Effect of self-awareness on goal engagement and outcomes after acquired brain injury

Introduction A client's level of self-awareness may change after acquired brain injury, including impaired self-awareness or hyper-awareness of impairments. As a result of these impairments, engagement in occupational therapy may be more challenging, especially the setting of client-centred goals. Understanding how engagement in goal setting differs according to level of self-awareness is therefore necessary. The aim of this study was to examine differences between: (a) the client-centredness of goal setting; (b) verbal participation in goal setting discussions and (c) the goal outcomes across clients with acquired brain injury who had different levels of self-awareness. Method A prospective cohort study design was used. Participants were 35 adults with acquired brain injury attending outpatient rehabilitation. Goal setting discussions were audio-recorded and measures of self-awareness and client-centredness completed immediately afterwards, and goal-outcome data collected 12 weeks later. Results Participants were classified into three self-awareness groups: hyper-awareness (n=9), accurate self-awareness (n=17) and impaired self-awareness (n=9). All groups demonstrated high levels of client-centredness of goals and achieved clinically significant goal outcomes. Conclusion Clients with impaired self-awareness, hyper-awareness and accurate awareness can be successfully engaged in rehabilitation goal setting to develop and achieve client-centred goals.