Awareness of disability and long-term outcome after traumatic brain injury.

The degree of long-term (7.41 yrs postinjury) impairment of disability awareness was quantified in 63 adults (aged 18–45 yrs) with closed-head injuries as the difference between self-ratings and staff ratings on the Scales of Independent Behavior. Other measures included the Wechsler Adult Intelligence Scale--Revised (WAIS--R), the Wechsler Memory Test—Revised, the Wisconsin Card Sorting Test, and ratings of actual functional status based on classifications in vocational and independent living level. Impaired awareness and its relationship to actual level of present vocational and residential status, maladaptive behaviors, attention and freedom from distractibility, and a measure of frontal system functioning was examined. Impaired awareness was significantly associated with lower vocational and residential status, maladaptive behavior, greater distractibility, and increased perseveration. Impaired awareness is directly proportional to duration of posttraumatic amnesia and general memory. Impaired awareness of disability appears to be a consequence of a general cognitive impairment rather than a specific deficit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)