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Self-Awareness After Brain Injury: Relation with Emotion Recognition and Effects of Treatment

  • K.F. Lamberts (a1), L. Fasotti (a2) (a3), D.H.E. Boelen (a2) (a4) and J.M. Spikman (a5) (a6)


Self-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17–70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n = 29) had better self-awareness after training than control patients (n = 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.


Corresponding author

Address for Correspondence: Prof. Dr. Jacoba M. Spikman, clinical neuropsychologist, Associate Professor, Department of Neurology, University Medical Center Groningen, Poortweg 4, 2e verdieping, Postbus 30.001, 9700 RB Groningen, the Netherlands. E-mail:


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