Project B1:   The Impact of Self-Awareness on Functional Outcomes Following Moderate and Severe Traumatic Brain Injury

Principal Investigator:  William Garmoe, PhD
Co-investigators: Michael O'Connell, Ph.D., Anne Newman, Ph.D.

Funding Source: Neuroscience Research Center (USAMRMC)

Abstract:
Traumatic brain injury (TBI) often results in impaired self-awareness.  Self-awareness is defined as the capacity to be an accurate judge of one’s physical, cognitive, and emotional functioning.  Following brain injury many individuals display poor self-awareness, overestimating their ability to do tasks such as remember important information, drive a motor vehicle, walk safely, etc.  Individuals with poor self-awareness show little recognition of the need to compensate for their deficits, and are the most likely group with those injuries to require long-term supervision.

Arm 1 
Most studies of self-awareness focus on individuals who are in post-acute settings (more than six months post-injury).  The present study is an extension of earlier research that developed a tool, called the Functional Self-Awareness Scale (FSAS), to examine self-awareness while individuals are still in an inpatient brain injury rehabilitation hospital.  The study will assess whether early assessment of self-awareness has predictive value regarding outcome six months later.  Subjects in the study will be assessed using the FSAS while in an acute inpatient brain injury rehabilitation hospital.  Other neuropsychological tests will also be administered.  Subjects will return six months later and be administered a battery of neuropsychological and functional outcomes measures.  This will help determine whether subjects with poor early self-awareness have worse functional outcome than those with good early self-awareness. 

Arm 2 
The question remains whether self-awareness deficits are specific to individuals with brain dysfunction, or may be found in non-brain impaired, hospitalized patients.  It is possible that impaired self-awareness is in some way related to the illness and hospitalization process, rather than being unique to brain injury.  The purpose of the present study is to examine the FSAS in a hospitalized but non-brain impaired sample.  Individuals who are hospitalized on an orthopedic rehabilitation unit, and who have no history of brain dysfunction, will be assessed using the FSAS, and will also take a brief mental status exam to be sure they have no cognitive problems.  It is hypothesized that individuals without brain dysfunction will not be rated as having impaired self-awareness on the FSAS. 

Progress and Outcomes:
Arm 1 of the project was reviewed and approved by the NRH Research Committee.  It was subsequently reviewed and approved by the Medstar Institutional Review Board (IRB).  HIPAA compliance forms were also filed with the Medstar IRB.  Arm 1 was then submitted to the Army IRB for review.  A response was received from the Army and revisions to the protocol are in progress, to be re-submitted to the Army IRB.

Arm 2 of the project was reviewed and approved by the NRH Research Committee.  It was subsequently reviewed and approved by the Medstar Institutional Review Board (IRB).  HIPAA compliance forms were also filed with the Medstar IRB.  Arm 1 was then submitted to the Army IRB for review.  The Army IRB requested revisions, which were made and the study resubmitted for review.  The Army IRB gave final approval to the study.  HIPPA compliance forms were filed wit the Medstar IRB.  The study is currently actively recruiting subjects, and at this point approximately 15 have been enrolled.  The pace of enrollment is proceeding as expected, based on the census of the unit from which subjects are being drawn. 

An Access database is being developed for purposes of data management and analysis.  A consultant within Medstar is being used for development of the database.  At this point a draft database with an initial set of variables has been constructed, and will be revised as appropriate.