Testing equipment, timing and environment

The minimum requirements for effective administration of the Westmead Post-Traumatic Amnesia (PTA) Scale in clinical settings.

Additional test equipment may be needed for patients with specific adaptation requirements.

The Westmead PTA Scale scoresheet

The sample scoresheet provides the minimum requirements to support the standard administration and scoring of the test. You may develop your own scoresheet, with branding and inclusions relevant to your service.

Picture cards

The 9 picture cards are black and white images of familiar things. The cards are not interchangeable with pictures of other items.

During the test, picture cards can be presented as printed cards or on a digital device, such as a tablet. Regardless, each should be displayed at approximately 9 cm (high) x 7 cm (wide).

The pictures can be individually printed and laminated as 9 separate picture cards or presented as a 3x3 layout on an A4 page. If using the latter, you will need to have different versions of the 3x3 layouts, with the positions of individual pictures varying on the page.

Staff photographs

Three staff photographs are needed to administer the protocol:

• One of the usual assessor.
• Two of other staff of similar appearance and the same gender as the usual assessor. These will be used when the usual assessor is not available, so these people should not be known to the patient.

Photographs can be in black and white or colour and should be approximately 15 cm (h) x 10 cm (w) in size. They must be a close-up front-on head shot of each staff member in uniform (if worn) and have the same background and lighting across all.

Nominating a consistent ‘usual assessor’ across the period of PTA testing is not always possible, as patients move between wards, units and hospitals, and staff change. Clinicians often use 3 photographs of people instead of in-person recognition of the assessor. While this may be considered an acceptable clinical practice, it is not consistent with how the scale was originally validated and therefore the impact on measurement of PTA duration is uncertain (Shores et al. 1986). Further research is needed to clarify.

Test environment

Administration of the scale generally occurs while a patient is in hospital following a suspected traumatic brain injury.

Perform the test in a quiet room free from distractions. The patient and assessor should be the only people present in the room, unless the patient is a child or there are cultural considerations for others being present. Where a family member is present, instruct them not to interrupt, distract, prompt or signal to the patient in any way.

During testing, conceal any visible cues or aids, such as clocks, orientation boards, watches, phones or staff name badges. Discourage the patient from writing down the information to be remembered.

Timing of test

Testing is performed daily and usually takes less than 10 minutes but may require up to 20 minutes if the patient needs a lot of prompting or adapted presentation. You may need additional time at the start or end to reassure the patient or their family regarding the purpose of the PTA testing.

Allocate sufficient time for reorientation and rehearsal of correct answers at the end of testing.

Complete the assessment:

• in a single session
• when interruptions caused by meals, medical interventions or visitors are minimised
• when the patient is most alert and able to maintain concentration.

This may vary from day to day but aim for 24 hours between assessments.

Complete the assessment efficiently to reduce fatigue and avoid triggering agitation.