Orientation questions are important questions to ask patients before we start any treatment with patients that have neurological problems. These questions will direct my treatment session and will also let me know if the patient’s answers are sane and coherent. These questions are simple questions that asks the patient the following:
1) What is the day today? Date? Month? Or Year?
2) What is your full name? Do you know who I am?
3) Where are you now? Do you know the name of this hospital?
If the patient is not able to answer the above questions, it will lead me to think that whatever the patient says next, may not be true. The patient may also appear to be very confused if they are not sure of the orientation questions.
For example, the patient may be talking to you, but saying illogical things? And when you try to engage in a conversation with them, the responses that you get from them may be something that you would never expect. I had a patient, who after surgery was very confused and disorientated. When I asked him the above questions, he got almost all of them wrong. Firstly, he did not know the day or date. He only managed the correct year. Next, he did not know his full name. He came up with all sorts of other names and said that was his name. Lastly, while he was lying on the hospital bed, he told me that he was in an office in Melbourne and was sitting on a horse!
When I first heard these responses, it made me want to laugh. But I controlled myself, as I knew that this was the effect of a brain lesion. It took time before the swelling in his brain would resolve, and he would slowly be more orientated. So when I was treating this patient, I had to be very careful with what I got him to do, as I was not sure if he could even differentiate sensations of pain. Performing objective assessments had to be tailored also because the patient’s answers may not be relevant all the time. I feel only time would help a patient like this get over his confused state of mind.
Does anyone else have other suggestions or precautions to take when dealing with patients like this?
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I recently had dealings with a patient that was dysphasic and thus his answers were unrealiable. Thus I relied very much on non verbal signals like gestures, body language, watching for signs like whincing/ retracting or closing eyes to monitor if they are in pain and also facial expression. Using touch/pinprick, clapping and quick hand movements in their R and L visual fields and moniotring their response will also give you an idea about sensation, hearing and visual deficits respectively.
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