BACKGROUND: Cognitive rehabilitation often involves teaching individuals with acquired brain injuries (ABI) to use compensatory strategies for cognitive deficits. The use of compensatory strategies is frequently limited by reduced awareness of deficits. The process through which a person with ABI develops awareness and begins to use compensatory strategies is rarely explored from the clients' perspectives. OBJECTIVE: To explore the development of awareness and the use of compensatory strategies by adults with ABI. SETTING: A cognitive rehabilitation day treatment programme. METHOD: A critical incidents, qualitative inquiry was conducted with three clients who had made good recovery. The development of awareness and the use of compensatory strategies is examined from the clients' perspectives. Their perspectives are compared to the perspectives of the therapists with whom they worked during the cognitive rehabilitation process. RESULTS: Clients described the development of deficit awareness as a slow process with occasional 'aha' moments. These moments involved a comparison of current performance to pre-morbid performance on functional tasks. There was agreement among clients and therapists on the cognitive deficits manifested and on the strategies used to compensate for those deficits. The description of the process of developing awareness, however, was different. CONCLUSION: In-depth qualitative exploration of the experiences of clients has the potential to provide guidance for more effective cognitive rehabilitation interventions.
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