Puroshotham, A., Kim, S.G., Ugurbil, K., Willingham, D., & Ashe, J. (2005). Neural correlates of encoding and expression in implicit sequence learning. Experimental Brain Research, 165, 114124.CrossRefGoogle ScholarPubMed
Sherer, M., Hart, T., Whyte, J., Todd, N.G., & Yablon, S.A. (2005). Neuroanatomic basis of impaired self-awareness after traumatic brain injury: Findings from early computed tomography. Journal of Head Trauma Rehabilitation, 20, 287300.CrossRefGoogle ScholarPubMed
Sherer, M., Hart, T., & Todd, N. (2003). Measurement of impaired self-awareness after traumatic brain injury: A comparison of the patient competency rating scale and the awareness questionnaire. Brain Injury, 17, 2537.CrossRefGoogle ScholarPubMed
Sherer, M., Boake, C., Levin, E., Silver, B.V., Ringholz, G., & Walter, M.H. (1998). Characteristics of impaired awareness after traumatic brain injury. Journal of the International Neuropsychology Society, 4, 380387.CrossRefGoogle ScholarPubMed
Stuss, D., & Alexander, M.P. (2007). Is there a dysexecutive syndrome? Philosophical Transactions of the Royal Society of London. Series B, Biological Science, 362, 901915.CrossRefGoogle Scholar
The Psychological Corporation (2001). Wechsler test of adult reading. San Antonio, TX: Harcourt Assessment.Google Scholar
Toglia, J., & Kirk, U. (2000). Understanding awareness deficits following brain injury. Neurorehabilitation, 15, 5770.CrossRefGoogle ScholarPubMed
Trahan, E., Pépin, M., & Hopps, S. (2006). Impaired awareness of deficits and treatment adherence among people with traumatic brain injury or spinal cord injury. Journal of Head Trauma Rehabilitation, 21, 226235.CrossRefGoogle ScholarPubMed
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio, TX: The Psychological Corporation.Google Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioural assessment of the dysexecutive syndrome. Bury St. Edmunds, England: Thames Valley Test Company.Google Scholar
Wise, K., Ownsworth, T., & Fleming, J. (2005). Convergent validity of self-awareness measures and their association with employment outcome in adults following acquired brain injury. Brain Injury, 19, 765775.CrossRefGoogle ScholarPubMed
Zajonc, R.B. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology Monograph, 9, 128.CrossRefGoogle Scholar
Zajonc, R.B. (1980). Feeling and thinking: Preferences need no inferences. American Psychologist, 35, 151175.CrossRefGoogle Scholar
Zigmond, A.S., & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.CrossRefGoogle ScholarPubMed
Wong, P.S., Bernat, E., Bunce, S., & Shevrin, H. (1997). Brain indices of nonconscious associative learning. Consciousness and Cognition, 6, 519544.CrossRefGoogle ScholarPubMed