Monitoring Behavior During Coma and Posttraumatic Amnesia
Barbara A. Wilson, Agnes Shiel, Martin Watson, Sandra Horn, Lindsay McLellan
This chapter is concerned with the assessment of severely head-injured people in the earliest days after insult. A set of scales for monitoring the recovery of functional skills in these people has recently been developed (the Wessex Head Injury Matrix, WHIM). The matrix is composed of 11 subscales for measuring progress in: (a) cognition, (b) self-care, (c) motor functioning, and (d) social behavior; and 1 scale for assessing posttraumatic amnesia (PTA). From the scales it is possible to (a) detect small improvements that might otherwise be missed, (b) see whether a patient is showing the typical order of recovery, and (c) pinpoint specific deficits in functioning. Observations are described in behavioral terms that enable therapists to determine steps to focus on in rehabilitation. Because this functional approach concentrates on skills required for everyday life, it has considerable implications for the care and rehabilitation of people recovering from severe head injury.
Severity of head injury is usually judged by (a) the depth and duration of coma, and (b) posttraumatic amnesia (PTA). Coma has been defined as ". . . not obeying commands, not uttering words, and not opening the eyes" ( Jennett & Teasdale, 1981). Posttraumatic amnesia has been described as ". . . a period of variable length following closed head trauma during which the patient is confused, disoriented, suffers from