Faculty Bibliography

The French philosopher Michel Eyquem de Montaigne (1533-1592) sustained a transient loss of consciousness due to a head injury. Montaigne described his concussion as a "swoon," with astutely illustrative details of the symptoms he experienced, including brief loss of consciousness, with apparent (temporary) confusion, and post-traumatic amnesia. His vivid portrayal of the recovery period lends understanding of the process of conscious awakening after his near-death experience. Thanks to his power of introspection and literary talent we may gain insight into the feelings and perceptions of some patients during their recovery from concussion.

BACKGROUND: Humanistic attitudes are essential in physicians and therefore supporting them is a key component in graduate medical education (GME). The importance of a physician's attitude toward people with disability is especially relevant within the rehabilitation discipline, as prevailing attitudes and misconceptions can be potential barriers to successful diagnosis and treatment. AIM: This study was designed to examine the relationship between participation in a brief disability sensitivity training and knowledge of disability and attitudes of physical medicine and rehabilitation (PM&R) residents toward people with disability. METHODS: A daylong training for residents consisted of lectures and a panel presentation that covered (1) disability facts, (2) personal stories of people with disabilities, and (3) medical evaluation of disability. The presentations were followed by a simulation experience where resident pairs (one assigned to a wheel chair, the other a 'caretaker') performed various tasks. This was followed by a group discussion of their experience. Three instruments were administered prior to the training: (1) a brief demographic questionnaire, (2) 30 multiple choice questions measuring various aspects of knowledge about disability, and (3) the Scale of Attitudes toward Disabled Persons, Form R (SADP). After the training experience, the knowledge instrument and the SADP were re-administered along with a series of items to measure various aspects of students' satisfaction with the training. The three instruments described were re-administered 3 months post-training. RESULTS: There was significant immediate gain in both the disability knowledge and the attitude scores among trainees as compared to a control group of physiatry residents in standard medical training. Knowledge gains of the disability sensitivity training group did not persist, but attitude toward disability gains remained at the 3 months follow up. CONCLUSION: After a brief curriculum in disability knowledge and sensitivity for PM&R physicians in training, there was a short-term improvement in disability knowledge and an improvement in disability attitudes sustained at 3 months

In 1914, Babinski first described 'anosognosia'; a term he coined for a phenomenon involving unawareness of disability in hemiplegia. Historical roots of contemporary perspectives on anosognosia after stroke may be found in early discussions among French neurologists. Current notions and debate regarding the roles played by cognition, emotional factors, sensory loss and somatosensory neglect in anosognosia, and the distinctness of anosognosia as a symptom echo the theoretical dilemmas of an earlier past. Historical overview of the development of perspectives on anosognosia enriches our understanding of unawareness of disability

OBJECTIVE: Unawareness in cerebrovascular accident (CVA) was investigated employing a multiple rater, multimodal assessment approach and by comparison with demographically matched musculoskeletal patients. BACKGROUND: Unawareness is a phenomenon often reported in CVA that poses challenges in neurorehabilitation settings, but debate exists regarding processes involved. METHOD: Three techniques for rating awareness were used: independent clinical rating, comparison of structured interview with medical information, and discrepancies in performance estimation. Association with neurocognitive and psychogenic factors was also explored. RESULTS: The specific association of unawareness with CVA was confirmed; CVA patients had less awareness of disability than musculoskeletal patients and underestimated performance difficulties relative to staff. Awareness measures showed convergent validity, yet were not redundant, perhaps tapping different aspects of awareness. Cognition, emotion, and group diagnostic classification successfully predict awareness when combined in multiple regression analyses. Unawareness had variable associations with cognition and emotion individually. Awareness was more consistently associated with cognition in musculoskeletal patients. Results suggested that unawareness is complex and multidimensional. Findings support some concurrence of cognitive and emotional factors in patients with unawareness of disability, yet suggest that unawareness may also have some distinct and independent status beyond contributions from associated factors