The "mild" in mild traumatic brain injury or mTBI does not mean mild after-effects. What it means is that the traumatic brain injury/"minor head injury"/ concussion is not life-threatening. Various studies show that 8% of all people with mTBI have permanent disability stemming from the brain injury itself.
A least 35% of mTBI survivors also have either a first-time occurence or exerbation of major depression. mTBI psychiatric inpatients also have longer stays on inpatient units and have a 19% higher chance of rehospitalization than non-mTBI peers. 33% of psychiatric outpatients were found to have had an undiagnosed TBI. The presence of even a mild TBI does have important ramifications for treatment in both mental health and addiction rehabilitation as well as in other medical arenas. More research needs desperately to be conducted in order to learn how to best be of service to those patients who have both an mTBI and a major mental condition.
Survivors of an mTBI one year after injury have shown continued significant changes in core personality as well as continued difficulties with anger, implusivity, mistrust, self-regulation, and ongoing sensory and perceptual distortions. Problems with word-finding and organizational functions are common. It is estimated that at least 75% of all traumatic brain injuries are mild.
Survivors of a mild traumatic brain injury caused by vehicular accidents have more problems with verbal aggressiveness, short-term memory losses, decreased attention and concentration, word-finding, judgement, and decision-making than survivors whose mild traumatic brain injury was caused by sports or recreation accidents.
Those survivors have more difficulty with poor planning and frustration levels. Both groups of survivors have equal difficulties with organization and with emotional lability. Data could not be found by sapphoq comparing the difficulties of survivors whose mild traumatic brain injury was caused by domestic or other violence.
The American Congress of Rehabilitation Medicine in 1993 defined specific criteria for the diagnosis of an mTBI:
~loss of consciousness of zero to less than 30 minutes,
~post-traumatic amnesia of zero to less than 24 hours,
~mental alteration existing at the time of the event causing the injury,
and
~either transient or persistent neurological focal signs.
By definition, those with post-concussive or post-concussion syndrome experience fleeting to no loss of consciousness [LOC] during the actual event of injury. Thus their Glasglow Coma Scale index is 13-15. [The lower the number, the worse off the patient is. 15 is the highest number.] So far, that is the same.
Survivors of a mTBI who report severe headaches, dizziness, and fatigue may then be diagnosed
as having post-concussive syndrome [PCS]. Those with a diagnosis of PCS may also show evidence of difficulties with memory and/or attention, slowed cognitive processing, and learning difficulties. Symptoms are said to typically resolve within three months or so in most survivors who present with PCS.
PCS is diagnosed in women more than in men. This is primarily associated with the presence of pre-existing mental disorders. Poorer outcomes are associated with age-- some sources say the cutoff is over 40 and and others say over 55 years old. Evidence also exist that those who have prior histories of addiction and/or mental conditions and those who are seeking monetary compensation have twice the rate of having a PCS diagnoses after an mTBI than other survivors.
PCS is also twice as likely to be diagnosed in survivors of traumatic brain injury who are seeking satisfaction through litigation. Physicians and attorneys traditionally do not "get along." Some medical researchers claim that post-concussive syndrome is a problem arising out of the desire for monetary compensation coupled with an unwillingness to return to work rather than from the brain injury itself.
Unfortunately, at least 50% of survivors of mild traumatic brain injury who are also
diagnosed with PCS who do settle lawsuits show little mprovement a year after settlement. Studies conducted post-mortem show diffuse axonal damage in humans and in other animals who were diagnosed with mTBI during their lifetimes. Repeated insults to the brain also predict poorer recovery outcomes.
Whether PCS is organic-- related to the insult to the brain itself, or functional-- related to factors which are environmental rather than to the mTBI is an issue that continues to be vigorously debated within the medical community. The jury is still out. It may very well be that PCS arises out of both structural and functional factors together.
Survivors of mTBI who have persistant symptoms and difficulties often have few meaning choices for cognitive rehabilitation. So-called PCS clinics are few and far in-between. Survivors are often forced to navigate the landscape of treatment modalities alone. The professionals they do find to help them with specific difficulties are from varying medical disciplines. mTBI survivors may find that they have to assemble their own health care team, advocate for their needs, and be in charge of their own rehabilitation.
They are often prey for less-than-honorable "professionals" who are underqualified or unqualified to offer cognitive rehabilitation services, have to fight for insurance companies to pay for what they do need, have the experience of payment for their medical bills being cut off, subjected to biased insurance "medical" examinations, and confronted with physicians and family members who do not understand why the "concussion" is still causing such gross difficulties. A diagnosis of PCS may also fan the prejuidices of some medical providers who equate PCS with malingering. Some medical providers may not recognize that a diagnosis of PCS means that the patient before them has BRAIN DAMAGE due to a mild traumatic brain injury. Thus, the patient is "blamed" for not getting well within the traditional three month time frame set out for "a mere concussion."
Other things that get in the way of healing [not "curing"] an mTBI can be the presence of an undiagnosed sleep disorder such as apnea, changed reactions to various prescriptions including but not limited to psychiatric medications, and unwillingness of vocational rehabilitation agencies to allow survivors to determine their own work goals and to ease back into a part-time work schedule. Fatigue can be long-term, demonstrable vision problems such as double vision in one or both eyes can contribute to the fatigue of brain injury, and neurological difficulties can point to need for accomodations which may be ignored in "individualized" return-to-work plans.
Every brain injury is different. That nugget of wisdom is something that staff members of state Brain Injury Associations repeat over and over again. That message is clearly not being heard.
~sapphoq
references:
http://www.medical-journals.com?r03109c.htm
http://www.drdiane.com
http://www.headinjury.com
http://www.medscape.com
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