The three vectors of consciousness and their disturbances after brain injury
The experience of attempting to rehabilitate post-acute traumatic brain injury (TBI) patients brought into focus the potential importance of disturbances in selfawareness for rehabilitation outcome (Prigatano et al., 1984). Since that time, studies have appeared which document that impaired awareness is related to employment outcome in TBI patients (Sherer et al., 1998a) and functional outcome after acute cerebrovascular accident (Pedersen et al., 1996). One interesting study documents the presence of impaired awareness early after stroke, which was related to worse functional outcome at 1 year follow-up (Jehkonen et al., 2000). The implication is that even when frank anosognosia disappears, there may be residual disturbances in self-awareness that continue and influence functional (including psychosocial) outcome. This is important from a theoretical perspective since it has recently been argued that disturbances in self-awareness change over time and that different syndromes may be
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identified that relate to neuropsychological rehabilitation outcome (Prigatano, 1999).