Reduced `Awareness of Disability´ – occupation-based diagnosis and intervention

Background: Patients often show deficient Awareness of Disability (AoD) for their stroke-induced impairments. Since awareness deficits have been shown to complicate the rehabilitation process, a structured diagnostic and... [ view full abstract ]

Background:
Patients often show deficient Awareness of Disability (AoD) for their stroke-induced impairments.
Since awareness deficits have been shown to complicate the rehabilitation process, a structured diagnostic and therapeutic procedure, focussing on occupational-performance, seems essential.
This presentation aimed to represent implications for occupation-based interventions derived from current literature.
Method:
Within a study with right-hemispheric stroke patients (n=22 with neglect; n=48 without neglect) a discrepancy-measure was developed as an indicator for AoD. Additionally current literature was reviewed.
Results:
Patients with neglect showed more deficient AoD. In addition differences were modulated by the type of test, so that discrepancy scores for the ADL-based tests were lower than for the neuropsychological paper-and-pencil tests in patients with neglect.
Conclusion:
The data showed that spatial-neglect is associated with reduced AoD which can be assessed by discrepancy measures of external- and self-ratings of test performance. Moreover, the degree of AoD in patients with neglect depends on the type of test employed, indicating that more abstract and complex tests further compromise the realistic self-reflexion of test performance.
Application to Practice:
It seems that the clinical diagnosis of AoD as well as the development of rehabilitative interventions in patients with neglect is beneficial when using realistic occupations. Furthermore this may raise the patients motivation during occupational performance to overcome awareness deficits.