Abstract
OBJECTIVES—Despite the growing number of instruments for the prospective measurement of post-traumatic amnesia (PTA) after traumatic brain injury, fundamental issues about the natural history of its resolution and methods of examination remain unresolved. The aims of the present study were to: (1) examine the sequence of resolution of disorientation and amnesia, and (2) determine if the method of measuring the memory component affected the duration of PTA. METHODS—The sample comprised 31 severely injured patients admitted to a brain injury rehabilitation unit who were examined daily until they emerged from PTA. They were administered a composite PTA scale, covering orientation and memory items from standard PTA scales. Patients were consecutively allocated to one of two groups according to the method of measuring the memory component. Each group was administered identical materials with a different procedure. RESULTS—The most common sequence for resolution of disorientation in both groups was person, followed by place, then time. Overall, amnesia resolved before disorientation in 94% of cases. Correlation coefficients between return of components of orientation and memory were all highly significant, ranging from r=0.81 to 0.93. Significant variability occurred in the number of days to emerge from PTA according to the scale used. There was evidence that the method of measuring memory influenced the patient's capacity to consistently sustain criterion scores on the scale. CONCLUSIONS—These results are contrary to findings in mildly injured patients, in whom orientation usually returns before memory. They also demonstrate that the duration of PTA will be dictated by the method used. These findings raise validity issues with respect to the prospective measurement of PTA, and in particular determining when an individual patient has emerged from PTA, which require further investigation.
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- Beukelman D. R., Kraft G. H., Freal J. Expressive communication disorders in persons with multiple sclerosis: a survey. Arch Phys Med Rehabil. 1985 Oct;66(10):675–677. [PubMed] [Google Scholar]
- Bishara S. N., Partridge F. M., Godfrey H. P., Knight R. G. Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury. Brain Inj. 1992 Jul-Aug;6(4):373–380. doi: 10.3109/02699059209034952. [DOI] [PubMed] [Google Scholar]
- Corrigan J. D. Development of a scale for assessment of agitation following traumatic brain injury. J Clin Exp Neuropsychol. 1989 Mar;11(2):261–277. doi: 10.1080/01688638908400888. [DOI] [PubMed] [Google Scholar]
- Daniel W. F., Crovitz H. F., Weiner R. D. Neuropsychological aspects of disorientation. Cortex. 1987 Jun;23(2):169–187. doi: 10.1016/s0010-9452(87)80030-8. [DOI] [PubMed] [Google Scholar]
- Forrester G., Encel J., Geffen G. Measuring post-traumatic amnesia (PTA): an historical review. Brain Inj. 1994 Feb-Mar;8(2):175–184. doi: 10.3109/02699059409150969. [DOI] [PubMed] [Google Scholar]
- Fortuny L. A., Briggs M., Newcombe F., Ratcliff G., Thomas C. Measuring the duration of post traumatic amnesia. J Neurol Neurosurg Psychiatry. 1980 May;43(5):377–379. doi: 10.1136/jnnp.43.5.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Geffen G. M., Encel J. S., Forrester G. M. Stages of recovery during post-traumatic amnesia and subsequent everyday memory deficits. Neuroreport. 1991 Feb;2(2):105–108. doi: 10.1097/00001756-199102000-00010. [DOI] [PubMed] [Google Scholar]
- High W. M., Jr, Levin H. S., Gary H. E., Jr Recovery of orientation following closed-head injury. J Clin Exp Neuropsychol. 1990 Oct;12(5):703–714. doi: 10.1080/01688639008401013. [DOI] [PubMed] [Google Scholar]
- Jackson W. T., Novack T. A., Dowler R. N. Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log. Arch Phys Med Rehabil. 1998 Jun;79(6):718–720. doi: 10.1016/s0003-9993(98)90051-x. [DOI] [PubMed] [Google Scholar]
- King N. S., Crawford S., Wenden F. J., Moss N. E., Wade D. T., Caldwell F. E. Measurement of post-traumatic amnesia: how reliable is it? J Neurol Neurosurg Psychiatry. 1997 Jan;62(1):38–42. doi: 10.1136/jnnp.62.1.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levin H. S., O'Donnell V. M., Grossman R. G. The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis. 1979 Nov;167(11):675–684. doi: 10.1097/00005053-197911000-00004. [DOI] [PubMed] [Google Scholar]
- McMillan T. M., Jongen E. L., Greenwood R. J. Assessment of post-traumatic amnesia after severe closed head injury: retrospective or prospective? J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):422–427. doi: 10.1136/jnnp.60.4.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
- RUSSELL W. R., SMITH A. Post-traumatic amnesia in closed head injury. Arch Neurol. 1961 Jul;5:4–17. doi: 10.1001/archneur.1961.00450130006002. [DOI] [PubMed] [Google Scholar]
- Shores E. A., Marosszeky J. E., Sandanam J., Batchelor J. Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Med J Aust. 1986 May 26;144(11):569–572. doi: 10.5694/j.1326-5377.1986.tb112311.x. [DOI] [PubMed] [Google Scholar]
- Sisler G., Penner H. Amnesia following severe head injury. Can Psychiatr Assoc J. 1975 Aug;20(5):333–336. doi: 10.1177/070674377502000502. [DOI] [PubMed] [Google Scholar]
- Tate R. L., Fenelon B., Manning M. L., Hunter M. Patterns of neuropsychological impairment after severe blunt head injury. J Nerv Ment Dis. 1991 Mar;179(3):117–126. doi: 10.1097/00005053-199103000-00001. [DOI] [PubMed] [Google Scholar]
- Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]