Variable 144a
date of last revision: 09/05/06
Date of emergence from Post-Traumatic Amnesia (PTA).

PTA emergence may be determined by any one of the following:

1) Two consecutive GOAT scores of 76 or greater within a period of 24-72 hours.
2) Two consecutive scores of *61 or greater on the Revised GOAT within a period of 24-72 hours.
3) Two consecutive scores of 25 or greater on the Orientation-Log within a period of 24-72 hours.
4) In the judgement of a qualified clinician (i.e., speech-language pathologist, physician, neuropsychologist), the person has cleared PTA but administration of the GOAT is not possible due to language functioning.

A modified GOAT may be used. The examiner presents three alternatives, in written form and orally, including the correct choice for each question. The patient is to indicate a choice in some manner, such as nodding or pointing. This procedure may be used for all questions except numbers 4 and 5. The three response alternatives for each question should be arranged vertically in large print on an index card. Errors points are assigned and subtracted from 80 (the maximum score with items 4 and 5 removed). A score of 61 or higher is reflective of orientation. PTA is considered resolved when a score of 61 or greater is achieved on two consecutive occasions within a period of 24-72 hours. *

In the case of a responsive patient, it is the choice of the neuropsychologist whether to use the GOAT, Revised GOAT (Bode, Heinemann, & Semik, 2000--see SOURCES) or the Orientation-Log (Jackson, Novack, & Dowler, 1998; Novack, Dowler, Bush, Glen, & Schneider, 2000--see SOURCES) to establish the duration of PTA. Alternating use of the scales in an individual patient is not acceptable, however.

Date of emergence from PTA can also be determined via chart review. For those patients who are oriented at rehabilitation admission (as defined by first two GOAT scores after rehab. Admission >75), the following procedure can be used to determine the length of PTA based on hospital records.

1. Obtain all available physician, nursing and therapy notes from the acute hospitalization. In most hospital medical records, physician, nursing and therapy notes are filed in different sections. You may have to specifically request therapy and nursing notes, if you routinely only receive the physician progress notes.
2. Review all notes to determine the first date on which all notes referencing orientation indicate that the patient is fully oriented, oriented X3 (or 4, or OX#, etc.). This is orientation day 1.
3. Review notes from the next calendar day to determine that all relevant notes indicate that the patient is fully oriented.
4. If Orientation Day 2 falls within three calendar days of Orientation Day 1, and if no notes from intervening days indicate less than full orientation, record Orientation Day 1 as the resolution date of PTA.
5. If any note from calendar days intervening between Orientation Days 1 and 2 indicate less than full orientation, use Day 2 as the new starting point (i.e. new Day 1) and repeat procedure from Step 3 above.
6. If there is no Orientation Day 2 (i.e., if the patient is never fully oriented on more than one day; or if more than 3 days elapse after Orientation Day 1 with no further notation about orientation), code date of PTA resolution as unknown. An exception would be if on the day before or the day of transfer to rehabilitation, the patient is specifically noted not to be oriented. If the patient then produces GOATs > 75 on the first two examinations after rehabilitation admission, code the date of PTA resolution in the usual manner

07/07/7777 Never had amnesia. [Code replaced with date of admission to ER.]
08/08/8888 Not Applicable - ptn still has amnesia or is unconscious as of discharge from TBI system.
09/09/9999 Unknown
Code date of admission to ER if person was never in PTA.
8 date
Computer calculates duration of post traumatic amnesia by subtracting the date of injury from this date. Duration of PTA is calculated only for those cases which emerge from PTA prior to discharge from inpatient rehabilitation.

Neuropsych Committee databusters has confirmed that duration of PTA is not to be calculated from date of emergence from coma (V130a).

The date emerged from PTA is the date of the first of the two consecutive GOAT scores greater than 75.

Administer the test every 1 to 3 days until patient emerges from PTA.

Dr. Novack clarifies assessing with the OLog : "I have no problem with someone looking at the calendar or clock in the room, which requires awareness that there is a calendar and some movement on the part of the person to see the calendar. That is a functional response that I employ as well. In my experience, when a person is confused they do not look for a calendar. I do not tell the person there is a calendar in the room or a clock. I do not ask the person to refer to either as a means of cueing."

If at your Model System emergence from PTA is not assessed for clinical purposes by a method appropriate for the TBIMS, be prepared to assess and document emergence from PTA retrospectively by chart review if the participant was not consented during the time of emergence from PTA.
Levin, HS, O'Donnell, VM, & Grossman, RG. (1979). The Galveston Orientation and Amnesia Test: A practical scale to assess cognition after head injury. Journal of Nervous and Mental Diseases, 167, 675-684. Link to PubMed: Levin, HS, O'Donnell, VM, & Grossman, RG for v144a (

Revised GOAT:
Bode RK, Heinemann AW, Semik P. Measurement properties of the Galveston Orientation and Amnesia Test (GOAT) and improvement patterns during inpatient rehabilitation. J Head Trauma Rehabil. 2000 Feb;15(1):637-55. Link to PubMed: Bode RK, Heinemann AW, Semik P. for v144a (

Jackson WT, Novack TA, Dowler RN. Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log.
Arch Phys Med Rehabil. 1998 Jun;79(6):718-20. Link to PubMed: Jackson WT, Novack TA, Dowler RN for v144a (

Novack, TA, Dowler, RN, Bush, BA, Glen, T, Schneider, JJ. Validity of the Orientation Log, Relative to the Galveston Orientation and Amnesia Test. J Head Trauma Rehabil, 2000, 15(3), 957-961. Link to PubMed: Novack TA, Dowler RN, Bush BA, Glen T, Schneider JJ. for v144a (

Introduction to O-Log (COMBI) (

O-Log frequently asked questions (COMBI) (

O-Log Syllabus (COMBI) (

O-Log Rating Form (COMBI) (

O-Log Properties (COMBI) (

O-Log References (COMBI) (
Patient entered inpatient rehab on 8/2/05. GOAT tests occurred on these dates in August:

04 57
06 56
07 61
10 72
12 64
14 70
17 79
19 74
20 75
22 78
23 76
26 72
29 77
30 79

Patient emerged from PTA on August 22, 2005.


Traumatic Brain Injury Model System National Database Live Syllabus V10.3
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