of patients: (a) those in PTA, (b) those with the amnesic syndrome, and (c) those with chronic memory impairment following severe head injury, but who were no longer in PTA. A control group of people with orthopedic injuries was also tested. Patients in PTA differed from all other groups on semantic processing, verbal fluency, and simple reaction time. The results suggested that PTA is not solely a disorder of memory and orientation as suggested by the Westmead, but includes slowness and impaired retrieval from semantic memory.
We have described the development of 11 scales for measuring progress of functionally relevant behaviors from the earliest days of coma in patients surviving severe head injury. We have also commented on aspects of PTA.
Because progress in the early days (particularly with long periods of coma) is often very gradual, it can easily be missed unless actively measured. When signs of progress are missed, staff may be poorly motivated and inattentive, thereby allowing potentially avoidable problems to develop. For example, behavior problems can arise because no means of communication is established in patients able to use a communication board or other signaling system. Inhalation pneumonia can arise because patients with no gag reflex are given liquids to swallow, and falls can occur because patient mobility has improved without staff being aware of it. Adequate monitoring of progress could reduce these and many other such problems.
Pinpointing the specific deficit and describing it in behavioral terms should inform therapists of the steps they need to focus on in rehabilitation. This is unlike other measures, such as MRI or CT scans. An MRI can identify the precise areas affected after brain injury, but cannot tell how the effects of the lesion are manifested when attempting to cope with real-life tasks. Nor does the MRI guide the sequence of stimulation and therapy required for rehabilitation. If we can identify a behavioral deficit, such as inability to grasp a spoon, we can try to remediate or compensate for the deficits.
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Bluma S., Shearer M., Frohman A., & Hilliard J. ( 1976). Portage guide to early education. Portage, WI: Co-operative Educational Service Agency.