Significance of Decreased Orientation Performance During Rehabilitation.

Abstract

To demonstrate the importance of careful attention to changes in orientation in neurorehabilitation inpatients. Study Design: Archival data analysis including 2 retrospective case studies. Setting: Inpatient rehabilitation unit. Participants: Four hundred twenty-eight neurorehabilitation inpatients. Main Outcome Measure: Orientation Log (O-Log). Results: Decrease in O-Log performance of 5 or more points followed by any decline on the subsequent administration occurred in fewer than 1% of the cases. Conclusions: Consecutive declines in orientation are extremely unusual in a rehabilitation population and warrant careful examination of patient medical status.

Lesion Localization of Time Disorientation in Patients With Focal Brain Damage

“…Studying patients with focal acquired brain lesions who are impaired in time orientation has the potential to aid in the elucidation of brain regions most critical for supporting time orientation. To date most lesion studies of time disorientation have been limited by small sample sizes, focusing on a specific brain region (e.g., the thalamus), or including multifocal lesions from progressive disorders or traumatic brain injury [14, 15, 18, 19]. Another challenge to this line of research is time disorientation after brain injury is relatively common in the acute epoch, but spontaneously resolves in ∼95% of patients within about six weeks [20].…”

After critical care: Challenges in the transition to inpatient rehabilitation.

“…The psychologist can monitor changes in mental status via frequent contact and interviews, discussion of team observations, and brief repeatable assessments such as the “O-log” (W. Jackson, Novack, & Dowler, 1998; Salisbury, Baños, Novack, & Schneider, 2005), or briefer tasks such as: “Tell me the days of the week, backwards, starting with Sunday.”…”

“…Delirium is increasingly viewed as occurring on a spectrum rather than as a unitary, present-absent phenomenon (Marcantonio et al, 2005;Ouimet et al, 2007;Velilla et al, 2012), with post ICU outcomes showing an orderly relationship with severity indicators. The psychologist can monitor changes in mental status via frequent contact and interviews, discussion of team observations, and brief repeatable assessments such as the "O-log" (W. Jackson, Novack, & Dowler, 1998;Salisbury, Baños, Novack, & Schneider, 2005), or briefer tasks such as: "Tell me the days of the week, backwards, starting with Sunday. "…”

Localization of a Medial Temporal Lobe—Precuneus Network for Time Orientation

“…To date most lesion studies of time disorientation have been limited by small sample sizes. 14,15,18,19 Time disorientation after brain injury is relatively common in the acute epoch, but spontaneously resolves in $95% of patients within about 6 weeks, leaving only a small percentage with a chronic impairment. 20 To date, a large-scale lesion-symptom mapping study of chronic time disorientation has not been performed.…”

“…Studying patients with focal, acquired brain lesions who are impaired in time orientation has the potential to aid in the elucidation of brain regions most critical for supporting time orientation. To date most lesion studies of time disorientation have been limited by small sample sizes 14,15,18,19 . Time disorientation after brain injury is relatively common in the acute epoch, but spontaneously resolves in ~95% of patients within about 6 weeks, leaving only a small percentage with a chronic impairment 20 .…”