Amnesia Test Research Articles

Psychometric validation and cultural adaptation of the Persian Galveston orientation and amnesia test and orientation-log for assessing traumatic brain injury

Post-traumatic amnesia (PTA) is a common symptom of acute traumatic brain injury (TBI). The Galveston Amnesia and Orientation Test (GOAT) and Orientation-Log (O-Log) are commonly used assessment tools to evaluate PTA following TBI. In this study, we aimed to validate the Persian versions of both scales. The forward-backward translation method was used, and a panel of experts, including three neuroscientists, one epidemiologist, and four lay experts with TBI experience, evaluated the scales. A total of 140 mild TBI patients aged 12 years and older were subsequently assessed with scales. Reliability was assessed using two approaches including Cronbach’s Alpha and Intraclass Correlation Coefficient (ICC). The total ICCs were 0.870 (95% CI: 0.818–0.907) and 0.687 (95% CI: 0.564–0.776) for the GOAT and O-Log, respectively. The Cronbach’s alpha values for the GOAT and O-Log were 0.64 and 0.75, respectively. A significant correlation was also found between the GOAT score and the O-Log (r = 0.729, p < 0.001). The Persian GOAT and O-Log were validated as reliable tools for monitoring TBI patients’ orientation. The interviews revealed significant cultural considerations that must be considered when the scales are translated and validated to ensure their validity and reliability in diverse cultural contexts and prevent bias.

Noninvasive neuromodulatory effect on cognition in individuals with traumatic brain injury: A single-blinded, two-arm parallel randomized clinical trial.

The study aimed to compare the effect of cranial electrical stimulation (CES) and transcranial direct current stimulation (tDCS) in improving cognition among individuals with mild traumatic brain injury. The pretest-posttest randomized controlled study was conducted between November 2020 and March 2022. Seventy-two patients (64 males, 8 females; mean age: 40.5±9.5 years; range, 18 to 45 years) experiencing cognitive impairment within three months of traumatic brain injury were recruited. Participants were randomly assigned into two groups: Group 1 (CES with cognitive training, n=36) and Group 2 (tDCS with cognitive training, n=36). Participants were blinded in the study. Both groups received 30-min sessions of neuromodulation along with 30 min of cognitive training five days a week for four weeks. The patients were assessed at baseline and at the end of two and four weeks of intervention. The primary outcome measure was the Montreal Cognition Assessment (MoCA), and the secondary outcome measure was the Galveston Orientation Amnesia Test (GOAT). Demographic and baseline characteristics depicted normal distribution for both groups (p>0.05). Within group analyses of both groups demonstrated significant differences for both outcome measures (MoCA: p=0.001; GOAT: p=0.001). Between group analyses of MoCA showed significant improvement with p-value of 0.001 while GOAT exhibited p-value of 0.002 showing significant difference between the two groups. Time group interaction effect and covariance analyses depicted significant improvement with p-value of 0.001 for both outcome measures with excellent effect size >0.80. Cranial electrical stimulation was a more effective noninvasive neuromodulatory device than tDCS in improving cognition among individuals with traumatic brain injury.

The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury.

Our Phase-I parallel-cohort study suggested that managing severe traumatic brain injury (sTBI) in the absence of intracranial pressure (ICP) monitoring using an ad hoc Imaging and Clinical Examination (ICE) treatment protocol was associated with superior outcome vs nonprotocolized management but could not differentiate the influence of protocolization from that of the specific protocol. Phase II investigates whether adopting the Consensus REVised Imaging and Clinical Examination (CREVICE) protocol improved outcome directly or indirectly via protocolization. We performed a Phase-II sequential parallel-cohort study examining adoption of the CREVICE protocol from no protocol vs a previous protocol in patients with sTBI older than 13 years presenting ≤24 hours after injury. Primary outcome was prespecified 6-month recovery. The study was done mostly at public South American centers managing sTBI without ICP monitoring. Fourteen Phase-I nonprotocol centers and 5 Phase-I protocol centers adopted CREVICE. Data were analyzed using generalized estimating equation regression adjusting for demographic imbalances. A total of 501 patients (86% male, mean age 35.4 years) enrolled; 81% had 6 months of follow-up. Adopting CREVICE from no protocol was associated with significantly superior results for overall 6-month extended Glasgow Outcome Score (GOSE) (protocol effect = 0.53 [0.11, 0.95], P = .013), mortality (36% vs 21%, HR = 0.59 [0.46, 0.76], P < .001), and orientation (Galveston Orientation and Amnesia Test discharge protocol effect = 10.9 [6.0, 15.8], P < .001, 6-month protocol effect = 11.4 [4.1, 18.6], P < .005). Adopting CREVICE from ICE was associated with significant benefits to GOSE (protocol effect = 0.51 [0.04, 0.98], P = .033), 6-month mortality (25% vs 18%, HR = 0.55 [0.39, 0.77], P < .001), and orientation (Galveston Orientation and Amnesia Test 6-month protocol effect = 9.2 [3.6, 14.7], P = .004). Comparing both groups using CREVICE, those who had used ICE previously had significantly better GOSE (protocol effect = 1.15 [0.09, 2.20], P = .033). Centers managing adult sTBI without ICP monitoring should strongly consider protocolization through adopting/adapting the CREVICE protocol. Protocolization is indirectly supported at sTBI centers regardless of resource availability.

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Invited Symposium 1: Traumatic Brain Injury: Highlighting the Contributions of Dr. Harvey S. Levin Ph.D., ABPP-CN, FACSM 1946 - 2022

Cognitive reserve index and long-term disability in patients with severe traumatic brain injury discharged from the intensive rehabilitation unit.

The "cognitive reserve" (CR) theory posits that higher premorbid cognitive activities can mitigate the effects of brain damage. This study aimed to investigate the association between CR and long-term functional autonomy in patients surviving a severe traumatic brain injury (sTBI). Data were collected from the database of inpatients with severe acquired brain injury in a rehabilitation unit admitted from August 2012 to May 2020. Patients that had incurred an sTBI, aged 18+ years, completing the phone Glasgow Outcome Scale-Expanded at follow-up (pGOS-E) in absence of previous brain trauma or neurological disease, or cognitive disorders were included. Patients with severe brain injury from non-traumatic etiologies were not included in the study. In this longitudinal study, all patients underwent a multidimensional assessment including the cognitive reserve index questionnaire (CRIq), the coma recovery scale-revised, the level of cognitive functioning, the Disability Rating Scale (DRS), and the Galveston Orientation and Amnesia Test at admission. At discharge, functional scales were administered again together with the Glasgow Outcome Scale. The pGOS-E was assessed at follow-up. pGOS-E. A total of 106 patients/caregivers underwent the pGOS-E after 5.8 [3.6] years from the event. Among them, 46 (43.4%) died after discharge, and 60 patients [men: 48 (80%); median age: 54 years; median time post-onset: 37 days; median education level: 10 years; median CRIq total score: 91] were included in the analysis exploring the association between pGOS-E and demographic data, cognitive reserve surrogates, and clinical variables at admission and discharge from the rehabilitation unit. A younger age (B = -0.035, p = 0.004) and a lower DRS category at discharge (B = -0.392, p = 0.029) were significantly related to a higher long-term functional autonomy in the multivariate analysis. Long-term functional autonomy was not influenced by CR as assessed through the educational level and the CRIq.

Post-Acute Care for Traumatic Brain Injury Patients in Taiwan.

Traumatic brain injury (TBI) can result in functional impairments. Many patients with TBI require post-acute care to improve their functional skills and allow for greater self-independence and a better quality of life. Taiwan's National Health Insurance proposed a nationwide post-acute care program in 2017 for patients with traumatic brain injury. The program's goal was to maximize patients' functional recovery and make it possible for them to return to their homes and communities. This study aimed to explore the effectiveness of such programs in Taiwan. This pilot study retrospectively evaluated a de-identified database that contained the scores of various assessments evaluated at admission and discharge. It used the data to determine the functional improvement of patients with traumatic brain injury after participating in post-acute care programs. This study collected complete data from 27 patients. After an average of 45.11 days in the program, the patients showed significant improvement in the Barthel Activity Daily Living Index, the Lawton-Brody Instrumental Activity Daily Living Scale, the Mini Nutrition Assessment, the EuroQol Five Dimensions Questionnaire, the Berg Balance Scale, the Galveston Orientation and Amnesia Test, the Rancho Los Amigos Scale, the Concise Chinese Aphasia Test, and the Mini Mental State Examination. After discharge, 96% of the patients could return to their community. This pilot study concluded that the program significantly promoted functional recovery for patients and could help patients with traumatic brain injury return to their communities and reduce the risk of institutionalization. Thus, patients with the potential for functional recovery could receive post-acute care in regional or community hospitals immediately after being discharged from acute wards. In the future randomized controlled trials are needed to further confirm the clinical impact of this program.

Epidemiology and management of traumatic brain injury in a regional Queensland Emergency Department

BackgroundThere is a paucity of traumatic brain injury (TBI) data in Australia in the regional and rural context. This study aimed to investigate the epidemiology, severity, causes, and management of TBI in a regional north Queensland population to plan acute care, follow up, and prevention strategies. MethodsThis retrospective study analysed TBI patients presenting to Mackay Base Hospital Emergency Department (ED) in 2021. We identified patients using head injury SNOMED codes, and analysed patient characteristics with descriptive and multivariable regression analysis. ResultsThere were 1120 head injury presentations, with an overall incidence of 909 per 100,000 people per year. The median (IQR) age was 18 (6−46) years. Falls were the most common injury mechanism (52.4% of presentations). 41.1% of patients had a Computed Tomography (CT) scan, while 16.5% of patients who met criteria had post traumatic amnesia (PTA) testing. Age, being male and Indigenous status were associated with higher odds of moderate to severe TBI. ConclusionTBI incidence in this regional population was higher than metropolitan locations. CT scan was undertaken less frequently than in comparative literature, and low rates of PTA testing were undertaken. These data provide insight to assist in planning prevention and TBI-care services.

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury.

A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation. Data were collected from medical files on 103 children aged 5.5-16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate-severe TBI (msTBI) between the years 2004-2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention-Child version (TEA-Ch). Three PTA duration groups were assembled out of a cluster analysis: "Long PTA" (M = 21 days), "Very Long PTA" (M = 47 days), and "Extremely Long PTA" (M = 94 days). Analyses revealed that the "Long PTA" group preformed significantly better than the "Very Long PTA" and "Extremely Long PTA" groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention. This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

Acute Cognitive Dysfunction in a Patient With Traumatic Brain Injury: A Clinical Vignette.

A Report of Post-Concussion Syndrome in Post-Moderate Traumatic Brain Injury Patients

Traumatic brain injury is the most common injury, especially in motorcycle riders who do not wear helmets or those who wear unsafe helmets. This injury can be fatal and result in death, but it can also be healed without any sequelae or with varying sequelae. The type of sequelae that commonly occurs after a traumatic brain injury is Post-Concussion Syndrome. Moreover, it has some symptoms such as headaches, impaired concentration, tiredness, anxiousness, dementia, and impaired cognitive function. Based on its onset, Post-Concussion Syndrome is classified into 3: acute (the symptoms appear less than one month after injury), subacute (the symptoms appear from 1 to 12 months), and chronic (the symptoms appear more than a year). The purpose of this research is to provide an overview of symptoms in cases of Post Concussion. Syndrome that occurs after 6 months after moderate head injury.The design of this study used a case report method in order to report cases in detail through interviews and direct observation on respondents. The results of Rivermead, Galveston Orientation and Amnesia Tests conducted 6 months after moderate traumatic brain injury, indicated that respondents experienced Post-Concussion Syndrome and Retrograde Amnesia. The conclusion of Post-Concussion Syndrome experienced by the respondents was subacute with several symptoms such as headache, dementia, impaired concentration, anxiousness, and memory loss of before injury.

Predictors of the duration of post-traumatic amnesia following traumatic brain injury

The duration of post-traumatic amnesia (PTA) helps estimate the level of recovery following traumatic brain injury (TBI). Yet, little information is available about which sociodemographic and clinical variables influence its duration. This study aims to identify them and create a predictive model that makes it possible to estimate the time it takes for a patient to emerge from PTA. The sample consisted of 40 adult patients with PTA admitted to a neurorehabilitation centre. A total of 89.7% had suffered a severe TBI, whereas the remaining 10.3% had had a moderate TBI. Cognitive status was assessed using the Galveston Orientation and Amnesia Test (GOAT) - a scale for determining at what point a patient can be considered to be emerging from PTA. A regression equation was found (F = 8.511; p < 0.001; R2 = 0.415), in which the following variables (ranked in order of importance) explained 41.5% of the variability observed in the duration of PTA: a) GOAT administered on arrival at the neurorehabilitation centre; b) years of formal education of the patient; and c) days with PTA prior to admission to the neurorehabilitation centre. The equation derived was as follows: 104.284 + (-0.708 x GOAT-initial) + (-4.124 x years formal education) + (0.219 x hospital acute-APT). The time it takes for a patient to emerge from PTA is conditioned by the score obtained in the first GOAT administered on admission to the neurorehabilitation centre, their level of education, and the number of days elapsed with PTA between occurrence of the TBI and admission to the neurorehabilitation centre.

Operative variations in temporal lobe epilepsy surgery and seizure and memory outcome in 226 patients suffering from hippocampal sclerosis

ABSTRACT Objective: The aim of this retrospective cohort study was to assess seizure and memory outcomes following temporal lobe surgery in patients suffering from medically refractory temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS). Methods: A retrospective monocentric data analysis was performed in consecutive patients who were operated on during 2002–2018. In the first decennium, standard temporal lobe resections (TLR) were predominately performed, and later, antero-temporal lobe resections (ATLR) were mainly performed. Seizure and memory outcomes over time were assessed according to ILAE/Engel classification and the Berlin Amnesia Test (BTA), respectively. Results: Altogether, 231 surgeries were performed on 226 patients (mean age, 40 years [range, 10–68 years]; male: female, 1:1.4; mean seizure duration, 25 years; and mean follow-up duration, 4.75 years [range, 1–16]). Recently, outcomes of 78.3% of the patients in the total cohort were classified as Engel class I, with 54.9% of patients being completely seizure free. The recent cohort of ATLR since 2012 showed significant more completely seizure-free patients than before 2012 (Engel IA 46.6% versus 67.7%, p < 0.0025, χ 2), although the Kaplan Meier analysis of all patients favors TLR for better seizure outcome (61% ATLR vs 73% TLR seizure free after 5 yrs, log rank p < 0.001). Verbal memory improved significantly in non-dominant patients. Minor neurological complications were noted (permanent severe complications, 0.4%; temporary severe complications, 4.8%). Conclusion: Significant improvements in seizure and memory outcomes were observed over time, with surgical technique and seizure duration as important prognostic factors. Early admittance for surgery may favor an excellent seizure outcome in patients undergoing temporal lobe resection for HS.

Correlation between post-traumatic amnesia with behavioral disorders in the mild- and moderate-traumatic brain injury patient

Introduction: Traumatic brain injuries (TBIs) could have short and long-term sequelae, including cognitive and behavioral changes and physical impairments. This study aimed to determine the correlation between post-traumatic amnesia and neurobehavioral disorders in mild and moderate TBI patients.Methods: A cross-sectional study was conducted on 75 patients with mild or moderate TBI who had or didn't have a period of post-traumatic amnesia during their hospital stay in the Department of Neurosurgery Dr. Hasan Sadikin Hospital (RSHS), Bandung, from January to August 2019. The Galveston Orientation Amnesia Test (GOAT) was performed, and neurobehavioral functions were examined in post-TBI patients (mild or moderate) using the neurobehavioral rating scale (NRS), which was performed at the time of hospital discharge.Results: The subjects were predominated with male patients (76%) with a mean age of 25 years old (15 – 35 years old). The analysis showed that the patients with post-traumatic amnesia had a higher median total NRS score (10.4 [5.0-18.0]) compared to those who didn't have any neurobehavioral disorders (2.6 [1.0-12.0]). The statistical analysis showed that the difference was statistically significant (p-value: 001; r: -0.776).Conclusion: According to the result, it can be concluded that post-traumatic amnesia was significantly associated with neurobehavioral disorders. However, further study is needed to confirm this finding and assess the other potential factors that may affect both variables.

The Effect of Foot Reflexology on Amnesia in Patients Undergoing Electroconvulsive Therapy: A Randomized Clinical Trial.

Introduction: Electroconvulsive therapy (ECT) is the oldest procedure among the early biological treatments introduced in psychiatry. However, the most debated and treatment-limiting adverse effect of ECT is amnesia. Therefore, due to the restriction of the use of drugs to manage amnesia in patients undergoing ECT, the present study investigated the effect of reflexology on amnesia.Methods: In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated to intervention and control groups. The intervention group received foot reflexology with olive oil 20 minutes a day for 3 days, while the control group was given a gentle foot rub with olive oil 20 minutes a day for 3 days. The amnesia rate of all patients was measured by the Galveston Orientation and Amnesia Test (GOAT) 30 minutes after the end of ECT. The data were analyzed using SPSS software version 11.5 and t-test, chi-squared test, and repeated measures ANOVA.Results: The results showed that reflexology significantly increased recalling scores in the intervention group compared to the control group. Foot reflexology seems to be effective in managing amnesia in patients after ECT.Conclusion: Foot reflexology, as a relatively simple, inexpensive, and non-invasive technique with few side effects, can be used to manage amnesia in patients after ECT.

More than amnesia: prospective cohort study of an integrated novel assessment of the cognitive and behavioural features of PTA

AbstractBackground and Objective:Post-traumatic amnesia (PTA) is an early significant stage of recovery from traumatic brain injury (TBI). Current prospective PTA scales do not assess the full range of PTA symptomatology. This study conducted a novel integrated assessment of cognition and behaviour during PTA.Method:Twenty-four moderate-to-severe TBI participants in PTA and 23 TBI controls emerged from PTA were matched for age, gender, and years of education. All completed PTA measures (Galveston Orientation and Amnesia Test: GOAT, Westmead Post-traumatic Amnesia Scale: WPTAS), a cognitive battery; and behaviour ratings scored by 2 independent raters (informant and staff).Results:Significantly poorer performance was found during PTA for attention, processing speed, delayed verbal free recall and recognition, and visual learning. A large effect size was found for category fluency only. Behaviour ratings were significantly higher during PTA. Five behaviours were rated as high frequency (&gt;50%) by both raters: Inattention, Impulsivity, Sleep Disturbance, Daytime Arousal, and Self-Monitoring. Prospective PTA measures produced significantly different duration estimates from 2 days (GOAT vs. WPTAS 1st day) to 9 days (WPTAS 1st day vs. 3-day). The WPTAS correlated most highly with processing speed and language tasks; whilst the GOAT correlated most highly with language and executive control of verbal memory.Conclusion:New prospective measures are needed that integrate core cognitive and behavioural features are brief, easy to administer, and capable of measuring emergence. The term PTA is a misnomer that requires revision to better accommodate the clinical syndrome.

Neuropsychological and behavioral disorders, functional outcomes and quality of life in traumatic brain injury victims.

Introductionthe assessment of neuropsychological and behavioral disorders outcomes, functional outcomes and quality of life in traumatic brain injury victims. It was also to evaluate initial means of care provided to these patients. Finally, to study correlations between neuropsychological and behavioral disorders with demographic characteristics, injury severity, functional status and quality of life.Methodsit was a cross-sectional study including 50 patients with traumatic brain injury conducted in the physical medicine and rehabilitation department of Sfax. Memory disorders were tested by the mini mental state and the Glaveston orientation and amnesia tests. Executive functions were evaluated by the dysexecutive function scale. The psychological profile was evaluated using the hospital anxiety and depression scale and behavioral disorders were tested by the agitated behavior scale. Glasgow outcome scale has allowed the assessment of traumatic brain injury severity in terms of disability. Otherwise, functional capacity was measured by functional independence measure scale. Finally, health-related quality of life was measured using a generic measure (short-form-36) and the QOLIBRI scales.Resultsabnormal executive functions were noted in 41 patients (82%) with a dysexcutive function average score of 33.20 ± 22.74. About psychological profile, depressive symptoms were found in 32 patients (64%). Moreover anxiety was noted in 20 patients (40%). Behavioral disorders such as aggressiveness and agitation were noted respectively in 32 (64%) and 8 patients (16%). The global social functional evolution was considered as unfavorable in 42% of the patients and favorable in 58%. Regarding to functional independence measure scale, 92% of the victims showed impairment. Memory impairment and abnormal executive functions were statistically correlated with traumatic brain injury severity. Elementary brain injury lesions shown on computed tomography were correlated with memory disorders especially for temporal, cortical brain contusion and diffuse axonal injury. Our study showed that patients with severe memory impairment, abnormal executive functions and depressive mood had significant functional.Conclusionthe executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in traumatic brain injury. We noted that it is so important to evaluate neuropsychological disorders in traumatic brain injury because they were underestimated. We have already started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neuropsychological assessment is essential to propose efficient means of rehabilitation.

Assessment and Management of Patients in the Acute Stages of Recovery after Traumatic Brain Injury in Adults: A Worldwide Survey

Most individuals with traumatic brain injury (TBI) experience a period of confusion after emergence from coma, termed post-traumatic amnesia, post-traumatic confusional state, or delirium. Recent guidelines suggest the importance of assessment and consistent management during this phase, but current practice worldwide remains unknown. This survey aimed to elucidate current international practice in assessment and treatment of patients in the acute stages of recovery after TBI. The web-based survey was distributed to clinicians working with patients with acute TBI. There were 400 participants (68.8% females), from 41 countries, mostly neuropsychologists, rehabilitation physicians, and occupational therapists (OTs), with an average 12.8 years of experience. Of those working with adults (n = 376, 94%), most described this acute period as post-traumatic amnesia and used its duration to indicate injury severity. More than 85% used a tool to assess patients; in order of frequency, the Glasgow Coma Scale (GCS), Westmead PTA Scale (WPTAS), Galveston Orientation and Amnesia Test, Rancho Los Amigos Scale, and O-Log. Meeting criteria on the assessment tool or clinical judgment determined emergence from this phase, indicated by recovery of orientation, day-to-day memories, and ability to follow commands or participate in rehabilitation. Most patients had physiotherapy, OT, speech therapy, and environmental changes, with a third of participants indicating sedating medication was prescribed during this phase. Findings suggest that, consistent with guidelines, PTA is a widely recognized and measured TBI recovery phase, used to determine injury severity and readiness for therapy.

Optimizing and simplifying post-traumatic amnesia testing after moderate-severe traumatic brain injury despite common confounders in routine practice

The duration of post-traumatic amnesia (PTA) following traumatic brain injury (TBI) is a key diagnostic and outcome indicator. However, concerningly, different PTA paradigms record different PTA durations: some over-estimate, others under-estimate, PTA. Thus, a compromise is implied. The potential effect of in-hospital confounders including opioids is unknown. Three clinical groups were prospectively recruited. Group-1: in-patients with moderate-severe-TBI (MS-TBI), considered likely ‘in-PTA’. Group-2: patients rehabilitating after recent MS-TBI, considered ‘out-of-PTA’. Group-3: orthopaedic in-patients without TBI undergoing elective surgery. Only Groups 1&3 were taking opioids. All were administered the Westmead Post-traumatic Amnesia Scale (WPTAS) and the Galveston Orientation and Amnesia Test (GOAT). Results were obtained in n = 56 (Group-1:n = 18, Group-2:n = 13 and Group-3:n = 25). On WPTAS, Groups 1&3 scored similarly, but significantly lower than, Group-2 (χ2 = 8.2, P = 0.017). Contrariwise, on GOAT, Group-1 scored significantly lower than Groups 2&3 (χ2 = 23.99, P < 0.001): however, no patient scored GOAT <75. WPTAS showed moderate sensitivity (72%) but poor specificity (40%) in distinguishing Group-1 from Groups 2&3. Contrariwise, GOAT showed 100% specificity but 0% sensitivity. WPTAS ‘day of week’ and ‘pictures’ combined with GOAT ‘transport medium to hospital’, ‘anterograde amnesia’ and ‘retrograde amnesia’ maximized sensitivity (100%), specificity (85–88%), PPV (77–83%) and NPV (100%) in distinguishing Group-1 from Groups 2&3. ConclusionsConfounders including opioids likely affected WPTAS overall, but not GOAT specificity. A merger, whereby WPTAS sensitivity augmented GOAT specificity, was therefore sought. Favourable items from WPTAS (4/12) and GOAT (3/10) together optimized, and yet simplified, PTA testing; despite prevalent clinical confounders. Less, not more, ‘PTA’ items would benefit both patients and staff alike.

Comparing the Westmead Posttraumatic Amnesia Scale, Galveston Orientation and Amnesia Test, and Confusion Assessment Protocol as Measures of Acute Recovery Following Traumatic Brain Injury.

The duration of the acute period of recovery following traumatic brain injury (TBI) remains a widely used criterion for injury severity and clinical management. Consensus regarding its most appropriate definition and assessment method has yet to be established. The present study compared the trajectory of recovery using 3 measures: the Westmead Post-Traumatic Amnesia Scale (WPTAS), the Galveston Orientation and Amnesia Test (GOAT), and the Confusion Assessment Protocol (CAP). Patterns of symptom recovery using the CAP were explored. Eighty-two participants with moderate to severe TBI in posttraumatic amnesia (PTA) on admission to an inpatient rehabilitation hospital. Prospective longitudinal study. Length of PTA (days), agreement between measures (%, κ coefficient), and pattern of symptom recovery. Participants emerged from PTA earliest on the CAP followed the GOAT, and last on the WPTAS. There was good agreement between the CAP and the GOAT as to PTA status, but both tests had poor agreement with the WPTAS. Of patients considered out of PTA on the CAP, the majority exhibited signs of amnesia on the WPTAS and one-third had clinical levels of agitation. The WPTAS identifies a later stage of PTA recovery that requires specialized management due to ongoing amnesia and agitation. The CAP and the GOAT are less sensitive to this extended period of PTA.

Post traumatic amnesia as a predictor for development and recovery of visual field defects following mild traumatic brain injury (mTBI)

Mild traumatic brain injury can trigger long term visual dysfunction in the form of visual field defects which can disrupt the normal lifestyle of any individual and other rehabilitation efforts resulting in social and professional distress. Post traumatic amnesia is one of the predictors of severity in mTBI.The purpose of this study was two fold (i)To find out the association between post traumatic amnesia and visual field defects following mild traumatic brain injury. (ii) The implication of post traumatic amnesia on the development and recovery of visual field defects post mTBI. Hospital based prospective, analytical, observational study. A total of 260 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.Visual field index (VFI) was taken to estimate the extent of visual field damage because it is a global index which expresses the amount of visual field loss as a percentage relative to the sensitivity of a reference group of healthy observers.The Galveston orientation and amnesia test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI was examined for Visual field defects at 1 month, 6 months and 1 year post injury. The main observation of this study were (i) It is important to look for visual field defects even in mild traumatic brain injury for atleast 6 months post injury because during this period the appearance of visual field defect peaked. (ii) There is a strong possibility of developing visual field defects among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (P=0.0001) (iii) If a patient with mild traumatic brain injury suffers from visual field defects, possibility of his/her symptoms persisting beyond 12 months increases significantly if there is history of post traumatic amnesia (P=0.0001).Mild traumatic brain injury can trigger long term visual dysfunction in the form of Visual field defects. Our results will help in providing information regarding development, progress and outcome of visual field defects following mild traumatic brain injury.