Cognitive Rehabilitation: An Integrative Neuropsychological Approach

By Mckay Moore Sohlberg; Catherine A. Mateer | Go to book overview

9

The Assessment and
Management of Unawareness

Unawareness, a common result of acquired brain injury, produces significant barriers to recovery. Individuals who have limited understanding of the nature, degree, and/or impact of their impairments may be resistant to therapy or reluctant learners of compensatory behaviors to lessen their handicaps. The prevalence of unawareness following brain damage, coupled with the problems produced when an individual does not recognize his or her difficulties, has encouraged researchers and clinicians to expand their knowledge of this complex and uniquely human phenomenon.

Awareness disorders possess a certain allure, due to the fascinating interplay among neurological, psychosocial, and cognitive factors. Successful management requires clinicians to merge behavioral, psychotherapy, and neurorehabilitation traditions. For example, the management of a psychological denial may require focused counseling, while the treatment of an organically based unawareness may suggest a combination of cognitive awareness exercises and behavioral logs. Before we begin our clinical discussion, we must recognize the field's infantile understanding of awareness. An attempt to address the clinical syndrome of unawareness could be considered premature. However, as modeled by Damasio (1994), it is through working with patients who have damaged awareness as a result of neurological trauma or disease that we extend our knowledge of this incredible ability and disability. These patients illustrate the complex interplay between cognition and emotion and serve as a reminder of the rich integration of the human neuronal networks. That said, this chapter humbly begins with a discussion of definitional issues related to unawareness. The remainder of the chapter presents a clinical framework for assessing and managing problems of unawareness of self based on our current state of knowledge.

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