Post-traumatic amnesia (PTA) relates to the time after a period of unconsciousness (although this is not always the case) following an acquired brain injury, when the injured person is conscious and awake, but due to their brain injury is behaving or talking in a bizarre or uncharacteristic manner.

Specific symptoms of PTA are individual, but most commonly involve memory and orientation impairment. When combined with confusion, agitation, distress and anxiety, uncharacteristic and difficult to manage behaviours can manifest.

These may include aggression, swearing, shouting, disinhibition, and wandering, which in the context of a trauma ward or general hospital setting, can be difficult or unsafe to manage.

PTA is a phase of the recovery after an ABI and is ordinarily temporary, lasting for a few minutes, hours, days, weeks or, in rarer cases, months.

However, it is difficult to predict its duration and how the person will be when they emerge from their PTA.

At St Andrew’s, we are able to respond quickly to assess and admit medically stable patients in PTA, whose behaviour makes it unsafe or clinically unsuitable to care for in their current setting.

Our environment provides a safe facility with specialised staff who are trained to support the person who is in PTA.

Our teams provide orientation, a flexible environment to suit individual needs and supervision to promote recovery.

We are also able to reduce medication that may have been used to limit the impact of the person’s behaviour whilst retaining safe management of risk.

In addition, we monitor recovery from PTA using standardised measures where possible, such as the Galveston Orientation and Attention Test (GOAT), and, when the person is able to engage, we carry out a range of post brain injury assessments, including;

• Neuropsychological
• Occupational therapy
• Physiotherapy
• Speech and language therapy
• Dietetics
• Physical health
• Psychiatry

We then work closely with local teams to establish the next step for the person. Everyone is different but admission of a person in PTA is typically between 4-6 weeks.

Our team will ensure the person leaves St Andrew’s with all their assessment and care information, to enable a smooth transition.

We provide support to help individuals move to local providers, home with support or offer further inpatient services, and we can also establish links to support services such as the Brain Injury Relatives Group that meets on our campus every month, and Headway, the brain injuries association.

Dr Keith Jenkins is consultant clinical neuropsychologist and Lorraine Nickolls is ward manager of the Brain Injury Rehabilitation and Care Integrated Practice Unit at St Andrew’s. See www.stah.org for more information.