title: Predictors of disorientation among brain injury and stroke patients during rehabilitation.
abstract: Predictors of temporal disorientation among brain injury and stroke patients undergoing rehabilitation were explored in this descriptive study. Cognitive orientation is a construct of consciousness, and the Parallel Distributed Processing model provided a framework for conceptualizing consciousness in this study. Data were collected by a retrospective chart review of a convenience sample of stroke and brain injury patients admitted to an acute rehabilitation hospital over 4 months. The dependent variable in the study was the Temporal Orientation Test used as a daily measure in the study hospital. A total of 167 patients were admitted during the time frame, and of those, 114 patients met the study criteria and were included in the data analysis. The independent variables were defined as age, gender, years of education, number of comorbidities, patient diagnosis, orientation status on admission, and use of narcotic/sedative medications. A logistical regression was performed using SPSS Release 11.01. Only one of the six variables--orientation status on admission-reliably predicted the onset of disorientation during the rehabilitation stay with an odds ratio of 0.217, p < .001. This indicates that the risk of becoming disoriented after a period of orientation during the rehabilitation stay increased by 78% among patients who are disoriented on admission to rehabilitation, compared with those who are oriented on admission. These findings confirm that temporal orientation is unstable during the period of rehabilitation following a brain injury or stroke.
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ, USA. jalverzo@kessler-rehab.com
authors.forename: Joan P
authors.initials: JP
authors.lastname: Alverzo
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation; D018680:Cholinergic Antagonists / Q000009:adverse effects; D015897:Comorbidity; D003221:Confusion / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000451:nursing*; D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D015994:Incidence; D016015:Logistic Models; D009460:Neurologic Examination / Q000379:methods / Q000451:nursing; D009730:Nursing Assessment / Q000379:methods; D015403:Nursing Evaluation Research; D009949:Orientation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives