RHD can cause a disorder called anosognosia (an-o-sag-no-zha), which is a reduced awareness of deficits. This can be one of the most difficult problems to deal with, as the person is not aware of the problems caused by the stroke. Because they do not ‘notice’ the problems, it can be difficult for them to participate in therapy. It can also be difficult for families when they see the problems. It is important to remember that these people are not being stubborn or simply not accepting the problems – their brain is not recognizing the problems. Deficits of awareness are not all or none. Some people with ansosognosia may be aware of some of their deficits but not others; some may be aware of difficulties with some tasks or activities but not others; some may be able to recite their deficits but then not do anything to compensate for them or to avoid problems related to the deficits.