Impaired self-awareness following acquired brain injury: current theory, models and anatomical understanding

Acquired brain injury/illness (ABI) can lead to a range of cognitive, physical, emotional, social and behavioural sequelae. Unawareness of these deficits and of errors made in activities of everyday living can be a significant barrier for successful outcomes in rehabilitation following ABI. This review presents several theories and clinical models that propose multiple psychological, neuropsychological and biopsychosocial underpinnings of impaired self-awareness (ISA). Current knowledge regarding neuropathology of awareness is discussed, highlighting the widespread locations and connections within the brain that are implicated in awareness. Clinical practice promotes a client-centred approach to rehabilitation that acknowledges the multiple contributing factors of ISA post-ABI. This review discusses the merits of theories and clinical models in providing a useful framework for assessing and treating the multifaceted and complex phenomenon of ISA following ABI.