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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. |
