Changes in orientation during acute rehabilitation after traumatic brain injury.

Abstract

To examine the profile of scores on a measure of orientation in a sample of patients with traumatic brain injury (TBI) during acute rehabilitation as a means of (a) assessing the extent of neural compromise, (b) assessing recovery of functioning, and (c) determining the relative difficulty of different indicators of orientation. Design: Repeated measures. Setting: Acute rehabilitation hospital. Participants: Forty-three patients with severe TBI interviewed daily throughout rehabilitation. Measures: The Orientation Log (O-Log) is a 10-item measure of orientation to place, time, and situation. Items are scored 0-3 on the basis of whether they are recalled spontaneously (3), with cueing (2), via recognition (1), or not at all (0). Results: O-Log score was correlated with severity of TBI. Return of orientation followed a consistent trajectory, with initial gains preceding a plateau effect. Patients had relatively more difficulty orienting to hospital name and date than to year, month, and city. Conclusions: The O-Log is sensitive to the severity of TBI. Progress in orientation, on average, occurs at a similar rate across patients, including those who present as severely disoriented, although those with severe disorientation may not achieve orientation by rehabilitation discharge.A period of disorientation, confusion, and amnesia for ongoing events is characteristic of severe traumatic brain injury (TBI). Measures of orientation to place, time, and person have traditionally been used to chart the course of acute

Prediction of Cognitive Abilities 1 Year Following Traumatic Brain Injury From Inpatient Rehabilitation Cognitive Screening.

“…The Cog-Log and the O-Log are similar in some respects, such as the range of scores and scaling of individual items. The Cog-Log also contains three items from the O-Log, the most difficult items from that scale (Israelian et al, 2000). The O-Log has been shown to predict cognitive abilities at 6 and 12 months after injury, reflecting the fact that orientation is a type of cognitive skill.…”

“…Scores are summed, with the resulting O-Log score ranging from 0 to 30. The most difficult items from the O-Log (hospital name, date, and time of day) are also included in the Cog-Log, which is intended as an extension of the O-Log for use in situations when a patient is oriented but still exhibiting cognitive difficulties (Israelian, Novack, Glen, & Alderson, 2000).…”