Development of the "insight interview": a new tool for assessing longitudinal change in awareness deficits following traumatic brain injury

"Awareness deficits are frequently observed in patients following a traumatic brain injury (TBI) and have been identified as one of the main factors in determining patients' functional and vocational outcomes. However, there is still relatively little known about the nature of awareness deficits in the early stages (< three months post-injury) following TBI, and even less is understood about the temporal profile of recovering awareness in people following TBI. This thesis investigates the longitudinal progression of awareness deficits and the neuropsychological factors which associate with the disorder and potentially predicts its persistence. Chapter 1 provides a general introduction by reviewing the current theoretical models with respect to causes as well as the nature and structure of different awareness deficits, and briefly discusses treatment approaches. Chapter 2 furthers the literature review with respect to measurement of awareness deficits and describes the development of a new tool, "The Insight Interview", designed to measure deficits across different domains of awareness (i.e., awareness of change, severity of impairments, current functional consequences and future functional consequences) over time and using both discrepancy "difference score" methods and interviewer-based ratings. Patients were found to demonstrate awareness deficits across all domains assessed, with the exception of the domain of awareness of current functional consequences. Chapter 3 examines the validity and reliability of the Insight Interview, both of which were found to be acceptable. Chapter 4 reports a study of the neuropsychological variables that may be predictive of awareness deficits in both the early stages (< three months post-injury) and 12 months later. The neuropsychological variables of memory, executive functioning and emotion recognition were all found to be associated with awareness deficits, however, patterns differed depending on both the domain of awareness being assessed and the time at which awareness was measured". -- Abstract.