Understanding and Interacting with People in Post-Traumatic Amnesia Information for Relatives, Carers and Friends.

  • Reference Number: HEY-979/2018
  • Departments: Neuropsychology, Rehabilitation Medicine

Introduction

This leaflet has been produced to give you general information about Post-traumatic Amnesia.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is Post-Traumatic Amnesia (PTA)?

Post Traumatic Amnesia (PTA) is a transient state of confusion, disorientation and memory loss that occurs immediately following a traumatic brain injury. PTA is sometimes also referred to as post traumatic confusional state and can occur from the moment of injury until the return of continuous memory.

PTA can vary in length. For some it can last for minutes, whilst for others it can last for weeks or months.  The length of PTA can help us estimate how severe someone’s injury is and can help us understand the nature of their recovery.  The staff team working with your relative / friend will therefore be monitoring this period of PTA to help support them and plan for their future rehabilitation.  Once PTA resolves, it is unlikely that your relative / friend will have significant memories of this period of time.  Therefore, any distress experienced during PTA is often forgotten.

Coping with PTA can be a very difficult period of time for family, friends and staff, as many of the behaviours shown can be very distressing or difficult to manage. This information leaflet outlines some of the typical symptoms that you may encounter during PTA and strategies to help support someone during this period of time.

What are the symptoms of PTA?

Disorientation and Confusion:

One of the most common symptoms that someone in PTA will present with is disorientation and confusion. Sometimes the person will not know where they are or what has happened to them.  They may also not recognise people that should be familiar to them. This can be very distressing both to the person in PTA and to their family / friends.

People in PTA may also become fixated on certain ideas or memories, which might appear unusual or strange. For example, they may talk and behave as if they are somewhere else or living through a different period of their life (e.g. they may believe grown up children are still young or that they should be at work). Understandably, this situation can be very confusing for the person.

Confusion may also appear worse at night, when the person is more tired and there are fewer cues to help orientate them to their surroundings. Due to their high levels of confusion, people in PTA often wander and may attempt to leave the ward.  As a result, a member of staff may be required to stay with your relative / friend at all times during this period, for the purpose of ensuring their safety and providing reassurance when necessary.

Things you could try:

It is important not to correct memory mistakes people make whilst in PTA, as their ability to learn new information is severely compromised. However, there may be times where it is appropriate to offer gentle prompts and cues if your relative is presenting with behaviour that is unusual to them or difficult to cope with. In these circumstances, it would be important to remain calm and to avoid confrontation as this may lead to your relative becoming anxious, agitated or distressed. Any mistakes they make in their understanding of their situation and surroundings during this period of time relates to their current perception of reality. Therefore, challenging someone in PTA is likely to cause a high level of distress. Strategies such as offering reassurance and distraction with pleasant events can help to reduce the distress associated with PTA.

Memory Difficulties:

One of the hallmark features of PTA is memory impairment. This presents as an inability to lay down and retain new information. Your relative/friend may still have a good memory for past events in their life that happened before their injury, but will be unable to recall new information or events that have occurred since the injury. You may find that your relative/friend is able to remember information in the here and now, which will allow them to have coherent conversations. However, this information will be lost after a short period of time and they may not remember that they have seen or spoken to you after only a matter of minutes. Due to their inability to retain information, you may find that your relative/friend repeats themselves or attempts to engage in activities that they have already completed, such as repeatedly requesting to see someone or do something that has recently occurred.

Once PTA is resolved, people may recount “islands of memory” during the period in which they were in PTA. These memories tend to be very brief and fleeting and, whilst a normal part of PTA, can be confusing for the person.

Things you could try:

Once again, it is important not to correct the memory errors people make whilst in PTA. This can feel difficult, as it can often feel as if you are colluding or reinforcing false beliefs. However, people in PTA are unlikely to learn from being corrected. Therefore, being continually challenged is likely to heighten their distress. Again, you might choose to try distraction as a strategy to cope with your loved one recalling inaccurate information whilst in PTA. Offer reassurance and try to engage them in conversations about events or topics that are well preserved, such as events from the past. This can be supported with the use of photographs. Engaging in distracting activities, such as going for walks or playing a game together, can also help to reduce distress.

Poor Attention and Slowed Information Processing:

People in PTA often struggle to pay attention and tend to take information in at a much slower rate, especially in busy and noisy environments such as hospital wards. Exposing people in PTA to environments or tasks that have high attentional demands can lead to high levels of distress and confusion.

Things you could try:

Where possible, creating a low stimulation environment is important for people in PTA. Low stimulation environments are helpful because they allow the person to rest, which aids in brain recovery. This will also reduce the cognitive demands placed on people in PTA, optimising their ability to take in new information and cope with daily tasks.

In order to try to create a low stimulation environment on busy wards, it will be necessary to reduce stimulation, such as removing TV’s, phones and IPAD/tablets from their room; encouraging dim lighting; reducing background noise and limiting/pacing visitors. For example, we might recommend the person in PTA has a maximum of 2 visitors for no more than 20 minutes at a time. We also recommend that only one person talks to the person in PTA at any one time, as they will need more time to process what they hear. Therefore, when talking to your relative/friend in PTA, it is important to pace the information you give to them, allowing them time to process and think about the things that they have just been told. Avoid giving them too much information at once and try to keep sentences short. The purpose of interacting in this way is to reduce cognitive overload, which can cause increased agitation, distress and confusion.

Changes in Emotion and Behaviour:

As has already been mentioned, PTA can have a significant emotional impact on the person. It is not uncommon for people in PTA to appear more tearful, anxious, frustrated or fearful, which is often triggered by their situation and the mismatch that can occur between their perception of reality and how others are interacting with them (e.g. people preventing them from leaving the ward when they may not believe that they are in hospital). Understandably, this may affect the way that they behave during this period of time. People in PTA may also engage in behaviours that are not typical for them, such as verbal or physical aggression, disinhibition, impulsivity or an inability to stop an action when it is complete. Again, these changes can be very distressing to observe, but they often resolve when PTA resolves.

Things you could try:

If your relative/friend is becoming distressed or showing any of these emotional or behavioural changes, try to stay calm and focus on reassuring and/or distracting them. Discuss any concerns you may have regarding any changes in emotion or behaviour with a member of staff, who should be able to reassure you and provide you with support. It is important to recognise the impact that these changes can have on us, as continually supporting loved ones in PTA can be physically and mentally exhausting. Due to the high levels of fatigue that people in PTA often experience, it is advisable to take periods of time away from visiting your relative/friend, as this will have a positive effect on them (due to their need for plenty of rest) as well as yourself. Therefore, taking some time out and/or drawing up a rota of visitors to reduce the impact on any one family member can be helpful for all involved.

It is also very important not to take any hurtful things personally that your relative/friend says or does during PTA, as they will not be able to regulate their emotions during this time and will not be in control of their behaviour.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Neuropsychology Service on telephone number: (01482) 461486

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you.  For further information visit Confidential Information about You

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