The Galveston Orientation and Amnesia Test (GOAT) is a specialized assessment tool used by healthcare professionals to evaluate cognitive function following a brain injury. Developed in 1979 by Levin, O’Donnell, and Grossman, its main purpose is to track a patient’s recovery by measuring their orientation to person, place, and time, as well as their memory for events before and after the injury. This instrument helps in understanding the extent of cognitive impairment and monitoring progress during the subacute stage of recovery from conditions like a closed head injury.
Understanding Post-Traumatic Amnesia
Post-Traumatic Amnesia (PTA) is a state of confusion that occurs immediately after a traumatic brain injury. During PTA, an injured person is conscious but disoriented and struggles to remember events that happened both before (retrograde amnesia) and after (anterograde amnesia) the injury. Patients may exhibit unusual behaviors, such as believing they are in a different location or time, or they might not recognize family and friends. This state can involve agitation, confusion, and difficulty processing new information.
The duration of PTA is an indicator of brain injury severity and can help predict long-term recovery outcomes. Monitoring PTA is important for assessing the impact of the injury and guiding treatment plans. The GOAT directly assesses this amnesic state, helping clinicians determine when a patient is emerging from PTA and regaining continuous memory.
How the Test is Administered
The Galveston Orientation and Amnesia Test consists of ten questions administered orally by a healthcare provider. For instance, questions about orientation to person include asking for the patient’s name, age, and where they were born.
Orientation to place involves asking about the current location, such as the city and hospital. Time orientation questions gauge awareness of the current date, day of the week, month, and year. The test also assesses memory for recent events, asking about the last thing the patient remembers before the injury and the first thing they recall afterward.
Each question is scored, with incorrect or partially correct answers receiving error points, usually ranging from 2 to 5 points depending on the item. These error points are deducted from a perfect score of 100 to yield the total GOAT score. The test is administered repeatedly, often daily, to track a patient’s cognitive progress. Modified versions, such as the Written GOAT or Modified GOAT (MOAT), exist for patients with communication difficulties.
Interpreting the GOAT Scores
The scores on the Galveston Orientation and Amnesia Test provide insights into a patient’s cognitive recovery from brain injury. Higher scores indicate better orientation and less amnesia, suggesting improved cognitive function.
A score of 75 or higher is considered to indicate that a patient is no longer in the post-traumatic amnesia phase. Specifically, achieving a score of 75 or greater on three consecutive administrations marks the resolution of PTA. Scores between 66 and 75 suggest a borderline status, where the patient may be emerging from PTA but still requires close monitoring.
A score below 66 on two consecutive days indicates that the patient remains in the post-traumatic amnesia phase. These scores guide clinical decisions, helping healthcare teams determine a patient’s readiness for discharge, the level of supervision needed, and the appropriate rehabilitation interventions. A lower GOAT score is also associated with increased hospitalization duration and the potential development of post-concussion syndrome.