Adapting administration of the Westmead Post-Traumatic Amnesia (PTA) Scale for patients with cognitive impairment or behavioural difficulties.
Perseverating patients
Patients with perseverative features may benefit from:
- being given 3 response options (written or verbal) to choose from
- repeating the question
- avoiding commonly perseverated words or themes within testing.
Agitated patients
Testing agitated patients can be difficult. They may become aggressive or wander from the room. Agitation does not preclude testing; however, the safety of the patient, assessor and others on the ward must be prioritised. Use clinical judgement to determine the risk of pursuing assessment.
Strategies to minimise agitation:
- Use familiar staff members or family to help settle the patient while testing takes place.
- Minimise distractions, such as excessive noise or light.
- Minimise the potential impact of fatigue, pain or hunger.
- Clearly explain to the patient that testing must be done every day but will only take a few minutes.
- Correct the patient's answers only after all questions have been given.
- Use praise and positive reinforcement for appropriate behaviour.
- Time the assessment for known periods of settled behaviour.
Patients who impulsively answer a question incorrectly
Patients with a traumatic brain injury frequently experience impulse-control problems and may hurriedly and incorrectly answer a question. If the patient self-corrects without any prompting or input from the assessor, then they score a point for answering correctly.
To pre-empt and manage impulsivity, instruct the patient to wait to respond until you have completed the question in full and given a choice of 3 response options, if relevant.
If impulsivity continues to impact on administration of the test, seek guidance from a neuropsychologist or other expert clinician.
Fatigue
If the patient experiences excessive fatigue during testing and is unable to complete the test in a single session, record the score they received up to the point of stopping. The following day, start the test from the beginning as per the standard administration procedure. Be mindful of selecting the time of day when the patient is most alert.