Predicting Post Traumatic Amnesia Patients'

The head injured (HI) population demonstrates a wide variety of impairment from person to person. Within single individuals the nature and severity of the injury can change rapidly as healing progresses. These complex cognitive, emotional, language and physical deficits often present cognitive rehab team members with diagnostic, prognostic, and treatment challenges (Hagen, 1981; Rollin, 1987). A common symptom resulting from head injury is post traumatic amnesia (PTA), a mental disturbance pattern characterized by disorientation, impaired attention, memory failure for day-today events, illusions, and misidentification of family, friends, and medical staff (Brooks, 1984). While PTA may vary from hour to hour and day to day, its duration has been used as a guide to the extensiveness of the damage; the longer the PTA the stronger the probability of extensive damage (Walsh, 1987). The duration of PTA appears to be a sensitive and reliable index of severity (Russell & Smith, 1961). It is suggested PTA be measured from the moment of the accident until memory becomes clear and continuous (Rutherford, Merrett & McDonald, 1977). In some patients the change from total amnesia to complete lucidity is rapid, and the FITA may be calculated with certainty, but with many, periods of increasing clarity alternating with episodes of confusion are demonstrated. The early phases of CHI recovery are usually times when patients exhibit confusion, disorientation and an inability to deal purposefully with internal and external stimuli; the random fluctuations of their performances and symptoms frequently require daily or weekly assessment (Hagen, 1981). It is often possible to recognize the end of PFA since it corresponds with the disappearance of confusion (Jennett,1976). As PTA fluctuates throughout the initial course of recovery, treatment decisions are difficult, since many CHI patients progress from relatively brief coma to prolonged periods of confusion which change with respect to the degree of disorientation, amnesia, and behavioral disturbance (Levin & Grossman, 1978). A remediation technique might be misinterpreted as ineffective because its application was too early in the patient's course of recovery (Bigler, 1984). Similarly, the clinician may obtain a diagnosis and begin a treatment only to find that all aspects of management are inappropriate the following day (Hagen, 1981). Variations either above or below a patient's optimal level of receiving and processing stimuli may act to intensify the already impaired ability to remain organized (Mayes, 1986). Additionally, a therapy program that requires a higher level of cognitive functioning than the …