For PTA testing the following pieces of equipment are required: a pen; the Westmead PTA Scale MR-120 Form; and the set of 9 Westmead PTA Scale Picture Cards.
For weekend testing, nursing staff will require a set of 3 photos. One of the regular examiner plus photos of 2 other staff members (see the PTA Photo section for details).
For testing nonverbal patients additional materials are required.
Testing should ideally take place at the bedside in a quiet ward room. There should be no distractions like television, food or young children. In busy / noisy wards it may be easier to move the patient to a quiet area, if the patient is mobile. However, if this is not the case, pull the curtain around the bed and try to minimise noise and interruption for the duration of testing.
There should also be no obvious cues or aids like clocks or orientation boards nearby. These should be obscured during testing or surreptitiously removed before testing starts. (One also needs to prevent the patient looking at their watch during testing.)
Who to test?
The Westmead PTA Scale was designed for patients with traumatic brain injury. Please note that this precludes penetrating or missile head trauma and other neurological disorders including hypoxia.
For patients with a history of psychiatric illness, developmental or intellectual disability, substance abuse, previous head trauma, or nervous system disease the usefulness of the scale remains undetermined.
When to start testing?
PTA testing begins when the patient has regained consciousness and can communicate intelligibly. (This is usually after the patient has been extubated.) Patients may be able to communicate via speech, writing, pointing to printed answers or by indicating 'yes' or 'no'. If communication can not be carried out via speech, the Westmead PTA Scale can be modified to support these nonverbal patients.
The ideal time to test a patient is when they are most alert. In general we find this to be soon after the patient has had their bath and breakfast, however, for some extremely severe patients this may not be the case and another time will be required. One also needs to ascertain whether these patients can concentrate for the duration of testing.
When to stop testing?
PTA testing stops when the patient has reached the Westmead PTA Scale's operational definition for being out of PTA (i.e. achieving a perfect score of 12 on the Westmead PTA Scale for 3 consecutive days). The only other reason to stop PTA testing is on the advice of the Clinical Neuropsychologist.
The following flow chart summarises the standard procedures for using the Westmead PTA Scale:
Quick rules for weekend or holiday testing
A hand-out that can be given to staff when they are asked to undertake weekend or holiday testing using the Westmead PTA Scale.
Ask the patient to answer the following questions once every 24 hours:
Westmead PTA Scale
- How old are you ?
- What is your date of birth ?
- What month are we in ?
- What time of day is it ? (Morning, Afternoon or Night)
- What day of the week is it ?
- What year are we in ?
- What is the name of this place ?
- Who do you have to remember ? (Show set of 3 photos)
- What is their name ?
- What were the 3 pictures that you had to remember ?
- Picture I
- Picture II
- Picture III
Record each answer and score 0 or 1 on the MR-120 Form. After each question tell the patient whether they were right or wrong and correct any incorrect answers. Sum the individual scores to give a total score out of 12. If the patient scores 12 out of 12, remember to show them a new set of picture cards to learn for tomorrow. Record these new cards in the appropriate area on the MR-120 Form. Finally, try not to discuss the questions with the patient until you test them again tomorrow.
3 simple rules when using the Westmead PTA Scale
- Before testing make sure you know the correct answer to all the items on the scale.
- Only change the three picture cards when the patient reaches a perfect score of 12.
- Rehearse the scale with the patient at the end of testing..