Reality orientation for brain injured patients: group treatment and monitoring of recovery.

A reality orientation group for brain injured patients was developed to improve attention deficits, confusion and anterograde amnesia during post-traumatic amnesia (PTA). Seven behavioral objectives are used to define adequate orientation, attention, immediate retention, episodic recall and use of memory aids. Daily performance in each of these areas is aggregated to establish a weekly summary score. Inter-rater reliability was found to be 0.875. The weekly aggregate score assesses recovery during PTA with increases corresponding to qualitative changes in patient progress. This weekly score has proven valuable as a management tool in rehabilitation by indicating when advanced training is warranted, whether a plateau in progress has been reached and when deterioration may be occurring.