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Significance of Decreased Orientation Performance During Rehabilitation

Categories: Cognitive Assessments - Thinking and Emotional Skills

The Question

Is there any significance to someone becoming less oriented during rehabilitation?

Early Studies 

Early Studies: Traumatic brain injury typically results in a person being confused for a period of time. The person may not be aware of their location, the month, the date, the year, or their difficulties from the injury. In most cases, the disorientation clears, although sometimes this can take several weeks. The amount of time that a person is disoriented is one measure of the severity of the injury. The usual pattern is for the person to slowly improve in being able to answer questions about orientation. The level of orientation on admission to rehabilitation is a predictor of other problems with thinking skills (such as concentration and memory) even a year after the injury. Sometimes, a person will display a decrease in orientation during rehabilitation. What this means is not clear.

This Study

This study included 428 people receiving inpatient rehabilitation. Almost 2/3 of these people had experienced traumatic brain injury. Each person was administered a test of orientation, the Orientation Log, on a daily basis. There was a decrease in orientation score from one day to the next 28% of the time, so a decrease in score was not rare. However, a decrease of 5 or more points on the Orientation Log occurred only 5.4% of the time. A further decrease in score on the next administration was very rare (0.6%). People that experience consecutive decreases in score may be experiencing neurological deterioration.

Who May Be Affected By These Findings

People with traumatic brain injury, care providers in acute rehabilitation.


A decrease in orientation performance is not always associated with neurological deterioration.

Bottom Line

When Orientation Log score falls by 5 points from one administration to the next and is followed by another decrease at the next administration, a medical work-up needs to be considered.

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Find This Study


Salisbury, D, Baños, JH, Novack, TA, Schneider, JJ. Significance of decreased orientation performance during rehabilitation. Rehabilitation Psychology 2005; 50: 174-176.

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