| 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. |
