Understanding awareness deficits following brain injury.

The critical role that awareness deficits play in contributing to rehabilitation outcome and independent functioning of brain injured adults is readily acknowledged by rehabilitation professionals. However, there are inconsistencies in the scope of what is included within the concept of awareness and the way in which it is measured within the literature. A comprehensive model of awareness is needed to guide the development of measurement tools and interventions. This paper expands upon concepts originally proposed by Crosson and colleagues [12] and proposes a comprehensive model of awareness that integrates parallel themes in cognitive psychology, social psychology and neuropsychology. It argues that a hierarchical view of awareness does not capture the complexities and subtleties of awareness symptoms and proposes a dynamic relationship between knowledge, beliefs, task demands and context of a situation. A distinction between knowledge and awareness, that one has prior to a task, and that, which is activated during task performance, is emphasized. Suggestions for expanding assessment and intervention methodology are derived from the perspective of research within the areas of metacognition and self-efficacy.