Question
What is post-traumatic amnesia and how does it impact assessment and treatment?
Answer
Post-traumatic amnesia (PTA), defined, is a period of confusion and disorientation following a TBI. It is important to note that post-traumatic amnesia is only going to be seen after a traumatic brain injury. 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.
Post-traumatic amnesia can last for a few minutes to days or months. The duration of PTA is directly correlated to the patient’s outcome. If a patient is in PTA for five minutes, then chances are they are going to recover to very limited symptoms. Whereas, a patient who is in a coma, then wakes up and is in PTA for months, is going to have a poorer prognosis.
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. 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. It is important to know that. 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.
You also want to make sure that you are focusing on implicit tasks as opposed to declarative memory tasks. This is not the time to teach a patient compensatory strategies for dysarthria. 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. That is really what the focus should be with a disoriented patient.
Many facilities run orientation groups and there are definitely pros and cons for these types of groups. Unfortunately, there is really no evidence of efficacy for orientation groups because the patients are not forming new memories. 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. However, the groups do provide peer interaction and exposure to others with injury, so there is that social aspect which can be a benefit. But I think that goals related to orientation will not be easily met or treated based on being part of an orientation group.
Again, the focus should be on implicit, procedural, routine activities. You do not want to focus on teaching compensatory strategies for memory, for example. These patients cannot learn new things at this time if they are in PTA. They are not laying down memories, and that is why they are not oriented.
Please refer to the SpeechPathology.com 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.
