Contact Tom
Novack ,
PhD, University of Alabama at Birmingham
at
Citation Novack, T. (2000). The
Orientation Log. The Center for Outcome Measurement in
Brain Injury. http://www.tbims.org/
combi/olog ( accessed
).
O-Log
Syllabus
Mental
confusion can be a significant barrier to independent living and
to participation in rehabilitation. Measuring orientation is one
way to evaluate confusion and has been helpful in documenting change
over time. Orientation assessment is a component of all measures
of mental status largely because it is quick to ascertain, can be
scored objectively, and is generally agreed to be within the cognitive
capacity of normal individuals. There are also individual scales
to assess orientation, the most widely used being the Galveston
Orientation and Amnesia Test (GOAT), particularly for those with
TBI.
The
GOAT was developed for use with people experiencing milder TBI,
but the subsequent norming and extensive application over the years
has included severely injured people. Unfortunately, there are several
drawbacks to the GOAT. It is not easily applied to populations other
than TBI because some of the questions relate directly to trauma.
For those who are severely injured, and particularly those undergoing
extended rehabilitation, some of the questions are confusing or
unessential. For instance, it is not important to this population
how the person was transported to the hospital and it is confusing
to ask when the person was hospitalized since there may have been
several hospital transfers prior to admission to the rehabilitation
program. Some of the questions are also subjective, such as those
involving the last recall of events prior to injury and the first
recall of events after the trauma. Severely injured people (unlike
those with milder injuries, with whom the scale was developed) often
provide vague responses. When more detailed responses are provided,
confabulation often becomes a factor. Finally, the scoring of the
GOAT can be confusing. The final score is derived by subtracting
error points from 100, although the scale items can add to 110.
Scoring for individual items also varies, presumably based on the
difficulty of the item. For instance, a subject may lose 30 points
if grossly in error in stating the year, but only five points if
the city is misstated. No objective data has been provided to justify
such differential scoring, which can result in significant fluctuations
in scores day to day if responses are inconsistent.
To
address these difficulties the O-Log was developed. The O-Log focuses
on orientation to place, time, and circumstance. It was decided
not to include questions concerning personal background, such as
a person's name and birth date, since such information does not
adequately define cognitive impairment and the accuracy of the information
may be questionable in some cases. Place is evaluated by asking
for the name of the city and the hospital. The person is asked for
the month, date, year, day of week and time of day to evaluate time.
Circumstance refers to awareness that an event has taken place,
such as a car crash or stroke or illness, and the impact of the
event, such as a brain injury with motor or cognitive difficulties.
The scale allows for spontaneous verbal responses, but responses
based on cueing and non-verbal communication are possible.
The
ten items of the O-Log are scored 0 to 3 depending on the response
provided. A spontaneous correct response is awarded 3 points on
any item. No item is weighted more than another. A score of 2 is
assigned if the spontaneous response is lacking or incorrect, but
a correct response is provided following a logical cue given by
the examiner. For instance, if the person misstates the location,
the examiner states, "This is a place where doctors and nurses work."
If the person states it is January when it is March, the examiner
states, "January was two months ago, so what month is it now." The
content of the cue will vary depending on the error. A score of
1 is given if spontaneous and cued responses are lacking or incorrect,
but a correct response is provided in a recognition format. For
instance, the examiner would name three months, three years, three
locations, etc. and ask the person to recognize the correct item.
Zero points are assigned if the spontaneous, cued, and recognition
formats do not generate a correct response. For fully oriented individuals
the scale takes as little as three minutes to administer, whereas
for those who are confused and require a recognition format for
every question 10 to 15 minutes may be required. The scale can be
administered at bedside or in any other setting.
Scores
for each of the 10 items are summed to obtain a total score that
ranges from 0 to 30. Specific domain scores can be calculated as
follows: Place = City + Kind of Place + Name of Hospital; Time =
Month + Date +Year + Day of Week + Clock Time; Situation = Etiology/Event
+ Pathology/Deficits.