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Anosognosia is a scientific term meaning “lack of self-awareness.” Many brain injury survivors suffer some form of anosognosia after their injuries. Anosognosia will often find expression in a survivor’s inability to comprehend the full extent of the deficits he or she has been left with in the wake of an injury. Part I of this series will explain about some of the common manifestations of and difficulties encountered due to anosognosia.
Anosognosia can cause many problems for brain injury survivors. They may put themselves into risky situations because they do not realize how extensively their injuries have affected them. For instance, prior to his admission to the Moody Neurorehabilitation Institute one of our patients with severe visual deficits attempted to drive his car. This attempt resulted in the outcome of him flipping that car in a ditch. If he’d had full awareness of and complete understanding regarding his deficits, he never would have gone through with such an obviously risky proposition. His anosognosia therefore led to a very scary situation.
Wheelchair-bound survivors with anosognosia may endure falls because they will try to get up from their wheelchairs when a loved one or caretaker leaves them for a moment. Were they fully aware of their deficits in this arena, they would remain in their wheelchairs in such situations. Speech-impeded survivors with anosognosia may grow inappropriately angry that other people cannot understand their speech. The survivor will often think that he or she sounds for the most part normal while in reality his or her speech is almost completely unintelligible.
Survivors with anosognosia tend to question or reject evaluations which show their deficits. Since the survivor does not recognize their own deficits, the negative evaluation results appear confusing and bizarre. For instance, a survivor with memory deficits may dismiss memory assessments as “stupid” or “useless.” He or she may say “I could never do that test even before my injury” or “the doctor thinks he is smart but he is just a dummy.” In truth, the assessments are not “stupid.” The survivor is simply unable to detect the blind spots anosognosia has left obscuring perception of his or her own deficits.
Anosognosia can also lead brain injury survivors to question the very need for rehabilitation and medication. Since he or she does not recognize the existence of any notable deficits, the patient can have a hard time seeing value in any treatment. This will often frustrate family members who can easily observe the survivor’s deficits and understand how treatment will be of great benefit. Sometimes in the absence of this recognition of a need for treatment, brain injury survivors with anosognosia will think that their family members or loved ones have sent them to treatment in order to simply get rid of them.
In many ways, anosognosia will magnify the impact of other brain injury deficits. The survivor not only has to learn to manage life under the limits to capabilities that come with those more direct deficits, but due to their lack of awareness it is hard for them to initiate methods by which to moderate those difficulties and avoid risks. A survivor with poor memory already has enough difficulty remembering to take necessary medication. If that survivor also suffers from anosognosia, he or she may also feel justified in refusing to write down medication times on a schedule in order to help bolster memory.
Hopefully this introduction gave the reader a basic understanding of anosognosia. The next part of this series will address methods of improving anosognosia.
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