Agitation during post traumatic amnesia: characteristics, predictors, and impact on therapy.

Abstract

BACKGROUND AND OBJECTIVES: Agitation is a common feature of post traumatic amnesia (PTA) after TBI, however, reported frequencies vary across studies, assumptions that agitation interferes with rehabilitation participation have rarely ben investigated, and relatively little is known about the relationship between agitation and cognitive impairments during PTA. The aims of this study were to examine: 1) the frequency and nature of agitation during PTA; 2) the impact of agitation on participation in therapy during PTA; and 3) the relationship between agitation levels and the cognitive impairments during PTA. METHOD: Prospective assessment of agitation (Agitated Behavior Scale, ABS), therapy participation (time in ADL retraining) and orientation/memory (Westmead PTA Scale) were conducted in consecutive patients who were admitted for inpatient rehabilitation during the PTA phase after severe TBI. RESULTS: Preliminary results based on 100 admissions show that agitation was observed in approximately 50% of participants (ABS score >21) in PTA, with disinhibited behaviors most common. Regression analyses found that agitation scores were not significantly associated with time spent in ADL retraining during PTA but they were associated with performance on the Westmead PTA Scale such that greater levels of disorientation and memory impairment predicted greater levels of agitation. CONCLUSIONS: Agitated behavior was common during PTA but it was not the presumed barrier to participation in active therapy during PTA. The observed association between agitation and concurrent cognitive impairments suggest that strategies to maximize orientation and memory may also help to minimize agitation.