Synapse - reconnecting lives

A person coming out of a coma doesn't just wake up, but goes through a gradual process of regaining consciousness called post-traumatic amnesia. 

When fully conscious, the brain is constantly active - perceiving, processing and remembering information. After a coma, it takes some time to reach full consciousness again, and this period of post-traumatic amnesia can last for hours, days or weeks. A mild concussion can also cause a brief period of post-traumatic amnesia (PTA).

PTA is considered a stage in the brain's recovery process. Typical effects include:

• disorientation and confusion about location, time and identity of others 
• Highly distractactable and disinhibited
• Difficulty with thinking, memory and concentration
• Anxiety, agitation and rapid changes in mood. 

People with post-traumatic amnesia can be partially or fully awake but they will be confused and have difficulties with their short-term memory. If physically able, they may wander, so it is important to make sure their surroundings are free of any hazards.

There can be significant behavioural changes can occur during this phase, where the patient may be quiet and passive, or aggressive, abusive and agitated. Patients usually have little or no awareness of these impairments and will usually remember nothing of what happened later.

The assessment and rehabilitation process does not commence until PTA is finished. The patient's memory is unable to retain information which makes most rehabilitation techniques ineffective.

What the family can do

Any challenging behaviour is likely due to the effects of the traumatic brain injury and therefore should not be taken personally. In most cases a person will usually not remember most, if any, of what has happened during this time.

Too much stimulation during PTA can lead to confusion and distress. The patient may be unable to cope with noise  and activity so ensure a peaceful quiet environment.

Avoid overloading the person with too much information at once when talking, and keep sentences short. It is important to carefully watch for cues of discomfort with levels of touch, noise, or activity.

The family needs to get enough sleep and 'time-out' from the hospital to maintain their own health and energy levels. It is normal for family members to feel they should not leave their loved one alone in hospital, but you need to pace yourselves for the long haul. Allowing time to rest will allow you to provide good support during critical phases such as rehabilitation.

If sleep proves too difficult, trying different relaxation techniques and make time to chat with someone you trust and feel comfortable with.

Upon returning home, see if you need to take precautions such as preventing the person from driving and not leaving them alone in the house.

When does PTA finish?

PTA usually is over when the patient begins to retain information such as where they are, why they are in hospital, and the month and year; in other words continuous memory returns.

However, sometimes there can be brief periods of orientation and good memory to it can take time to ensure the PTA phase has finished. The good news is that signs of orientation and memory ability are indicators that PTA may be drawing to a close. 

Following PTA, more assessments are conducted to gain further insight into the nature and extent of injury, along with the commencement of rehabilitation. Behavioural issues sometimes worsen at this point as the patient becomes aware of what has happened to them, and may have difficulty coping with the various emotions that arise.

PTA as a guide to recovery

Along with Glasgow Coma Score, the length of PTA is often seen as one of the best measures of severity of a traumatic brain injury  or similar brain disorder. This also means it can give a rough indication as to the degree of recovery that can be expected.

In Australia the Westmead Post Traumatic Amnesia Scale is the most widely used measure:

• PTA less than 5 minutes = "very mild injury"
• PTA between 5-60 minutes = "mild injury"
• PTA between 1-24 hours = "moderate injury"
• PTA between 1-7 days = "severe injury"
• PTA greater than 7 days = "very severe injury".