Mild Traumatic Brain Injuries: A Perspective
Avery M. Silverstein, Ph.D., B.C.E.T.S., F.A.A.E.T.S.

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.