Executive function and metacognitive self-awareness after Severe Traumatic Brain Injury

Umberto Bivona, Paola Ciurli, Carmen Barba, Graziano Onder, Eva Azicnuda, Daniela Silvestro, Renata Mangano, Jessica Rigon, Rita Formisano

Research output: Contribution to journalArticlepeer-review


The objective of this study is to identify the clinical, neuropsychological, neuropsychiatric, and functional variables that correlate with metacognitive self-awareness (SA) in severe traumatic brain injury (TBI) outpatients and to assess the influence of the same variables on the sensory-motor, cognitive, and behavioral-affective indicators of SA. This cross-sectional observational study evaluated 37 outpatients from May 2006 to June 2007 in a neurorehabilitation hospital on the basis of the following inclusion criteria: (1) age ≥15 years; (2) diagnosis of severe TBI (Glasgow Coma Scale, GCS ≤ 8); (3) posttraumatic amnesia (PTA) resolution; (4) capacity to undergo formal psychometric evaluation despite cognitive and sensory-motor deficits; (5) absence of aphasia; (6) availability of informed consent. A neuropsychological battery was used to evaluate attention, memory, and executive functions. SA was assessed by the awareness questionnaire (AQ), administered to both patients and relatives. Decreased metacognitive self-awareness is significantly correlated with increased problems in some components of executive system, even when the AQ subscales were considered separately. The significant correlation found between some components of executive system and metacognitive self-awareness confirmed the importance of addressing this issue to treat SA contextually in the rehabilitation of executive functions.

Original languageEnglish
Pages (from-to)862-868
Number of pages7
JournalJournal of the International Neuropsychological Society
Issue number5
Publication statusPublished - 2008


  • Executive functions
  • Metacognitive self-awareness
  • Perseverative responses
  • Set shifting ability
  • TBI rehabilitation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Psychiatry and Mental health
  • Neuroscience(all)
  • Psychology(all)


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