The purpose of this study was to explore the pattern of the development of self-awareness following traumatic brain injury (TBI). Further, the antecedents to change in self-awareness and the use of compensatory strategies were examined.

A longitudinal descriptive method was used with 18 adult participants and their significant others. Each pair was interviewed at 1 week, 1 month, 4 months and 1 year post-injury, using the Awareness Questionnaire, the Patient Assessment of Own Functioning Inventory and the Personal Evaluation of Community Integration. Comparative analyses were conducted between the participants and their significant others, as well as among the different levels of severity of brain injury.

The participants with mild TBI showed better self-awareness than the participants with moderate/severe TBI. By 1 year post-injury, however, the level of self-awareness for the participants with mild TBI was not significantly different from that for the participants with moderate/severe TBI. The pattern of the development of self-awareness was different between the two groups. The participants with mild TBI initially overestimated deficits, but demonstrated good self-awareness throughout. The participants with moderate/severe TBI significantly underestimated deficits, but demonstrated a gradual increase in self-awareness. The reported antecedents to self-awareness were similar. Both groups primarily used a comparison of their ability to perform familiar occupations after the injury as a means for developing self-awareness.

Severity of injury and time post-injury are both significant variables in the pattern of recovery of self-awareness following TBI. Occupational therapists should consider the use of familiar occupations to assist in the recovery process.