Activities of daily living retraining and goal attainment during posttraumatic amnesia

ABSTRACT

It is uncertain whether therapy delivered during posttraumatic amnesia (PTA) following traumatic brain injury can be effective due to risk of agitation and poor learning capacity. This study used goal attainment scaling (GAS) to assess gains in activities of daily living (ADL) retraining during PTA. Occupational therapists’ perspectives on goal setting and therapy delivery were also explored qualitatively. Forty-nine rehabilitation inpatients were provided with manualised ADL retraining following errorless and procedural learning principles during PTA. From 104 GAS goals, 90% were achieved at PTA emergence. GAS T-scores changed significantly (p < .001) from baseline (M = 26.94, SD = 4.90) to post-intervention (M = 61.44, SD = 11.45). Mean post-intervention T-scores correlated significantly (p < .001) with change in Functional Independence Measure scores. The four therapists reported that GAS was unfamiliar and time-consuming initially, although it aided goal-directed therapy and measurement of patient performance. Application of manualised skill retraining using errorless and procedural learning techniques was described as novel and challenging, but providing valuable structure. The intervention reportedly promoted therapeutic alliance, skill-building and meaningful time-use without elevating agitation, but fatigue impeded therapy. Overall, GAS captured positive individual change following ADL retraining during PTA and therapists indicated that the intervention and use of GAS was generally beneficial and feasible within clinical practice.

KEYWORDS:

• Activities of daily living
• Goal attainment scaling
• posttraumatic amnesia
• rehabilitation
• traumatic brain injury

Acknowledgements

This project was funded by the Transport Accident Commission, through the Institute for Safety, Compensation and Recovery Research. We also thank the occupational therapists, neuropsychologists and nursing staff working in the Brain Injury Unit at Epworth Healthcare.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study was granted ethics approval from Epworth Healthcare HREC (581-13) and Monash University HREC (CF13/1682 - 2013000861).

ORCID

Jessica Trevena-Peters http://orcid.org/0000-0002-1063-9372

Jennie Ponsford http://orcid.org/0000-0003-0430-125X

Additional information

Funding

Financial support was provided by Epworth Research Institute Grant; William Buckland Foundation Grant; Transport Accident Commission, through the Institute for Safety, Compensation and Recovery Research (grant no: N-13-089) but parties did not participate in design or write-up of the study.