fact that awareness deficits are more typically associated with more severe injuries. The committee reviewed four studies of participants with moderate-severe injuries who were in the chronic stage of recovery—two RCTs (Cheng and Man 2006; Goverover et al. 2007) and two single-subject, multiple baseline experiments of treatments intended to improve awareness of deficits (Sohlberg et al. 1998; Toglia et al. 2010). The committee did not find any nonrandomized, parallel group studies or pre-post designs on awareness. Table 8-1 presents a summary of all included studies in this review.

Chronic Phase of Recovery, Moderate-Severe TBI

Randomized Controlled Trials

Goverover et al. (2007) examined the effects of an awareness training protocol embedded within the practice of instrumental activities of daily living (IADLs) as compared to IADL training without any self-awareness training. The 20 participants had moderate-severe injuries that occurred an average of about 10 months prior to trial entry; participants’ phase of recovery ranged between the subacute and chronic stages. Participants were randomly assigned to either group, and treatments were provided in six, 45-minute sessions, two or three times per week, across 3 weeks. Tasks were identical in the treatment and control groups; however, the treatment group participants were asked to predict their own performance on the IADL tasks and to self-evaluate performance immediately after tasks. They received immediate feedback from therapists, as well as instruction to write about their experiences in a journal. Improvement in task-specific self-awareness (AAD scores) was not significantly different between the groups. Improvement in a self-regulation skill inventory was significantly greater in the treatment group, after adjusting for baseline scores. Functional performance as reflected by Assessment of Motor and Process Skills (AMPS) scores also improved significantly more for the treated group than for the control group. Distal outcomes (e.g., secondary measures) were not significantly different between the groups, including an Awareness Questionnaire.

Cheng and Man (2006) investigated a newly developed Awareness Intervention Program (AIP) compared to a conventional rehabilitation program. The AIP focused on improving awareness of the patient’s disease and related deficits such as physical or cognitive function. The AIP included educational sessions based on the types of deficits manifested by the patients and functional training sessions, in which patients practiced setting performance goals and then evaluating their own performance against those goals. The conventional rehabilitation program included physical, functional, and cognitive aspects of occupational therapy. The 21 subjects participating in the study were in the subacute phase of recovery from



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