Self-Awareness in Survivors of an Acquired Brain Injury and Its Impact on Caregiver Burden

BACKGROUND/OBJECTIVES: After an acquired brain injury (ABI), caregiver burden in family members is a clinical concern. Prior research has demonstrated that improved self-awareness in survivors of an ABI reduces caregiver burden. We examined the relationship between caregiver burden and ABI survivors' levels of self-awareness across a span of injury chronicity following discharge from outpatient holistic milieu neurorehabilitation. METHOD: This retrospective observational study analyzed data on 59 individuals with heterogeneous ABIs who participated in an outpatient holistic milieu neurorehabilitation program from 2021 to 2025. This study utilized the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) to measure self-awareness in survivors of an ABI by calculating a discrepancy score from the self- and caregiver-rated MPAI-4 total score. Demographic information (age, education, race/ethnicity), injury history (injury type, age at injury, chronicity), program variables (length of program participation), functionality (MPAI-4), and caregiver burden (Zarit Burden Interview) at discharge were collected. RESULTS: In order to predict caregiver burden based on self-awareness of an ABI survivor and time since injury, a multiple linear regression analysis was used. Although the multiple regression model significantly predicted caregiver burden, only self-awareness added significantly to the prediction and accounted for a modest proportion of the variance in caregiver burden. CONCLUSIONS: Self-awareness, as measured by utilizing the MPAI-4 discrepancy model, explained a modest proportion of the variance in caregiver burden regardless of time since injury. Among family members of survivors of an ABI, self-awareness of the survivor is a predictor of burden experienced by the family and would be beneficial to address as part of neurorehabilitation.