Tag Archives: aware

Mood and Awareness

It can be scary when a brain injury survivor lacks sufficient awareness of the full effect an injury has had upon his or her life.   It can be all too easy for a survivor in such a circumstance to engage in what could potentially be extremely risky behavior. For instance, if a survivor does not realize that he can no longer walk, he may attempt to get up from his wheelchair anyway to walk to the bathroom. This could lead to a terrible fall. Similarly, a survivor who is not aware that she now suffers from severe memory deficits may turn on a curling iron for her hair and forget to turn it off. This could lead to a fire. When survivors gain in awareness of their situations post-injury, families understandably feel much more at ease as these risky behaviors can only decline.

However, there is one downside to such improved awareness. When a survivor first becomes significantly aware of his or her deficits, he or she often experiences a marked decline in mood. The survivor is suddenly aware of the severity and implications of the injury. It is depressing to realize that life has changed, in some cases irrevocably, and that success over these new challenges can only come after many trials and tribulations. It is important that the loved ones of brain injury survivors understand that this decline in mood is natural and expected. This is the time when a psychologist, counselor or psychotherapist can step in and help the survivor adjust to his or her new situation. With therapy and support, most brain injury survivors will see an improvement in mood after this initial decline due to increased situational awareness.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org

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Anosognosia – Part I

Anosognosia is a scientific term meaning “lack of self-awareness.”  Many brain injury survivors suffer some form of anosognosia after their injuries.  Anosognosia will often find expression in a survivor’s inability to comprehend the full extent of the deficits he or she has been left with in the wake of an injury.  Part I of this series will explain about some of the common manifestations of and difficulties encountered due to anosognosia.

Anosognosia can cause many problems for brain injury survivors.  They may put themselves into risky situations because they do not realize how extensively their injuries have affected them.  For instance, prior to his admission to the Transitional Learning Center one of our patients with severe visual deficits attempted to drive his car.  This attempt resulted in the outcome of him flipping that car in a ditch.  If he’d had full awareness of and complete understanding regarding his deficits, he never would have gone through with such an obviously risky proposition.  His anosognosia therefore led to a very scary situation.

Wheelchair-bound survivors with anosognosia may endure falls because they will try to get up from their wheelchairs when a loved one or caretaker leaves them for a moment.  Were they fully aware of their deficits in this arena, they would remain in their wheelchairs in such situations.  Speech-impeded survivors with anosognosia may grow inappropriately angry that other people cannot understand their speech.  The survivor will often think that he or she sounds for the most part normal while in reality his or her speech is almost completely unintelligible.

Survivors with anosognosia tend to question or reject evaluations which show their deficits.  Since the survivor does not recognize their own deficits, the negative evaluation results appear confusing and bizarre.   For instance, a survivor with memory deficits may dismiss memory assessments as “stupid” or “useless.”  He or she may say “I could never do that test even before my injury” or “the doctor thinks he is smart but he is just a dummy.”  In truth, the assessments are not “stupid.”  The survivor is simply unable to detect the blind spots anosognosia has left obscuring perception of his or her own deficits.

Anosognosia can also lead brain injury survivors to question the very need for rehabilitation and medication.  Since he or she does not recognize the existence of any notable deficits, the patient can have a hard time seeing value in any treatment.  This will often frustrate family members who can easily observe the survivor’s deficits and understand how treatment will be of great benefit.  Sometimes in the absence of this recognition of a need for treatment, brain injury survivors with anosognosia will think that their family members or loved ones have sent them to treatment in order to simply get rid of them.

In many ways, anosognosia will magnify the impact of other brain injury deficits.  The survivor not only has to learn to manage life under the limits to capabilities that come with those more direct deficits,  but due to their lack of awareness it is hard for them to initiate methods by which to moderate those difficulties and avoid risks.  A survivor with poor memory already has enough difficulty remembering to take necessary medication.  If that survivor also suffers from anosognosia, he or she may also feel justified in refusing to write down medication times on a schedule in order to help bolster memory.

Hopefully this introduction gave the reader a basic understanding of anosognosia.  The next part of this series will address methods of improving anosognosia.

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org