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How to Improve Awareness: Treating Anosognosia in Dementia, Stroke, Brain Injury

For treatment to be the most effective, speech therapy patients need to have at least some awareness of their deficits.

But what do you do if they don’t?!

In this post, you’ll find a 3-step guide on how to improve awareness in your adult patients with anosognosia. Use these steps and our Self-Awareness Worksheet for patients with concurrent deficits in visual neglect, memory, problem-solving, attention, right hemisphere damage, etc.

And for hundreds of evidence-based Handouts, Worksheets, Goal Banks, and much more, check out the Adult Speech Therapy Starter Pack!

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What to Remember When Treating Awareness

how to improve awareness

Working on awareness can be very challenging to both the patient and the therapist.

Validate their hard work.

Be non-confrontational.

Give hope.

Take breaks.

And allow both you and the patient however long it takes.

How to Improve Awareness

how to improve awareness

The goal of awareness treatment is for self-assessment to become a habit.

The 3-step process of improving awareness is to gently point out the deficit, educate about the deficit, and then help patients improve awareness and/or compensate for a lack of awareness.

More on each below.

1. Point Out the Area of Concern

  • Respectfully point out the difference between the patient’s point of view and reality

  • Start with things important to the patient’s daily life. For example, grocery shopping or a meaningful relationship

2. Educate About Their Impairment

metacognition education speech therapy
  • Keep your patient education specific & functional

  • Educate about what their specific type of brain damage may look like in daily life

For example: “After a head injury, many people forget what they wanted to buy at the grocery store or they lose their keys.”

3. Practice Being More Aware

anosognosia stroke
  • Use our Self-Assessment Worksheet

  • Make self-assessment a regular part of treatment

  • The goal is that, with practice, self-assessment becomes a daily habit for your patient

Self-Assessment Worksheet PDF

How to Use the Self-Awareness Worksheet

anosognosia in dementia

Depending on your patient, you may ask questions and then fill out the worksheet for them. Or have them fill it out themselves.

Before the Task

  1. Write down the task

  2. Ask the patient to predict how long the task will take

  3. Ask the patient to predict how well they’ll do (by the number of errors or another measure)

  4. Ask the patient to predict errors (in problem-solving, planning, attention, memory, etc.)

  5. Ask the patient to choose a strategy to make up for possible errors (visual reminders, timers, etc.)

During the Task

  1. Ask the patient to record the start time and end time

  2. Ask the patient to record the number of breaks needed

  3. Ask the patient to record the amount of help needed

After the Task

  1. Ask the patient to record how long it actually took to do the task

  2. Ask the patient to record their accuracy level

  3. Discuss:

    1. Did it take longer (or shorter) than you predicted? Why do you think that is?

    2. Did you make more (or less) errors than you predicted? Why?

    3. What factors impacted how well you did?

    4. What strategies did you use that helped you perform better?

    5. What strategies could you use to perform better next time?

More Speech Therapy PDFs

References

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