Rehabilitation of Awareness of Deficits in Patients with Acquired Brain Injury: Applying a User-friendly Computerised Intervention Approach
Citation:Mary FitzGerald, 'Rehabilitation of Awareness of Deficits in Patients with Acquired Brain Injury: Applying a User-friendly Computerised Intervention Approach', [thesis]
FitzGerald MCC Thesis.pdf (Phd Thesis) 1.573Mb
This dissertation consists of three studies that examined the phenomenon of emergent awareness following acquired brain injury. Despite the putative influence that impaired emergent awareness can have on rehabilitation outcomes, there are few studies that have investigated the potential of improving this debilitating deficit. In the three studies of this thesis an intervention training programme was developed to explore the possibility of enhancing online emergent awareness. Relationships between neuropsychological, emotional and accuracy of metacognitive awareness and emergent awareness were explored in an attempt to clarify this vital everyday skill. The first study explored the differences in neuropsychological, emotional and metacognitive awareness across levels of emergent awareness in eighty-two participants. Impaired emergent awareness was characterised by high intra-individual variability (IIV), poor metacognitive awareness of executive dysfunction and cognitive failures. High emergent awareness was characterised by low IIV and high levels of executive behaviour, attention and metacognitive awareness. Emotional state and awareness of frontal systems behaviours did not influence emergent awareness. Knowledge of these relationships is valuable to guiding clinical practice in the rehabilitation process. The second study sought to uncover relationships between emergent awareness and metacognitive awareness of executive behaviours, functional competency, and cognitive failures in eighty-two participants. Data were categorised into under-, iv accurate and over-estimators based on discrepancy scores between self and family. Accurate estimators of metacognitive awareness of executive function demonstrated higher emergent awareness than under-estimators. Greater emergent awareness was related to greater awareness of cognitive failures. Higher IIV was related to poorer awareness of apathy. Over-estimation of cognitive failures and greater emergent awareness were related. Over-estimators of cognitive failures demonstrated more stable IIV than accurate estimators. Evidence of an interactional rather than hierarchical relationship between emergent, anticipatory and metacognitive awareness implies that improvement in one may enhance the others. The third study describes a computer-based intervention programme that was developed as part of this thesis to enhance emergent awareness. Twenty participants were required to monitor performance during a sustained attention task administered in eight sessions over four weeks. Ten received feedback-on-error and ten did not receive feedback. A further nine received no treatment. Emergent awareness increased in the treatment groups but not in the no treatment group from pre- to post-intervention suggesting that repetitive practice may engender processes of error detection, evaluation or the deployment of controlled processes that underpin awareness deficits following acquired brain injury. In summary, this thesis has demonstrated that it is possible to enhance impaired emergent awareness. Several characteristics indicative of frontal systems behaviour, functional competency and cognitive errors are associated with emergent awareness.
Author: FitzGerald, Mary
Type of material:thesis
Availability:Full text available