Traumatic Brain-Injury

A traumatic brain injury (TBI), or concussion, can leave a person with lifelong symptoms and disability, requiring a multidisciplinary approach to the management of this condition. In this, our third installment in our series on TBI, we will describe the evaluation and treatment of mild TBI from different clinical perspectives. The three authors come from different training and medical backgrounds (neurology, neuropsychology, and physical medicine & rehabilitation).

Using their unique backgrounds, the authors describe the cellular mechanism of TBI as gleaned from high-grade imaging devices, review neuropsychological evaluation for patients with TBI, and provide an overview of a comprehensive approach to lifelong treatment within a comprehensive physical medicine and rehabilitation model.¹

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Introduction

TBIs can occur any time, any place, and from myriad sources. The recent coverage of sports-related concussions and improvised explosive device/combat-related explosions in the armed forces has brought more awareness of the subject to the public eye. But, TBIs are not new. According to the Centers for Disease Control and Prevention, approximately 1.7 million TBIs occur every year in the US,² accounting for close to a million and a half emergency room visits, and over 50,000 deaths.³ Sports-related TBI raises the specter of repeated TBIs, which can lead to chronic traumatic encephalopathy (CTE).

The majority of mild TBI survivors recover fully 3 to 4 weeks after the injury, but a significant minority (10%-20%) continue to experience symptoms months (acute post-concussion disorder [PCD]) and even years (chronic PCD) after their injury.

Physical complaints after mild TBI include headache, dizziness, photophobia, phonophobia, fatigue, nausea, insomnia, vision impairment, and seizures. Cognitive complaints include decreased arousal, attention, and concentration, as well as short-term memory loss.

Despite its high incidence and profile, TBI and its many post-concussional clinical issues (Table 1) are not addressed in medical school training. The available pool of clinicians who are interested and actively work in this area of medicine is quite small but growing. The good news is that the specialized tools for evaluation and treatment of the many symptoms that result from TBI are expanding. Indeed, this has been a multidisciplinary effort.