Conceptualization of self-awareness in adults with acquired brain injury: A qualitative systematic review

Danielle Sansonetti, Jennifer Fleming, Freyr Patterson, Natasha A. Lannin

Research output: Contribution to journalReview ArticleResearchpeer-review

10 Citations (Scopus)


Self-awareness is an important consideration in cognitive rehabilitation for clinicians working with individuals following acquired brain injury (ABI), with impaired self-awareness linked to poor outcomes. To appropriately target assessment and intervention for self-awareness, its theoretical foundation and definition must be considered. The aim was to identify the definitions, theoretical models and conceptual frameworks of self-awareness in adults with ABI, and how self-awareness is conceptualized within those models. A qualitative systematic review was completed using search terms related to descriptions of models/frameworks, ABI and self-awareness. Data were analysed by narrative synthesis. Thirty-five papers were included in the review. Within these, 13 models, 12 conceptual frameworks and 2 theories were described. The main themes and subthemes conceptualized in the synthesis were: Clinical presentation of self-awareness (classifications and dimensions of self-awareness), development of self-awareness (knowledge, feedback mechanisms, temporal aspects, self-evaluation, enablers, barriers), understanding (dys)function (cognitive processing mechanisms, neurological foundations, causal factors), and practice guidance (assessment and intervention). This review identified an extensive theoretical basis to support conceptualization of self-awareness following ABI, underpinned by a distinction between intellectual awareness, on-line awareness, and psychological denial. Clinical application of an evaluation process that includes these elements would be beneficial to inform the rehabilitation process.

Original languageEnglish
Pages (from-to)1726-1773
Number of pages48
JournalNeuropsychological Rehabilitation
Issue number8
Publication statusPublished - 14 Sept 2022


  • Anosognosia
  • Brain injury
  • Occupational therapy
  • Rehabilitation
  • Self-awareness

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