Activities of daily living retraining and goal attainment during posttraumatic amnesia. Issue 10 (26th November 2019)

• Record Type: Journal Article
• Authors: Trevena-Peters, Jessica; McKay, Adam; Ponsford, Jennie
• Is Part Of: Neuropsychological rehabilitation. Volume 29:Issue 10(2019)
• Page Start: 1655
• Page End: 1670
• Publication Date: 2019-11-26
• Subjects: Activities of daily living -- Goal attainment scaling -- posttraumatic amnesia -- rehabilitation -- traumatic brain injury; Brain damage -- Patients -- Rehabilitation -- Periodicals; Clinical neuropsychology -- Periodicals; 617.4810443
• DOI: 10.1080/09602011.2018.1441033
• Languages: English
• ISSNs: 0960-2011

Abstract

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.