Orientation Log

Last Updated

December 07, 2012

Purpose

The O-Log was developed to measure orientation to time, place and situation in a rehabilitation environment and can be used for serial assessments over time.

Link to Instrument

Instrument Details

Acronym O-Log

Cost

Free

Diagnosis/Conditions

Brain Injury Recovery
Cardiac Dysfunction

Brain Injury

10 questions; 0-30 points possible.
Each item is scored from 0 to 3:
3) Spontaneous and correct response
2) Spontaneous response is lacking, but correct response with a logical cue (e.g. to identify place, cue “This is a place where doctors and nurses work”)
1) Spontaneous and cued responses are incorrect, but correct response when provided if given choices to recognize (e.g. to identify the month, provide three months from which to choose)
0) Spontaneous, logical cue and recognition cue approaches don’t cause a correct response
Domain specific scores can be generated:
1) Place (3 items)
2) Time (5 items)
3) Situation (2 items)
Scoresheet provides a graph to plot serial assessments over time.

Number of Items

3-15 minutes

3 minutes if fully oriented
up to 15 minutes if patient requires multiple cues

Required Training

No Training

Instrument Reviewers

Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI Edge task force of the Neurology Section of the APTA in 6/2012

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
LS / UR	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	Yes	Yes	Not reported

Considerations

Designed for use in an inpatient rehabilitation environment to monitor orientation change; not specific to diagnosis. A more extensive cognitive assessment may be necessary in many situations.
Developer selected items in common with the GOAT, but excluded items that refer specifically to the onset of injury which can be cumbersome to ask about repetitively. The removal of items inquiring about injury allow the O-log to be used with individuals who are disoriented for other reasons (degenerative disease, tumor, etc).
Per Kean et al (2011), the O-Log can be used to indicate presence or absence of PTA but not incremental progress during recovery.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Standard Error of Measurement (SEM)

Acquired brain injury: (Jackson et al, 1998, n=15 rehabilitation inpatients, 11 TBI, 3 stroke, 1 multi-trauma, mean age=42.2(26.3), total of 75 O-Log scores)

SEM for individual items = 0.114 - 0.459
SEM for total score = 0.637

Cut-Off Scores

Traumatic brain injury: (Novack et al, 2000; n=68 patients with moderate to severe TBI; mean age 39.8; mean time since injury 26 days; 554 total O-Log observations)

A score of 25 or better is associated with normal orientation, comparable to a 75 or better on the Galveston Orientation and Amnesia Test (GOAT)

Normative Data

Traumatic brain injury: (Alderson et al, 2002; n=389 individuals with primarily moderate to severe TBI, mean age 39.4 (17.9))

Data below were collected prospectively on serial tests of a subgroup of 90 and applied to the larger sample to develop templates for orientation recovery.

O-Log Assessment	Severe TBI			Mild to Moderate TBI
	Lower	Mean	Upper	Lower	Mean	Upper
1	5	6	8	8	11	14
2	7	9	11	9	12	15
3	9	11	13	11	14	17
4	11	13	16	13	16	19
5	13	15	17	16	18	21
6	14	16	18	16	19	22
7	15	17	19	18	21	24
8	16	18	20	18	21	24
9	17	19	21	18	20	23
10	19	21	23	19	22	24
95% Confidence Intervals for O-Log performance for two levels of injury severity

Interrater/Intrarater Reliability

Acquired brain injury: (Jackson et al, 1998)

Excellent interrater reliability (ICC=.993 total, individual items .851-1.0)

Internal Consistency

Acquired brain injury: (Jackson et al, 1998)

Excellent internal consistency of place, time and situation components (ICC=.806, .865 and .834)
Excellent internal consistency (ICC= .922)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Traumatic brain injury: (Novack et al, 2000)

Excellent correlation between GOAT and O-Log scores (r=.90) and estimation of PTA duration (r=.99) using a cut-off score of >75 for the GOAT and 25 or better for O-Log

Traumatic brain injury: (Kean et al, 2011; n=90 inpatients with TBI; mean age=48.25(18.87) years; mean time since injury=23.79 (14.1) days); 257 ratings total)

Excellent correlations for raw scores (r=.901) and estimates of duration of PTA (r=.99) for O LOG and GOAT

Predictive validity:

Traumatic brain injury: (Novack et al, 2000)

Adequate predictive validity of minimum O-Log score with rehabilitation discharge FIM score (r=.575)

Traumatic Brain Injury: (Alderson et al, 2002; n=229 from pool of 389; primarily moderate to severe TBI who were disoriented at inpatient rehabilitation admission, mean age 41.3 (18.6) years)

Initial O-log, time since injury and number of O-log assessments predicted resolution of disorientations for 76.4% of sample

Traumatic Brain Injury: (Dowler et al, 2000; n=60 individuals with moderate to severe TBI; mean age 31.3(13.6)years; mean time since injury=6 months (SD=4 weeks))

Poor to adequate but significant correlation between minimum rehabilitation O-Log score and Community Integration Questionnaire score (r=.395) and Disability Rating Scale scores (r=-.295) at 12 months post-injury.
Poor to adequate but significant correlations between minimum O-Log scores in rehabilitation and neuropsychological tests (r=-.295-.395).

Traumatic Brain Injury: (Frey et al, 2007; n=83 inpatients with TBI; mean age 47.4 (20.4) years)

PTA determined by O-Log demonstrated better prediction of rehabilitation outcomes than GOAT

	O-LOG (r^2)	GOAT (r^2)
Total LOS	0.04	0.03
D/C total FIM	0.08	0.06
D/C motor FIM	0.04	0.03
D/C cogntive FIM	0.18	0.13

Construct Validity

Traumatic Brain Injury:

Excellent correlation of O-Log score to admission total FIM score (r=0.783) and adequate correlation to GCS score (r=.434) (Novack et al, 2000)
O-log scores of 25 or greater were associated with significantly higher DRS and FIM scores (Alderson et al, 2002)
Adequate correlation with O-Log and GOAT (r=0.72). (Frey et al, 2007)

Aquired Brain Injury: (Penna and Novack, 2007; n=45 inpatients with acquired brain injury, including TBI, CVA, brain tumor; mean age 39.7 (18.5) years)

Excellent correlation with MMSE (r=.65) and Cog-Log (r=.75)

Content Validity

Traumatic Brain Injury: (Kean et al, 2011)

Rasch analysis of O-Log results were below criterion level of person separation (reliability coefficient of .72), only able to determine 1 or 2 strata of patients. Authors suggest that O-Log is insufficient to capture the complexity of cognitive issues in TBI recovery, suggest combining it with other instruments.

Bibliography

Alderso, A. L. and Novack, T. A. (2002). "Measuring recovery of orientation during acute rehabilitation for traumatic brain injury: value and expectations of recovery." J Head Trauma Rehabil 17(3): 210-219. Find it on PubMed

Dowler, R. N., Bush, B. A., et al. (2000). "Cognitive orientation in rehabilitation and neuropsychological outcome after traumatic brain injury." Brain Inj 14(2): 117-123. Find it on PubMed

Frey, K. L., Rojas, D. C., et al. (2007). "Comparison of the O-Log and GOAT as measures of posttraumatic amnesia." Brain Inj 21(5): 513-520. Find it on PubMed

Jackson, W. T., Novack, T. A., et al. (1998). "Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log." Arch Phys Med Rehabil 79(6): 718-720. Find it on PubMed

Kean, J., Abell, M., et al. (2011). "Rasch analysis of the orientation log and reconsideration of the latent construct during inpatient rehabilitation." J Head Trauma Rehabil 26(5): 364-374. Find it on PubMed

Novack, T. A., Dowler, R. N., et al. (2000). "Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test." J Head Trauma Rehabil 15(3): 957-961. Find it on PubMed

Penna, S. and Novack, T. A. (2007). "Further validation of the Orientation and Cognitive Logs: their relationship to the Mini-Mental State Examination." Arch Phys Med Rehabil 88(10): 1360-1361. Find it on PubMed