Recovery of orientation following closed-head injury

The pattern of recovery of orientation to person, place, and time was investigated in 84 patients who were initially disoriented while hospitalized on the neurosurgery service after sustaining a closed-head injury (CHI) of varying severity. Results of daily administration of the Galveston Orientation and Amnesia Test revealed that the most common sequence of recovery of orientation was person, place, and time: accounting for about 70% of the patients. Return of orientation to time preceded reorientation to place in 13% of the patients while other orderings of reorientation were present in 11% of the cases. Temporal disorientation was initially characterized by backward displacement of the date from the actual date in 68% of the patients. The magnitude of this displacement progressively shrank as the patients became more oriented. Patients who exhibited the greatest backward displacement of the date had more severe and persistent impaired consciousness, were older and had longer durations of posttraumatic amnesia. These data support Ribot's hypothesis that older memories are relatively resistant to cerebral insult.