PCRS Syllabus

Introduction

Impairment in the ability to recognize deficits has been observed in a number of neurologic syndromes including stroke, dementia, and traumatic brain injury (TBI). In moderate and severe TBI, impaired self-awareness is a common phenomenon that can interfere with rehabilitation efforts. Impaired self-awareness has also been linked to less favorable outcome in this population. It is, therefore, worthwhile to measure self-awareness quantitatively in order to monitor changes over time, evaluate the efficacy of treatments designed to improve accuracy of self-appraisal, and predict functional outcomes.

There are several approaches to the quantitative measurement of self-appraisal in clinical settings. The most common of these is the questionnaire approach, in which the subject and an informant who is familiar with the subject's abilities both rate the subject using the same items and rating criteria. Discrepancies between the ratings, particularly when the subject provides higher or more favorable ratings than the other informant, are interpreted as impaired self-awareness. This is the approach used by the PCRS, a 30-item questionnaire completed by the subject and a significant other (relative or therapist). On each item, ratings are made as to "how much of a problem" the subject would have in completing various activities, on a 5-point Likert scale from "1 - can't do" to "5 - can do with ease."

Administration

The questionnaire is given to subjects and respondents to fill out after the Instructions (first paragraph on the rating form) are explained orally. Subjects may ask questions as needed to clarify the meaning of items. If necessary, the examiner may read the questions orally and record the responses. In this case, the subject should have a copy of the response scale (printed on the questionnaire) in front of him/ her as a reminder of the response options.

Scoring

The PCRS consists of 30 items, each scored 1 to 5. Total scores therefore range from 30 to 150, with higher scores indicating greater competency. Studies using the PCRS have described 3 different approaches to calculating discrepancy scores (adapted from Fleming et al., 1996):

1) The total score, or the average score across all items (average competency rating), may be calculated for both subject and significant other and then compared. This approach gives an overall measure of the discrepancy between self- and other-ratings but is insensitive to differences that may exist as a function of the type of item.

2) The following 3 scores may be computed: The # of items on which the subject's rating is higher than the respondent's; the # of items on which the respondent's rating is higher; and the # of items on which the ratings are identical. Subjects may then be classified according to which of these 3 scores is highest.

3) The actual magnitude difference between the subject's and respondent's ratings on specific items may be calculated. This method is sensitive not only to the degree of discrepancy, but to differences as a function of item type (e.g., cognitive/ behavioral versus physical).