Jf. Malec et al., DIFFERING PROBLEM PERCEPTIONS OF STAFF, SURVIVORS, AND SIGNIFICANT OTHERS AFTER BRAIN INJURY, The journal of head trauma rehabilitation, 12(3), 1997, pp. 1-13
Objective: To examine the relationships of the perceptions of staff, s
urvivors of brain injury (BT), and significant others (SOs) as represe
nted on their respective versions of the Mayo-Portland Adaptability In
ventory (MPAI) to each other, to psychometric markers of memory and ex
ecutive cognitive function, and to depression. Design: Nonparametric a
nalyses of data obtained from consecutive clinical cases; exploratory
individual item comparisons of MPAI forms. Setting: Outpatient clinic
in a hospital-based comprehensive rehabilitation center. Participants:
45 to 51 pairs of staff, survivors, and SOs who had rated the survivo
r on the appropriate form of the MPAI. Main Outcome Measures: Ratings
on staff, survivor, and SO forms of the MPAI; MPAI indicator of depres
sion; Trailmaking Test; Rivermead Behavioral Memory Test. Results: Sta
ff and survivor MPAIs correlated moderately well with each other only
for subjects identified as depressed by staff. SO MPAI summary scores
correlated moderately well with Staff MPAI scores for both depressed a
nd nondepressed survivors. SO MPAI summary scores were more strongly r
elated to those of staff than to those of survivors for nondepressed s
urvivors. Survivors with impaired self-awareness (ISA) (ie, those who
tended to greatly underestimate their problems relative to staff) were
infrequently depressed and had more difficulty on a measure of execut
ive cognitive function than did other survivors. Depressed survivors d
id not consistently over- or underestimate their level of disability r
elative to staff Conclusions: A degree of dysphoria may represent an a
ppropriate reaction to BI and set an appropriate emotional tone for ac
curate self-assessment after BI. Conversely, more extensive disability
, impaired executive cognitive function, and ISA subsequent to BI are
likely to interfere with normal emotional adaptation. primary and expl
oratory analyses suggest six major sources of bias affecting problem a
ssessment by survivors, SO, and staff: depression, ISA, lay versus pro
fessional terminology, values, observational opportunities, and impact
/burden.