Prospective and Retrospective Metacognitive Abilities and Their Association with Impaired Self-awareness in Patients with Traumatic Brain Injury.

Metacognitive impairment often occurs in patients with traumatic brain injury (TBI) and is associated with clinical problems. The aim of this study was to clarify the pathology of metacognitive impairment in TBI patients using a behavioral task, clinical assessment of self-awareness, and lesion-symptom mapping. Metacognitive abilities of TBI patients and healthy controls were assessed using a modified perceptual decision-making task. Self-awareness was assessed using the Patient Competency Rating Scale and the Frontal Systems Behavior Scale. The associations between estimated metacognitive abilities, self-awareness, and neuropsychological test results were examined. The correspondence between metacognitive disabilities and brain lesions was explored by ROI-based lesion-symptom mapping using structural magnetic resonance images. Overall, 25 TBI patients and 95 healthy controls were included in the analyses. Compared with that in healthy controls, the prospective metacognitive ability of TBI patients was lower, with metacognitive evaluations revealing a bias toward overestimating their abilities. Retrospective metacognitive ability showed a negative correlation with self-awareness but not with neuropsychological test results. In the lesion-symptom mapping analysis, the left pFC was associated with lower retrospective metacognitive ability. This study contributes to a better understanding of the pathology of metacognitive and self-awareness deficits in TBI patients and may explain the cause of impaired realistic goal setting and adaptive behavior in these patients.

Flow experience enhances the effectiveness of attentional training: A pilot randomized controlled trial of patients with attention deficits after traumatic brain injury.

BACKGROUND: Flow is an optimal psychological state when people engage in a training task, and it is a theory explaining the absorbed state. OBJECTIVE: To investigate the additional effect of flow on attention deficits for chronic patients after traumatic brain injury. METHODS: Twenty patients were randomly assigned to the flow group (n = 10) or the control group. Patients performed a video game task, one inducing flow (flow group) and the other not (control group) for 4 weeks, and they were assessed with the flow state scale for occupational tasks (FSSOT) regularly and neuropsychological tests at baseline, after intervention, and at 4 weeks after intervention (follow-up). RESULTS: Although both groups significantly improved their attentional function after intervention, patients in the flow group tended to show more improvement of attention. The effect size of the neuropsychological test of attention was positive, and its value was small to medium. There was a significant positive correlation between improvement of attention and the FSSOT score. CONCLUSIONS: Attention training with induction of the flow was associated with greater improvement of attention. The results of this study may provide provisional evidence of the effectiveness of rehabilitation considering the patient's psychological state.