Lack of awareness in brain injiured patients: the importance of a multidisciplinary assessment in the functional autonomy recovery

In patients with results of severe Traumatic Brain Injury (TBI), the skill of being aware of the causes and the results of illness, alongsi- de the impact it may have on their daily functioning, are the ele- ments that tie all the aspects of the treatment and their lack repre- sents the greatest obstacle to rehabilitative intervention. In the most serious cases of unawareness for motor deficits, the patient seems to be totally unaware of them: if asked about his/her health and the reason why he/she is in a Hospital, his/her answers are vague, or focused on secondary aspects of the main neurological disease. Answers can be expressed through confabulations, otherwise patients could become aggressive and oppositive: the patient does not realize his/her situation, and he/she experiences difficulties also in the simplest things, such as undergoing a pharmacological, motor or cognitive therapy, abiding by the rules, paying attention when he/she gets up or he/she walks. It is very frequent to observe that a lack or loss of awareness of the illness in brain injured patients coexists with other factors: two of these are the mnesic deficits and the lack of self-criticism. The patients with memory deficits, besides their not recalling the infor- mation, are not even able to remember of having some important physical and cognitive deficits. The influence of awareness is fundamental for the compliance of the patient, for his/her acceptance of the therapies and, therefore, for his/her motivation to develop what it is required: it drives to a general functional improvement due to changes, as it regards emo- tional and behavioural aspects as the improvement of the depressed and confusional state, and the use of functional compensation's stra- tegies (Mazzucchi, 1998).