Self Awareness and Executive Function

Self Awareness

includes cognitive process and ability to self-monitor, regulate, and evaluate one’s cognition and task performance

Impaired self-awareness

• lack of knowledge about one’s own physical or cognitive perceptual impairments and/or the functional implications

• inability to anticipate difficulites, recognize errors, or monitor performance within the context of an activity

Denial

a subconscious process that spares the patient the psychological pain of accepting the serious consequences of a brain injury and its unwanted effects on the brain

T or F: impaired awareness of cognitive deficits is more prevalent than impaired awareness of motor deficitis

True

T or F: for clients with stroke, impaired awareness is more prevalent among damage to the left hemisphere according to lesion size

F, more prevalent to right hemisphere

What is the foundation of the levels of awareness?

Intellectual awareness

Intellectual awareness

understanding, at some level, that a function is impaired

Emergent awareness

ability to monitor performance during a task “online awareness”

Anticipatory awareness

understand types of problems that will result from impairment

What is the goal for levels of awareness?

Anticipatory awareness

Anticipatory compensatory strategies

requires anticipatory awareness and involves planning so problems are avoided

Recognition strategy

person recognizes problem is occurring and does something to correct.

Situational strategy

using the same strategy for the same type of tasks

External strategy

triggered via an external agent

What does decreased self awareness result in?

• increased caregiver burden

• Decreased motivation and/or participation

• Maladaptive behavior

Increased self awareness results in…

• better employment outcomes

• improved well being

What are some interventions for awareness?

• occupation

• video feedback

• mirror therapy

• use of game format

• skillful use of prompts and feedback - error awareness

• awareness intervention program

• group intervention

Documentation for self awareness

• identify and indicate a deficit of self-awareness

• create goals

• document performance of treatment activity

• relate self-awareness deficits to functional impact and state any changes noted through intervention

• utilize terminology from levels of awareness and compensation strategies

Executive function

defined as a complex multifaceted construct that comprises those abilities that allow one to plan, organize, and successfully execute purpose, goal-oriented, and future-oriented activities

Initiation

the ability to start a task or activity

planning, organizing, sequencing

goal attainment through a series of intermediate steps

problem solving

integration of several cognitive skills, the means to achieve a goal

mental flexibility

ability to initiate, stop, and switch actions

concept formation or abstraction

ability to conceptualize and make inferences from information

categorization

finding commonalities and assignment objects or events into groups

decision making

making a choice among options

transfer and generalization

learning new skills and applying them in specific training environments or within different environments or situations

metacognition

self awareness and monitoring

Executive function deficits

• poor planning and organization

• poor time management

• poor set-shifting, working memory

• poor emotional regulation

  • poor social interaction

Time Pressure Management

Focus is to teach clients how to give themselves enough time to deal with situations