AWARENESS OF DISABILITY IN PATIENTS FOLLOWING STROKE

Lack of awareness, minimization, and exaggeration are behavioral descriptions that have been associated with both the duration of stroke and the laterality of brain damage. This study examined awareness of post-stroke changes in physical, cognitive, and affective domains of functioning in a group of 37 left brain damage (LBD) and 45 right brain damage (RBD) stroke patients. Awareness was operationally defined as agreement between a patient's subjective descriptions of post-stroke change and empirical measurement of the same domain of functioning. Although 70% of the patients in the sample were aware of having had a stroke, a small number of patients were totally unaware of their medical condition. Only half of the patients were accurate in their assessment of post-stroke changes in cognition, memory, and mood. While no lateralized differences were found in levels of awareness of physical, memory, and mood domains, LBDs exaggerated the extent of their abstraction deficits more frequently than did RBDs. Minimization was equally prevalent in both groups of patients. Time since the onset of stroke, extent of physical impairment, and gender were not predictors of awareness. Finally, patients' awareness of post-stroke changes was inconsistent across the physical, cognitive, and affective domains examined. Thus, awareness is not a unitary phenomenon. The implications of these findings for both patient management and rehabilitation planning are discussed.