Mild Traumatic Brain Injury (“MTBI”) is characterized by one or more of the following symptoms: loss of consciousness, loss of one’s memory immediately before or after the brain injury, any alteration in mental state at the time of the accident, or focal neurological deficits. In many MTBI cases, a person may seem just fine on the surface, yet he will continue to endure chronic functional problems. Some people suffer long-term effects of MTBI, aka postconcussion syndrome (“PCS”). Persons suffering from PCS can experience significant changes in cognition and personality.
Most traumatic brain injuries cause widespread damage to the brain because the brain ricochets inside the human skull during the impact of an accident or collision. Diffuse axonal injury occurs when the nerve cells are torn from one another. Localized damage also occurs when the brain bounces against the skull. The brain stem, frontal lobe, and temporal lobes are especially vulnerable because of their location near bony protrusions.
About the Brain Stem
The brain stem is located at the base of the human brain. Aside from regulating basic arousal and regulatory functions, the brain stem is involved in attention and short-term memory. Trauma to this area can lead to disorientation, frustration, and anger. The limbic system, higher up in the brain than the brain stem, helps regulate emotions. Connected to the limbic system are the temporal lobes which are involved in many cognitive skills such as memory and language.
Damage to the temporal lobes, or seizures in this area, have been associated with a number of behavioral disorders. The human frontal lobe is almost always injured due to its large size and its location near the front of the cranium. The frontal lobe is involved in many cognitive functions and is considered our emotional and personality control center. Damage to this area can result in decreased judgment and last, increased impulsivity. Learn more
Diagnosing an MTB Definition of MTBI: A person with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, which is manifested by at least one of the following:
- 1. loss of consciousness;
- 2. loss of memory for events immediately before or after the accident;
- 3. alterations in one’s mental state at the time of the injury or collision (e.g., seeing stars, lethargy, or confused);
- 4. neurological deficit(s) that may be transient but the severity of the injury doesn’t exceed the following:
a. loss of consciousness of around 30 minutes or less; b. after 30 minutes, a preliminary Glasgow Coma Scale (GCS) of 13-15; and c. posttraumatic amnesia (“PTA”) not greater than 24 hours.
What to Look For in General
- Determine whether or not consciousness was lost.
- Determine length of unconsciousness.
- Determine if there was an alteration of consciousness.
- Determine the duration of altered consciousness.
- Classify the specifics of how the injury occurred.
- Determine history of previous head injuries or concussion by interview with the patient and family.
- Determine former alcohol use.Determine former substance use.
- Determine former vocational pursuits, positions, and durations.
- Determine former leisure pursuits, to include hobbies, athletics, and other recreational pursuits.
- Determine and, if possible, obtain academic record and rule out pre-existence of attentional deficit disorder or learning disabilities.
- Determine social/legal history.
- Determine one’s current sleep patterns, time to bed, time to sleep, times wake up, activities during wakefulness, rise time, and restedness upon awakening.
- Determine one’s dietary habits.
- Determine one’s exercise routine.
- Determine one’s caffeine usage and outline any changes since injury.
- Determine past medical history.
- Determine family medical history.
- Determine his past medications.
- Determine his current medication; chronicle changes in medications.
- Correlate his symptomatology with medications. Look at side effects. Determine use of over-the-counter medications/vitamins/supplements.
- Review the EEG’s.
- Review the CT scans of the head.
- Review the skull x-rays.
- Review the cervical x-rays, CT’s, and MRI’s.
- Review the headache history. List headaches to look for sinusitis, tension. TMJ dysfunction, medication/substance withdrawal, migraine. Headaches should be fully characterized and described completely.
- Characterize and describe all one’s vision complaints. Differentiate from one’s blurred vision from diplopia. Evaluate the visual fields and one’s ocular motor skills. Determine if there is presence of photophobia, image suppression, image persistence in the patient.
- Characterize and describe all the patients pain complaints as well as past/current treatments for same.
- Characterize patients complaints of dizziness, imbalance, and disco-ordination.
- Evaluate patients’ balance by single-foot standing, Romberg, star-march.
- Evaluate patient’s history of balance in low-light conditions.
- Evaluate for patient’s perilymphatic fistula, cupulolithiasis, and cervical dizziness.
- Evaluate for patient’s cardiac status and serum glucose levels as possibly contributory to dizziness. * The term “concussion” should be avoided and replaced with the term “mild traumatic brain injury”
(MTBI) (American Congress of Rehabilitation Medicine, 1992).
- Review ENG’s.
ADL’s (Activities of Daily Living) * Characterize the individual patient’s daily living routine.
- Completely describe the individual’s vocational history.
- Completely describe the individual’s current job description. Include whether or not the work is full-time, part-time, seasonal.
- Determine for the presence or absence of a supplemental disability insurance income.
- Determine if workers’ compensation TD payment level.
- Determine if presence of salary continuation agreement.
- Determine if there is a status vs. wage loss compensation.
MTB Victim’s Psychosocial
- Evaluate injury patient for anxiety, depression, panic attacks, somatization, hypochondriasis, malingering.
- Evaluate injury patient for issues of secondary gain.
- Evaluate injury victim for family system adaptation/adjustment.
- Differentiate victim’s psychiatric symptoms from iatrogenic or seizure-induced symptoms.
- Evaluate injury victim for overall fitness and conditioning, muscular strength, range of motion, sensation, proprioception.
- Characterize injury victim’s pain complaints.
- Balance/coordination diagnostics.
Tests that should be considered: Wide Range Achievement Test, Motor Free Visual Perception Test, Test of Visual Perception Skills, and the Santa Clara Valley Perceptual Motor Evaluation MMPI-II, Beck’s Depression Inventory, Taylor-Johnson Temperament Analysis, FIRO-B, Woodcock-Johnson Psychoeducational Battery, Detroit Tests of Learning Aptitudes, Booklet Category Test, Wisconsin Card Sort, Trails-A, B Neuropsychological Battery. Learn more at (888) 400-9721.