Most individuals who sustain mild TBI recover fully and do not experience long-term cognitive impairments. When such long-term impairments occur, however, they contribute to disability and often are distressing to the person with TBI and his or her family. Fortunately, long-term cognitive impairments of these types are not universal nor are deficits in these domains uniform within or across individuals with such injuries. After moderate TBI, processing speed, episodic memory, and executive function also are commonly affected in both the early and late post-injury periods. In the subacute and late post-injury periods after severe TBI, impairments of attention, processing speed, episodic memory, and executive function are common. They are so common that they are embedded in most clinical case definitions of TBI.
Injury-event related cognitive impairments, including loss of consciousness, attention and memory impairments, and/or other alterations of consciousness, are typical manifestations of biomechanically-induced alterations of brain function. Please refer to the course, Functional Treatment for Acquired Brain Injury in Inpatient Rehabilitation, for more in-depth information on functional therapy ideas for patients with acquired brain injury during the acute rehabilitation phase.Traumatic brain injury (TBI) is a common problem in the United States, affecting more than 1.5 million individuals each year. They are not laying down memories, and that is why they are not oriented. These patients cannot learn new things at this time if they are in PTA. You do not want to focus on teaching compensatory strategies for memory, for example.
But I think that goals related to orientation will not be easily met or treated based on being part of an orientation group.Īgain, the focus should be on implicit, procedural, routine activities. However, the groups do provide peer interaction and exposure to others with injury, so there is that social aspect which can be a benefit. You can repeat to them all day long what the date and day are and where they are, but that is not going to help with the post-traumatic amnesia. Unfortunately, there is really no evidence of efficacy for orientation groups because the patients are not forming new memories. Many facilities run orientation groups and there are definitely pros and cons for these types of groups. That is really what the focus should be with a disoriented patient. The focus should be on more procedural, automatic tasks such as steps to brushing their teeth or steps to getting dressed if the patient is safe for transfers and stable. This is not the time to teach a patient compensatory strategies for dysarthria. You also want to make sure that you are focusing on implicit tasks as opposed to declarative memory tasks. For that reason, you do not want to have an orientation goal for this patient because there is really no treatment that is going to cause that patient to become oriented. Everyone - the neurologist, other physicians, nurses, everyone is going to ask, “What is the date? Where are you? What happened?” A patient who is in PTA is not oriented and cannot be oriented because he/she is not laying down new memories. The most important question for the SLP is, “How does post-traumatic amnesia impact my treatment and assessment?” The primary focus is always on orientation and that is one of the first things that you want to look at when assessing a patient. Whereas, a patient who is in a coma, then wakes up and is in PTA for months, is going to have a poorer prognosis. If a patient is in PTA for five minutes, then chances are they are going to recover to very limited symptoms. The duration of PTA is directly correlated to the patient’s outcome.
Post-traumatic amnesia can last for a few minutes to days or months. A patient who has survived a stroke may have a memory issue or an orientation issue, but he/she is not considered to be in PTA. It is important to note that post-traumatic amnesia is only going to be seen after a traumatic brain injury. Post-traumatic amnesia (PTA), defined, is a period of confusion and disorientation following a TBI. What is post-traumatic amnesia and how does it impact assessment and treatment? Answer
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