Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-21T10:26:16.526Z Has data issue: false hasContentIssue false
  • English
  • Français

Connecting Self-Awareness and Error-Awareness in Patients with Traumatic Brain Injury

Published online by Cambridge University Press:  03 August 2015

Paul M. Dockree ,
Yvonne M. Tarleton ,
Simone Carton  and
Mary C.C. FitzGerald
Paul M. Dockree*
Affiliation:
School of Psychology & Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
Yvonne M. Tarleton
Affiliation:
School of Psychology & Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
Simone Carton
Affiliation:
National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland
Mary C.C. FitzGerald
Affiliation:
School of Psychology & Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland
*
Correspondence and reprint requests to: Paul M. Dockree, School of Psychology, Aras an Phiarsaigh, Trinity College Dublin, College Green, Dublin 2. E-mail: dockreep@tcd.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Impaired self-awareness after traumatic brain injury (TBI) is often seen in stark contrast to the observations of significant-others, who are acutely aware of the difficulties experienced by patients. Our objective was to investigate the relationship between metacognitive knowledge in daily life and emergent awareness of errors during laboratory tasks, since the breakdown of error detection mechanisms may impose limitations on the recovery of metacognitive knowledge after TBI. We also examined the extent to which these measures of awareness can predict dysexecutive behaviors. A sample of TBI patients (n=62) and their significant-others, provided reports of daily functioning post injury. In addition, patients underwent a neuropsychological assessment and were instructed to signal their errors during go/no-go tests. Interrelationships between metacognitive and emergent levels of awareness were examined, after controlling for the influence of secondary cognitive variables. Significant-other ratings correlated with errors made by the patients on neuropsychological tests but not with their premorbid function. Patients who under-reported daily life difficulties or over-reported their competency, compared to significant-other reports, were less likely to show awareness of laboratory errors. Emergent awareness was also identified as the sole predictor of performance on the modified six-element test, an ecologically valid test of multitasking. The online breakdown of error awareness after brain injury is related to difficulties with metacognitive awareness as reported in daily life, and is also predictive of dysexecutive behaviors. These findings are discussed in the context of multidimensional and neural models of awareness and error monitoring. (JINS, 2015, 21, 473–482)

Keywords

VolitionIntentionGoalsExecutive functionNeuropsychologyCaregivers
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Issue 7 , August 2015 , pp. 473 - 482
Copyright
Copyright © The International Neuropsychological Society 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anson, K., & Ponsford, J. (2006). Who benefits? Outcome following a coping skills group intervention for traumatically brain injured individuals. Brain Injury, 20(1), 1–13.CrossRefGoogle ScholarPubMed
Bivona, U., Ciurli, P., Barba, C., Onder, G., Azicnuda, E., Silvestro, D., & Formisano, R. (2008). Executive function and metacognitive self-awareness after severe traumatic brain injury. Journal of the International Neuropsychological Society, 14(5), 862–868.Google Scholar
Broadbent, D.E., Cooper, P.F., FitzGerald, P., & Parkes, K.R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. The British Journal of Clinical Psychology, 21(1), 1–16.Google Scholar
Burgess, P.W., Veitch, E., de Lacy Costello, A., & Shallice, T. (2000). The cognitive and neuroanatomical correlates of multitasking. Neuropsychologia, 38(6), 848–863.Google Scholar
Chiou, K.S., Carlson, R.A., Arnett, P.A., Cosentino, S.A., & Hillary, F.G. (2011). Metacognitive monitoring in moderate and severe traumatic brain injury. Journal of the International Neuropsychological Society, 17(4), 720–731.Google Scholar
Ciurli, P., Bivona, U., Barba, C., Onder, G., Silvestro, D., Azicnuda, E., & Formisano, R. (2010). Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury. Journal of the International Neuropsychological Society, 16(2), 360–368.Google Scholar
Clare, L., Whitaker, C.J., & Nelis, S.M. (2010). Appraisal of memory functioning and memory performance in healthy ageing and early-stage Alzheimer’s disease. Neuropsychology, Development, and cognition. Section B, Aging, Neuropsychology and Cognition, 17(4), 462–491.Google Scholar
Dockree, P.M., Bellgrove, M.A., O’Keeffe, F.M., Moloney, P., Aimola, L., Carton, S., & Robertson, I.H. (2006). Sustained attention in traumatic brain injury (TBI) and healthy controls: Enhanced sensitivity with dual-task load. Experimental Brain Research, 168(1-2), 218–229.Google Scholar
FitzGerald, M.C.C., Carton, S., O’Keeffe, F., Coen, R.F., & Dockree, P.M. (2012). Impaired self-awareness following acquired brain injury: Current theory, models and anatomical understanding. The Irish Journal of Psychology, 33(1-4), 78–85.Google Scholar
Fleming, J.M., Strong, J., & Ashton, R. (1998). Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationshipto outcome. The Journal of Head Trauma Rehabilitation, 13(5), 39–51.Google Scholar
Grace, J., & Malloy, P.F. (2001). Frontal Systems Behaviour Scale. Lutz, FL: Psychological Assessment Resources.Google Scholar
Ham, T.E., Bonnelle, V., Hellyer, P., Jilka, S., Robertson, I.H., Leech, R., & Sharp, D.J. (2014). The neural basis of impaired self-awareness after traumatic brain injury. Brain, 137(2), 586–597.CrossRefGoogle ScholarPubMed
Hart, T., Giovannetti, T., Montgomery, M.W., & Schwartz, M.F. (1998). Awareness of errors in naturalistic action after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 13(5), 16–28.Google Scholar
Harty, S., O’Connell, R.G., Hester, R., & Robertson, I.H. (2013). Older adults have diminished awareness of errors in the laboratory and daily life. Psychology and Aging, 28(4), 1032–1041.Google Scholar
Hester, R., Foxe, J.J., Molholm, S., Shpaner, M., & Garavan, H. (2005). Neural mechanisms involved in error processing: A comparison of errors made with and without awareness. Neuroimage, 27(3), 602–608.CrossRefGoogle ScholarPubMed
Hoerold, D., Pender, N.P., & Robertson, I.H. (2013). Metacognitive and online error awareness deficits after prefrontal cortex lesions. Neuropsychologia, 51(3), 385–391.Google Scholar
Kolakowsky-Hayner, S. (2010). The Patient Compentency Rating Scale. Retrieved from http://www.tbims.org/combi/pcrs (accessed October 23, 2014). The Center for Outcome Measurement in Brain Injury.Google Scholar
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., & Stuss, D.T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6(3), 299–312.CrossRefGoogle ScholarPubMed
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment. Oxford: Oxford University Press.Google Scholar
Manly, T., Hawkins, K., Evans, J., Woldt, K., & Robertson, I.H. (2002). Rehabilitation of executive function: Facilitation of effective goal management on complex tasks using periodic auditory alerts. Neuropsychologia, 40(3), 271–281.CrossRefGoogle ScholarPubMed
McAvinue, L., O’Keeffe, F., McMackin, D., & Robertson, I.H. (2005). Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight. Neuropsychological Rehabilitation, 15(5), 569–587.Google Scholar
Morton, N., & Barker, L. (2010). The contribution of injury severity, executive and implicit functions to awareness of deficits after traumatic brain injury (TBI). Journal of the International Neuropsychological Society, 16(6), 1089–1098.Google Scholar
Nelson, H.E. (1982). National Adult Reading Test (NART): Test manual. Berkshire, England: NFER-Nelson.Google Scholar
Nelson, T.O., & Narens, L. (1990). Metamemory: A theoretical framework and new findings. In G. Bower (Ed.), The psychology of learning and motivation. New York, NY: Academic Press.Google Scholar
Nieuwenhuis, S., Ridderinkhof, K.R., Blom, J., Band, G.P., & Kok, A. (2001). Error-related brain potentials are differentially related to awareness of response errors: Evidence from an antisaccade task. Psychophysiology, 38(5), 752–760.Google Scholar
O’Connell, R.G., Dockree, P.M., Bellgrove, M.A., Kelly, S.P., Hester, R., Garavan, H., & Foxe, J.J. (2007). The role of cingulate cortex in the detection of errors with and without awareness: A high-density electrical mapping study. The European Journal of Neuroscience, 25(8), 2571–2579.Google Scholar
O’Keeffe, F., Dockree, P., Moloney, P., Carton, S., & Robertson, I.H. (2007). Awareness of deficits in traumatic brain injury: A multidimensional approach to assessing metacognitive knowledge and online-awareness. Journal of the Neuropsychological Society, 13(1), 38–49.Google ScholarPubMed
O’Keeffe, F.M., Dockree, P.M., Moloney, P., Carton, S., & Robertson, I.H. (2007a). Characterising error-awareness of attentional lapses and inhibitory control failures in patients with traumatic brain injury. Experimental Brain Research, 180(1), 59–67.CrossRefGoogle ScholarPubMed
O’Keeffe, F.M., Dockree, P.M., & Robertson, I.H. (2004). Poor insight in traumatic brain injury mediated by impaired error processing? Evidence from electrodermal activity. Brain Research, Cognitive Brain Research, 22(1), 101–112.Google ScholarPubMed
O’Keeffe, F.M., Murray, B., Coen, R.F., Dockree, P.M., Bellgrove, M.A., Garavan, H., & Robertson, I.H. (2007). Loss of insight in frontotemporal dementia, corticobasal degeneration and progressive supranuclear palsy. Brain, 130(3), 753–764.CrossRefGoogle ScholarPubMed
Orr, C., & Hester, R. (2012). Error-related anterior cingulate cortex activity and the prediction of conscious error awareness. Frontiers in Human Neuroscience, 6, 177.Google Scholar
Phillippi, C.L., Feinstein, J.S., Khalsa, S.S., Damasio, A., Tranel, D., Landini, G., & Rudrauf, D. (2012). Preserved self-awareness following extensive bilateral brain damage to the insula, anterior cingulate, and medial prefrontal cortices. Plos One, 7, e38413.Google Scholar
Prigatano, G.P. (1991). Disturbances of self-awareness of deficit after traumatic brain injury. In G.P. Prigatano & D.L. Schacter (Eds.), Awareness of deficit after brain Injury: Clinical and theoretical issues. New York, NY: Oxford University Press.Google Scholar
Prigatano, G.P. (2005). Disturbances of self-awareness and rehabilitation of patients with traumatic brain injury: A 20-year perspective. The Journal of Head Trauma Rehabilitation, 20(1), 19–29.Google Scholar
Prigatano, G.P., & Altman, I.M. (1990). Impaired awareness of behavioral limitations after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 71(13), 1058–1064.Google Scholar
Robertson, I.H., Manly, T., Andrade, J., Baddeley, B.T., & Yiend, J. (1997). Oops!: Performance correlates of everyday attentional failures in traumatic brain injured and normal subjects. Neuropsychologia, 35(6), 747–758.CrossRefGoogle ScholarPubMed
Sherer, M., Boake, C., Levin, E., Silver, B.V., Ringholz, G., & High, W.M. Jr (1998). Characteristics of impaired awareness after traumatic brain injury. Journal of the International Neuropsychological Society, 4(4), 380–387.Google Scholar
Shimamura, A.P. (2008). A Neurocognitive approach to metacognitive monitoring and control. In J. Dunlosky & R. Bjork (Eds.), Handbook of memory and metacognition. Mahwah, NJ: Erlbaum Publishers.Google Scholar
Smeets, S.M., Ponds, R.W., Verhey, F.R., & van Heugten, C.M. (2012). Psychometric properties and feasibility of instruments used to assess awareness of deficits after acquired brain injury: A systematic review. The Journal of Head Trauma Rehabilitation, 27(6), 433–442.Google Scholar
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. Lancet, 2(7872), 81–84.Google Scholar
Toglia, J., & Kirk, U. (2000). Understanding awareness deficits following brain injury. Neurorehabilitation, 15(1), 57–70.Google Scholar
van Veen, V., & Carter, C.S. (2002). The anterior cingulate as a conflict monitor: fMRI and ERP studies. Physiology & Behavior, 77(4-5), 477–482.Google Scholar
Wilson, B.A., Alderman, N., Burgess, P.W., Emslie, H., & Evans, J.J. (1996). Behavioural assessment of the dysexecutive syndrome. San Antonio, TX: Harcourt Assessment.Google Scholar
Yeung, N., Botvinick, M.M., & Cohen, J.D. (2004). The neural basis of error detection: Conflict monitoring and the error-related negativity. Psychological Review, 111(4), 931–959.Google Scholar
Zigmond, A.S., & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.CrossRefGoogle ScholarPubMed