From the Guidelines
To improve recovery in patients with post-traumatic amnesia (PTA), a multidisciplinary approach incorporating early information and advice, graded physical exercise, and psychological treatment is crucial. This approach is supported by a recent systematic review and meta-analysis published in JAMA Network Open in 2021 1, which evaluated the effectiveness of nonpharmacological interventions in adults experiencing persistent postconcussion symptoms (PPCS). The study found that these interventions can be effective in managing PPCS, which includes symptoms similar to those experienced by patients with PTA, such as cognitive, emotional, and behavioral disturbances.
Key Strategies for Recovery
- Early information and advice: Providing patients and their families with accurate and timely information about the condition, its management, and expected recovery trajectory can help reduce anxiety and improve adherence to treatment plans 1.
- Graded physical exercise: Gradually increasing physical activity can help improve cognitive function, reduce symptoms of depression and anxiety, and enhance overall quality of life 1.
- Psychological treatment: Cognitive-behavioral therapy (CBT) and other forms of psychological treatment can be effective in managing emotional and behavioral symptoms, such as irritability, anxiety, and depression 1.
- Interdisciplinary coordinated rehabilitative treatment: A team-based approach involving neurologists, rehabilitation specialists, neuropsychologists, and occupational therapists can provide comprehensive care and address the complex needs of patients with PTA.
Additional Considerations
- Environmental management: Creating a calm and quiet environment with minimal stimulation can help reduce confusion and agitation in patients with PTA.
- Family education and support: Educating families about PTA symptoms and management strategies can help them provide better support and care for their loved ones.
- Consistent care team and daily routine: Maintaining a consistent care team and daily routine can help provide stability and reduce cognitive demands on the injured brain, allowing natural recovery processes to proceed.
From the Research
Strategies for Improving Recovery in Patients with Post-Traumatic Amnesia (PTA)
- Non-pharmacological interventions, such as structured retraining of activities of daily living, reality orientation programmes, and therapeutic application of music, have been shown to have positive effects on reducing cognitive-behavioural signs and symptoms associated with PTA 2
- Behavioural and environmental measures are recommended as the mainstay of treatment for patients in PTA with behavioural disturbance, while avoiding pharmacological interventions where possible 3
- Regular assessment of patients is necessary to determine their need for further rehabilitation and to facilitate safe discharge planning 3
- The use of validated tools, such as the Westmead Post-Traumatic Amnesia Scale, Galveston Orientation and Amnesia Test, and Confusion Assessment Protocol, can help to assess the severity of PTA and monitor recovery over time 4, 5
- A combination of tests, including orientation questions, reaction time measures, visual recognition tests, and speed of information processing measures, can be effective in distinguishing between people in PTA and those not in PTA, as well as monitoring recovery from PTA 5
Assessment and Monitoring of PTA
- The duration of PTA has been shown to be a predictor of subsequent everyday memory performance, with longer durations of PTA associated with poorer performance 6
- The use of a PTA scale, such as the one developed in the 1991 study, can be useful in assessing the severity of brain injury and predicting subsequent everyday memory performance 6
- Regular assessment of patients using validated tools can help to identify those who are at risk of prolonged PTA and provide targeted interventions to improve recovery 4, 5