Post-traumatic amnesia following a traumatic brain injury Irving Building Occupational Therapy 0161 206 1475 All Rights Reserved 2017. Document for issue as handout. Unique Identifier: NOE46(17). Review date: September 2017
This booklet has been designed to give information and advice to people who have a friend or family member who has had a traumatic brain injury (TBI). The information is general, as each individual will be affected by TBI in different ways. For more specific advice please speak to a member of the multi-disciplinary team. Problems caused by Traumatic Brain Injury The problems caused by Traumatic Brain Injury (TBI) may be influenced by 3 things: 1. The nature of the injury 2. The part of the brain that has been affected 3. Whether there have been complications such as brain swelling or blood clots A common consequence of a TBI is Post-traumatic amnesia, which is often referred to as PTA. What is post-traumatic amnesia? Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a TBI in which the injured person is disorientated and unable to remember events that occur after the injury. Disorientation, restlessness and problems learning new information after a TBI, are sufficient signs for judging that the individual is in a state of PTA. The person may have no continuous memory of recent day to day events. Therefore, they may have difficulties remembering what happened a few hours or even a few minutes ago. Why measure posttraumatic amnesia? The length of time a person is in PTA has been considered a predictor for the severity of the injury. The length of time a person is in PTA varies. For some individuals this period may last for a few minutes, hours, days, weeks or even months. A standardised assessment will be completed daily by the Occupational Therapist to monitor if the individual is still in PTA, but occasionally the Neuropsychology and/ or psychiatric services will be involved. 1
What are the symptoms? Disorientation: During the period of PTA the injured person may show confusion and disorientation about where they are, or how they came to be there. For example if the individual in PTA was asked whether they are in a hospital, a hotel or at home, they may answer a hotel despite the obvious environmental cues of a hospital setting. Reduced memory: Most obvious is the loss of memory of present time. The person may become fixated on certain things and ask the same thing over and over again. The person may recognise family and friends but be unable to remember that they are in hospital or have had an injury of some kind. Poor attention: Their ability to concentrate may also be greatly affected, for example, the person may be easily distracted by other things they may hear or see around them. Altered behaviours: They may be very confused, agitated, distressed or anxious, and may even express themselves as if they were being held prisoner and have to escape. They may talk and behave as if they were in work, or need to get to a meeting. At this time it may be difficult to reason with them. You may observe uncharacteristic behaviours which may include violence or aggression (both physical and verbal), disinhibition (e.g. taking their clothes off), being sexually inappropriate, making verbal remarks about other people etc. Occasionally the injured person may become introverted, affectionate or over-familiar. The person may also attempt to wander if they are physically able to, or may try to get out of bed even if they have physical deficits. The risk of falls or of causing themselves further injury may be a problem at this time as they have poor safety awareness and altered judgement. They may also lack appropriate decision making skills and may begin to refuse treatment and/or attempt to take their own discharge. The multidisciplinary team (MDT) may be required to assess the individual s ability to give informed consent and then treatment may be provided in their best interest. What can be done about it? PTA is a stage of recovery that the person goes through after a TBI and at times may be distressing for family and friends. Below is some advice that can be followed to assist during this stage. Environment: The brain is struggling to cope with the injury, and too much stimulation is best avoided. Visitors should be limited to two at a time for brief periods with rest periods in between. Visitors may discuss what is appropriate with members of the MDT. Background noise should be kept to a minimum, for example, TV s, radios and lights should be switched off if the person is not attending to them or does not need them on. Communication: Stay as calm as possible, seeing other people distressed and not being able to understand the reason may add to the confusion and agitation the injured person is feeling. Visitors should speak one person at a time. The individual should be spoken to in short simple sentences, in a gentle and calm voice. Loud or fast speech should be avoided. 2 3
Summary of advice Stay calm & model calm behaviours Limit visitors to two at a time Limit visiting to brief periods with rest periods in between Try to speak one person at a time Speak in short simple sentences in a calm and gentle voice Keep background noise to a minimum Provide regular orientation information by stating the date, time of day, the name of the hospital and the reason for admission. Do not reinforce incorrect information Encourage use of orientation charts, signs and clocks Talk about familiar events from before admission to hospital Bring in photos and familiar belongings and toiletries Distract the person if they are becoming fixated on certain things If the individual begins to wander, allow them to do so with appropriate supervision - seek advice from ward staff regarding this Encourage structured routine. A rota of familiar faces may be useful Look after yourself and take some time out Orientation programme: It is helpful if visitors and staff members provide regular orientation information to the person by stating the date, time of day, the name of the hospital and the reason that they were admitted. Use of orientation charts, signs and clocks will all help to give the individual the correct information. It can also be useful to talk to the individual about familiar events in their life before the accident and for visitors to bring in familiar items such as photos, toileteries or significant objects that will have some meaning to them. It is important not to reinforce incorrect information. If the person trys to argue when they are being corrected, visitors and staff may say we will agree to disagree and move on to a different topic. Distraction may be required if the person becomes fixated on certain things. This will reduce the risk of increased agitation. Structured routine: By structuring the individuals day and providing routine, gradually the person will hold on to more information and begin to make sense of the world around them and interact more appropriately with their environment. Look after yourself: It is vital that you as a visitor/ relative look after yourself. Being overtired adds to already stretched emotions. Be sure to take time out for yourself and/ or share the visiting. Remember... PTA occurs as a direct result of trauma to the brain and this is likely to interfere with the person s efforts to interact appropriately. Therefore, the person does not have full control of what they do or say. It may be of some sort of comfort to the family to realise that the person who is injured may have little memory of their behaviour whilst in PTA. PTA ends when the injured person demonstrates improved orientation and continuous day-to-day memory is restored. Once it has been established through assessment that the individual has emerged from PTA, further cognitive and functional assessments will be completed, as residual cognitive impairments and/or altered behaviour/emotions may be present. The need for further rehabilitation may be required depending on the individuals needs. 4 5
G17090107W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: NOE46(17) Review Date: September 2019 For further information on this leaflet, it s references and sources used, please contact 0161 206 1475 Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients