| Mild
Traumatic Brain Injuries (MTBI) are exactly what
the term implies "traumatic." Placing
the word "mild" at the beginning was
not meant (clinically) to minimize the seriousness
of such an injury. Individuals who have sustained
a "mild" TBI typically experience a
myriad of complicating cognitive and emotional
sequelae, which will require treatment in one
form or another. To disregard this injury can
leave these individuals at a level of functioning
far below their pre-morbid functional condition.
For the purposes
of this article, "mild" TBI will be
operationalized as an injury requiring less than
24 hours of hospitalization (if any at all), less
than 30 minutes of unconsciousness and no loss
of consciousness. Moreover, the individual is
discharged from the ER with nothing more than
some Motrin and is physically and electroencephalographically
normal within a brief period of time.
Frequently individuals
who have sustained a MTBI have been described
as the "walking wounded." They are oftentimes,
unaware of the changes that have occurred in their
life, deny changes have occurred or are frightened
that others, such as their employers, will find
out that their abilities have diminished. Typical
signs of a MTBI are problems communicating, short-term
memory problems, inability to concentrate, as
well as mood swings, fatigue and anxiety, among
other symptoms.
Individuals who
have sustained a MTBI do not readily voice their
problems in the terms delineated above, but rather
describe occurrences in their life which illustrate
that an injury has occurred.
The difference
between symptoms of TBI and the general aging
process or pre-existing psychiatric condition
is the sudden onset of the symptoms associated
with TBI. An individual does not just wake up
one day with a host of cognitive and emotional
functioning problems unless an altering event,
such as an automobile accident, an assault or
a slip-and-fall accident has preceded the onset
of the symptoms. It is important to be aware that
sustaining a TBI can exacerbate a pre-existing
condition for elderly patients and for those individuals
who have a pre-existing psychiatric condition.
It is necessary
for a comprehensive evaluation to be conducted
to determine the extent of the brain injury. As
mentioned previously, findings on the physical
neurological examination or imaging tests, such
as CAT scans, MRI, or SPEC scans are not exact
when evaluating for a MTBI because these individuals
rarely present with hard abnormal results. Quite
often a more subtle examination procedure, such
as a neuropsychological examination is required
to uncover such deficits, as well as other rehabilitation
evaluations to assist in determining any treatment
needs, such as occupational, speech-language and
cognitive evaluations.
"Mild"
TBI is often diffuse in nature. Thus different
areas of the brain may have impairment while other
areas remain intact. These brain injuries can
be caused by a shock, jam or actual blow to the
head.
MTBI requires
treatment just as much as any other serious injury.
However, one treatment does not fit all and that
is why a comprehensive set of evaluations conducted
by a team of specialists with experience working
with TRI individuals is essential. Since MTBI
is generally diffuse in nature, different treatment
plans may be needed. Each person's injury requires
their own individualized treatment focus. Remember,
no two brains (people) are alike! Even the most
competent professional may not readily predict
exactly when a MTBI individual's condition will
reach maximum improvement.
©1999
by The American Academy of Experts in Traumatic
Stress, Inc. |
