¶ … condition known as Post-traumatic Amnesia. This condition occurs when an individual suffers an acute brain damaging injury. Automobile crashes are said to be the most common origin of such injuries, and thus, the fundamental source of this disorder, in young adults. The condition persists for a few minutes or hours after the accident, or may go on for as long as weeks, months or years. Post-traumatic amnesia is accompanied chiefly by memory loss and other similar impairments.
The paper begins with an introduction to the disorder, followed by a section on the characteristics that help diagnose post-traumatic amnesia (PTA). The third section of the paper is dedicated to neuropsychological testing/evaluation for identifying behavioral or cognitive shortfalls, such as a patient might experience with post-traumatic amnesia. The factors for evaluation described here are: unconsciousness, scores on the Glasgow Coma Scale, and duration of diagnosed post-traumatic amnesia. Furthermore, treatment techniques for PTA that consider sensory, motor, cognitive, and behavioral issues are addressed in the fourth section.
Methods for cognitive rehabilitation are also explained, in the following section, taking into consideration the role of smells and sounds in sparking memories. The final section of the paper addresses general principles that ought to be followed while managing patients with traumatic brain injury. This is followed by a conclusion that concisely wraps up the paper.
Post-traumatic amnesia (PTA) is a type of amnesia that occurs 'post' or after a traumatic incident; it refers to a phase of recuperation from a severe, moderate or mild brain injury. Patients who suffer from PTA are incapable of processing and retrieving new information or recording new memories. This type of amnesia can be stated to be a mental disturbance that is characterized by impaired attention, disorientation, illusions, mis-identification of friends, family members, nursing and medical staff, and by a failure to remember everyday events (Kneafsey, 2003).
The true pathophysiogical process of PTA is unknown, but it is argued by many that PTA can be linked with a traumatic injury to the brain and shearing of accelerative or decelerative axons in the brain's temporal and frontal lobes. These forces cause bruising, breakage and/or inflammation of axons, with message pathways consequently being disrupted and/or damaged. This can be commonly described as DAI, Diffuse Axonal Injury. Evidence from magnetic resonance imaging (MRI), however, has shown that some PTA patients do not show any evidence of diffuse axonal injury on their MRI reports (Korinthenberg et al., 2004: Gumm et al., 2014).
The greatest source of Traumatic Brain Injury (TBI) is from car crashes. As many as 17% of TBIs, in fact, are caused by motor vehicle accidents (CDC, Centers for Disease Control and Prevention, 2010). For young males, TBIs remain the leading source of death. Evidence from numerous severe automobile crashes indicates that the victim's head often crashes into the windshield, damaging the brain's prefrontal lobes. This frontal lobe damage may cause long-term memory deficits, problems in planning/organizing and emotional complications. Further, damage may also occur in the temporal lobe regions, resulting in added memory complications. A blow at the back of the head, or counter-coup, may damage the brain's occipital lobe, causing deficits in vision as well. A clearer grasp of the character of memory in the human brain can accord much-sought-after relief to such individuals. However, motorists should bear in mind to fasten their seat belts and not disconnect the safety airbag (Schwartz, 2014).
Treatment and care of patients suffering from brain damage comes under the clinical neuropsychology field. Given that a majority of victims of automobile crashes tend to be young adults likely having long lives ahead of them, traumatic brain injury treatment and rehabilitation are of immense social significance in today's auto-centric culture. Thus, clinical neuropsychology concentrates on restoration and rehabilitation of intellectual skills for car-crash victims. However, because of the regular pattern of extensive damage in auto accidents, victims are rarely used for research to examine the relationship between behavior and brain (Schwartz, 2014).
Traumatic Brain Injury (TBI) diagnosis
Guidelines have been published by numerous national organizations to define and describe the causes of mild traumatic brain injury (MTBI). They include the Veterans Affairs/Department of Defense...
All of the definitions concur that the process must comprise a direct external force, accompanied by a subsequent physiologic alternation in the brain's functioning. Though the language that describes the nature of alteration in the brain's function differs, it is agreed by most that presenting Glascow Coma Scale (GCS) scores ought to be in the range of 13-15 (Barbosa et al., 2012), that any unconsciousness must be under half an hour, and that the post-traumatic amnesia duration must be lesser than a day. Post-traumatic amnesia (PTA) can be distinguished by one or more of the following conditions:
• Disorientation and/or perplexity
• Restlessness, a need to wander, thrashing
• Aggressiveness and/or anxiety
• Combativeness, such as tugging at medical tubes and/or devices
• Moaning, "childish" behavior, calling out
• Inappropriate or disinhibited social behavior
• Paranoia and fear
• Over-sensitivity to light
• Decreased attentiveness and/or focus
• Lack of constant memory
• Confabulation (making up stories)
• Repetitious thoughts or movements
• Obsessed with a single issue
• Sleeping/waking cycle disruption
• Reduced planning ability or problem solving skills
An ending to the PTA may be explained as disappearing of confusion, along with the capability of recording new information. PTA can last for periods as short as a few minutes, or even up to days, several weeks, or as long as many months. (However, as described above (vide supra) most organizations such as the VA, describe PTA as ending within one day). As well, PTA symptoms can be seen to vary from one person to another. The individual may be talkative or drowsy, aggressive or docile, irritable or impudent. While some individuals may, after a period of suffering from PTA, make a brilliant physical recovery, it is also possible that a range of emotional and cognitive issues might disable these individuals in the long run. The duration of PTA and coma can help to predict how severe the total brain injury is (Gumm et al., 2014).
A formal neuropsychological examination may identify various behavioral, cognitive or other shortfalls. Limited information exists to guide clinicians on which of their patients to send for evaluation. Research on the topic is likely to be influenced by various weaknesses summarized by Sherer et al. (2010). Also, the influence on patient's result is uncertain. This therapy has been considered to be more beneficial in case of mild traumatic brain injury than in cases of moderate to severe traumatic brain injury. However, in research conducted on patients suffering from significant post-concussive syndrome (PCS), a decrease of symptoms was not caused by neuropsychological therapy (Barbosa et al., 2012). Researchers can study the relationships between behavioral and cognition deficits, and the correlation to the locus of injury in the individual's brain through neuropsychological research. Generally, most brain damage is rather evenly dispersed over large parts of the person's brain. In some instances, however, often resulting from strokes, bullet wounds, or surgery, damage may be relatively localized; therefore, clear correlations can be drawn, of brain damage with memory deficits (Schwartz, 2014).
Perhaps the first step taken by healthcare experts when treating an individual with traumatic brain injury is to evaluate the injury's severity. Severity level is determined for facilitating initial triage, as well as to help treatment planning. Various factors are to be considered when evaluating the severity of injury, and these include unconsciousness, scores on the Glasgow Coma Scale, and length of post-traumatic amnesia (Struchen et al., 2009).
Loss of Consciousness (LOC)
Individuals may lose consciousness after receiving head injuries (Struchen et al., 2009). In general, the longer the duration of unconsciousness, the greater is the severity of the injury. In a perceptive hospital environment, the consciousness of the patient will be tracked hourly as well as daily by the medical team. Usually, this tracking is carried out using the Glasgow Coma Scale (GCS), described below (O'Donnell et al., 2010).
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale is essentially a measurement that assesses responsiveness of patients after traumatic brain injury. It is widely used in hospitals all over the United States (U.S.), and other countries of the world. This scale evaluates three responsiveness factors: eye opening (whether the patient is capable of spontaneously opening his/her eyes); motor responses (whether the individual is capable of moving when requested or when reacting to painful stimulus); and lastly, verbal responses (whether the individual is capable of speaking, and whether he/she is oriented or not). Typical GCS scores range from 3-15, with 13-15 on the scale being considered as mild injury levels, 9-12 as moderate levels and 3-8 as severe injury levels. The medical unit generally uses this scale to evaluate the patient in the place where…
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, 1992, Bogduk 2002), cervical traction (Olson 1997), acupuncture (Fattori et al., 1996), transcutaneous nervous stimulation (Foley-Nolan et al., 1990) and myofascial trigger point's treatment (Hong and Simmons 1993) have been proven to improve movement and function following whiplash injuries. The tutor suggested that I should put this entire section on the whiplash guidelines in the preliminary literature review chapter. It should also include discussion about my thoughts on the guidelines.