Clinician Reports of Self-Awareness after Traumatic Brain Injury: A Retrospective Chart Review

Background: Impaired self-awareness (i.e., lack of insight) is experienced by most individuals after a moderate to severe traumatic brain injury (TBI). These individuals do not recognize their abilities and limitations which can negatively impact daily life and function. Although there are evidence-based approaches to improve self-awareness after TBI, it is not known how clinicians respond and address this impairment in an inpatient rehabilitation setting. Objective: To examine how clinicians report, assess, and provide intervention for impaired self-awareness after TBI. Methods: A retrospective chart review was conducted on interdisciplinary rehabilitation clinician entries for individuals with TBI (n=67) who received inpatient rehabilitation within a five-year period (2014-2019). A reflexive thematic analysis approach was used to analyse the data. Results: : Three themes were generated to explore clinician responses to their clients’ impaired self-awareness: 1) ‘recalling and understanding’ described clinicians observing client behaviours and expressions of self-awareness, 2) ‘applying and analyzing’ identified clinicians providing relevant tasks and advice to clients, and 3) ‘evaluating and creating’ described clinicians actively interacting with clients by providing feedback, guided prompts, and a follow-up plan. Conclusion: Clinicians described varied responses to clients’ impaired self-awareness after TBI. Findings may help to develop research priorities and integrated knowledge translation initiatives to increase evidence-based practice for impaired self-awareness after TBI.