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Unawareness of Disability in CVA: A Comparison Study With Musculoskeletal Patients

Langer, Karen G. PhD*; Samuels, Mark C. PhD

Cognitive and Behavioral Neurology: December 2008 - Volume 21 - Issue 4 - p 206-213
doi: 10.1097/WNN.0b013e3181864a4b
Original Studies

Objective Unawareness in cerebrovascular accident (CVA) was investigated employing a multiple rater, multimodal assessment approach and by comparison with demographically matched musculoskeletal patients.

Background Unawareness is a phenomenon often reported in CVA that poses challenges in neurorehabilitation settings, but debate exists regarding processes involved.

Method Three techniques for rating awareness were used: independent clinical rating, comparison of structured interview with medical information, and discrepancies in performance estimation. Association with neurocognitive and psychogenic factors was also explored.

Results The specific association of unawareness with CVA was confirmed; CVA patients had less awareness of disability than musculoskeletal patients and underestimated performance difficulties relative to staff. Awareness measures showed convergent validity, yet were not redundant, perhaps tapping different aspects of awareness. Cognition, emotion, and group diagnostic classification successfully predict awareness when combined in multiple regression analyses. Unawareness had variable associations with cognition and emotion individually. Awareness was more consistently associated with cognition in musculoskeletal patients. Results suggested that unawareness is complex and multidimensional. Findings support some concurrence of cognitive and emotional factors in patients with unawareness of disability, yet suggest that unawareness may also have some distinct and independent status beyond contributions from associated factors.

*Rusk Institute, NYU Langone Medical Center and NYU School of Medicine, New York, NY

Psychology Department, New Mexico Institute of Mining and Technology, Socorro, NM

Reprints: Karen G. Langer, PhD, New York University Medical Center, Rusk Institute of Rehabilitation Medicine, 400 East 34th Street, New York, NY 10016 (e-mail:

Received for publication November 21, 2007; accepted July 9, 2008

This research was conducted while Dr Samuels was a postdoctoral fellow funded by a NIH National Research Service Award (NRSA) postdoctoral training grant at the Rusk Institute-NYU Medical Center.

© 2008 Lippincott Williams & Wilkins, Inc.