Tag Archives: orientation

Post-Traumatic Amnesia

In fairy tales the stricken princess lies still on the bed, oblivious to the world around her.  With the prince’s kiss, she suddenly wakes from her stupor and greets the world as if she had just simply been asleep.  Unfortunately, returning to life after a brain injury is no fairy tale and brain injury survivors do not simply wake with all of their skills intact.  For most survivors of serious brain injuries, there is a period of time after they “wake” from their comas in which they are in a state called Post-Traumatic Amnesia (PTA).  PTA contains many unique features and experiences which are important to understand.

Two of the main features of PTA are an inability to make new memories and disorientation.  This inability to make new memories (hence the “amnesia” portion of PTA’s name) manifests itself in many ways.  For instance, a brain injury survivor may report that though a coma suffered lasted for only two weeks, he or she has no memories of his or her first three months of therapy.  Brain injury survivors often relay that they were told  of visits by significant others and acquaintances during the survivors’ hospital stays, but due to PTA the survivors have no memory of these visits.  When PTA is particularly severe, a visitor may simply walk out of the room for a minute and find upon return that he or she is greeted by the survivor as a fresh arrival.  Sometimes family and friends can become unnecessarily upset that a survivor does not remember a visit, not understanding that making new memories is generally beyond the emerging skill level of a survivor in PTA.  Moreover, due to these memory difficulties survivors have significant difficulty learning new information in therapies (though they may still benefit from repetition of desired behaviors).

The second hallmark characteristic of PTA is disorientation.  Survivors in the midst of PTA often have difficulty recalling the month or year when prompted to do so.  They might not be able to accurately relate which city they are currently in or even state their own ages.  It is often helpful to have such information readily available, possibly on a notebook in front of the survivor or on a large board in a survivor’s room (though others may still need to cue the survivor to look at the accurate information).  Sometimes, a survivor may dispute accurate orientation information.  For instance, a survivor undergoing inpatient therapy in Galveston may argue that the therapist is crazy and that he or she is actually in Houston.

While survivors contending with PTA will often have a “deer in the headlights” look, as they improve this look eventually fades.  Families and therapy staff might notice that the survivor’s pupils may be dilated.  PTA is frequently accompanied by agitation.  Survivors often say and do things they normally would not say or do.  This excessive agitation may see expression in threatening or lashing out at loved ones or tearing out tubes and monitors attached to survivors’ bodies. It is not uncommon for a survivor to attempt to remove even an item as critical to his or her continued well-being as a breathing tube when in PTA.  Doctors may put the survivor on medication to help with agitation, though some are wary to do so as this may cause the PTA to take longer to resolve.

Survivors under the effects of PTA may struggle with hallucinations or delusions.  These hallucinations and delusions can take a paranoid flavor, such as believing that doctors are trying to poison them or that nurses are trying to steal their money.  Survivors in PTA may try to escape the hospital or take other unhealthy risks, such as trying to walk to the restroom when they are unable to physically do so.  As survivors with PTA generally have poor awareness of their injuries and can be impulsive, they will usually require 24/7 supervision and careful monitoring.

When survivors are in PTA, it is helpful to reduce the number and intensity of stimuli around them.  Making sure that a room is generally quiet and limiting the number of people in the room with the survivor at a given time can help lessen issues arising from agitation.  All important information should be easy to find, and a good example of a handy way to accomplish this is to put the date and what happened to the survivor on a dry-erase board or on the front of a notebook he or she is using.  Repetition is also important, as survivors with PTA may pick up information after many repetitions.  This can be as verbal repetition (e.g. repeating the year) or physical repetition (e.g. practicing a wheelchair transfer).  There is no way to “rush” a person through PTA nor is there a “magic pill” to cure it.  Families need to be patient as for some survivors, it may take months to emerge out of PTA.  Unfortunately, a few survivors will never quite fully emerge from it.

It is also important not to take negative words or behaviors from the survivor as personal attacks.  Such negativity is generally due to the brain injury and is not reflective of how a survivor really feels.  When brain injury survivors become healthier and are no longer in PTA, they often feel embarrassed by their PTA behaviors.  The survivors did not intend to be rude or mean, but their injuries were not yet healed enough to allow them to behave in a normal fashion.

Hopefully this post helped to clarify the symptoms of Post-Traumatic Amnesia.  Feel free to leave a comment below with any questions!

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/

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New Year’s Disorientation

As 2014 comes to a close and 2015 is upon us, some brain injury survivors may find themselves facing greater than normal levels of disorientation.  Often brain injury survivors, particularly those with memory deficits or in the earlier stages of recovery, will have trouble keeping track of basic orientation information such as the month or the day of the week.  The change in year represents yet one more piece of new information they have to worry about remembering.  Survivors may seem confused or express doubt when told of the change in year.  Some survivors may even argue that therapists, staff and family are giving them false information.

 
Many patients with orientation difficulties can get stuck on the last date or location they remember and have trouble incorporating new information.  For example, a survivor may last remember living in Dallas and struggle with integrating into his or her life knowledge of moving in post-injury with his or her parents in Houston.  This same issue can occur with a change in year.  As the survivor last remembers the year being 2014, it takes considerable effort to make the switch to recognizing that it’s now 2015 (and to making realization of that switch stick).  To put it in perspective, people often temporarily forget the correct year during the first few days of January and will then write the wrong year on checks.  But imagine if instead of being stuck on the wrong year for a few moments, you continually find yourself stuck on the wrong year for weeks upon weeks.  This is what brain injury survivors with orientation deficits may experience when confronted by a change of year.

 
Brain injury survivors can be helped by keeping relevant orientation information presented in many easily accessible locations.  Families and survivors may want to place more calendars around the home.  If a survivor has considerable problems with disorientation, he or she will likely do best with a one page per day calendar, one that displays on each page the day, date and year.  This type of calendar can generally be found at teller stations in banks in order to help ensure that customers write the correct date on checks.  This is in contrast to the month at a glance calendar, in which the entire month is shown on a single page.  The date can also be written on a dry erase calendar in a bedroom or on a refrigerator so that the survivor can easily see the new year.

 
Families can also make extra effort to insert the correct year into daily conversation.  This can be done simply by saying more often than one might otherwise things like “Wow, 2015 has really started off well for us” or “I’m glad that 2015 has rolled around as last year was quite difficult.”  The more that a survivor is exposed to the correct information, the more quickly and permanently he or she will learn this new information.

 
Lastly, please make sure to dispose of old calendars and similar items displaying the old year as quickly as possible.  Some brain injury survivors will become confused or distressed when confronted by both an old calendar and a new calendar.  This can cause a temporary (and entirely avoidable) setback in efforts to properly align orientation.

 

Learn about brain injury treatment services at the Transitional Learning Center: tlcrehab.org