Understanding Mild Traumatic Brain Injury and TBI Terminology
Mild traumatic brain injury can be very difficult to understand. Often, the victims of mild head trauma may look perfectly normal to the rest of us. However, the mental, emotional and cognitive symptoms they are experiencing beneath the surface can be debilitating at times. In order to better understand brain injuries, it is helpful to understand the terminology doctors often use when talking about mild traumatic brain injury. Keep in mind, the information below is being provided by a traumatic brain injury lawyer and is for educational purpose only. It is not intended to replace the advice of a licensed medical professional. Please consult a neurologist and/or neuropsychologist for diagnosis of your specific condition and treatment.
What is a Mild Traumatic Brain Injury?
According to the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine, a patient with MTBI is defined as follows:
“A a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:
- any period of loss of consciousness;
- any loss of memory for events immediately before or after the accident;
- any alteration in mental state at the time of the accident (eg, feeling dazed, disoriented, or confused); and
- focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed the following:
- loss of consciousness of approximately 30 minutes or less;
- after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13–15; and
- posttraumatic amnesia (PTA) not greater than 24 hours.”
The traumatically induced physiological disruption of brain function can be the result of the head being struck, the head striking an object or the brain undergoing an acceleration/deceleration movement (ie, whiplash) without direct external trauma to the head.
Generally, if the period of unconsciousness or altered mental state lasts shorter than a period of 30 minutes, the TBI will be classified as “mild.” Most documented traumatic brain injuries are classified as mild. (See Ruff, Ronald M. Mild traumatic brain injury and neural recovery: Rethinking the Debate, NeuroRehabilitation Vol 28, pages 167-180, 2011.)
What is a “Concussion?”
In medical records, you often find emergency medicine doctors identifying the signs of a mild traumatic brain injury with generic terms such as a “concussion” or “minor head injury.” A concussion is a mild traumatic brain injury. It can be the result of a direct impact to the head or the result of an acceleration/deceleration injury. Other terms that may describe it include: minor head trauma, closed head injury, minor TBI, and minor brain injury. 15% of people who sustain a mild traumatic brain injury will continue to have significant symptoms for longer than one year. For these people, the symptoms may never go away.
What is a Post-Traumatic Brain Injury?
Post-traumatic brain injury typically refers to a brain injury that begins as the result of a specific traumatic event. It may be a sports injury or an automobile collision or a fall or any event that results in the brain being slammed back and forth inside the skull. It may also be the result of an object piercing the skull to injure the brain directly. While it is common to think of a brain injury as an event that occurs, many doctors prefer to think of it as a disease process with the traumatic event being the triggering event. Once the process starts, it may be influenced by additional outside factors or events, but the condition often acts like a disease once set in motion.
What is Post Concussive Syndrome?
Post concussion syndrome refers to the collection of symptoms that follow a concussion or MTBI. There are numerous symptoms associated with TBI and the victim of the injury may have any mix of them. They may occur immediately or they may take days or even weeks to occur. Often, the person will look normal, but the cognitive effects of the injury will be present. This often leads to a misdiagnosis at the time of the initial injury. Common symptoms include:
- visual disturbances ranging from color changes to double-vision
- loss of memory (short term or long term)
- photophobia (sensitivity to light)
- dizziness or vertigo
- emotional disturbances
- impaired or slow thinking
What is a Cognitive Deficit?
Cognitive deficit is an impairment of a person’s ability to acquire and process knowledge and use it to understand the world.
How is a Cognitive Deficit Diagnosed?
Cognitive deficits are most often diagnosed clinically by a neurologist questioning the patient as to the symptoms and the patient reporting a mixture of symptoms that fall under the category of those seen in post concussive syndrome and other brain injuries. The neurologist, then, will refer th patient out to a neuropsychologist for a two-day set of tests, including a General Diagnostic Battery and Neuropsychological Evaluation and also a Brain Injury Functional Evaluation Program.
What is a General Diagnostic Battery and Neuropsychological Evaluation?
A General Diagnostic Battery and Neuropsychological Evaluation is a series of tests performed by a neuropsychologist to evaluate a patient’s mental, cognitive and emotional condition. This test generally takes about 4 hours to complete and it is completely noninvasive. Typically, a history is taken and then the test is performed. This test evaluates a patient in six areas:
- Intellectual capacity
- Higher cortical functioning
- learning and memory
- perceptual and motor, and;
- personality and mental health,
Additionally, the test has fail-safes built in to test the validity of the patient’s responses.
Intellectual capacity is measured using commonly accepted tests such as the WAIS-IV and the Full Scare I.Q. test. It measures verbal comprehension, perceptual reasoning, working memory and processing speed. Higher cortical functioning tests a number of brain functions including: visual tracking, immediate auditory memory and information processing, numeric reasoning, and problem-solving skills. Learning and memory tests the ability to recall things long term and short term as well as to identify images recently observed. Language is a test of reading, , spelling, sentence repetition and general academic functioning. Perceptual and motor tests a person’s visual-spatial function, visual form discrimination, hearing, and tactile function. Personality and metal health is an assessment of emotional distress in the patient.
What is a Brain Injury Functional Evaluation Program?
A Brain Injury Functional Evaluation Program is another series of tests designed to assess the impact of a patient’s cognitive deficit upon their daily function. Again, this is about a four-hour test and is usually done on a separate day from the General Diagnostic Battery and Neuropsychological Evaluation to avoid unnecessary stress and fatigue on the patient. The test involves a CNS Vital Signs Assessment, which is a computerized assessment of cognitive function. It tests many of the same things as the prior test. It also tests executive functioning including problem-solving, self-restriant, self-motivation and self-regulation of emotions. A number of activities are performed as a part of the test to analyze the patient’s functional cognitive activities. These test memory, ability to follow instruction, attention to visual details, cognitive flexibility, frustration control, dexterity, hand/eye coordination, following directions, comprehension, and math. In the end, the neuropsychologist is better able to understand the specific tasks of day-to-day function that have been affected and design a cognitive rehabilitation program to help the patient work around them.
Can MTBI be Treated?
Only a qualified neuropsychologist can truly answer this question for any particular case. However, the above-tests are specifically aimed at determining whether there are areas in which the person’s quality of life may be improved. In many cases, the treatment is simply teaching a patient to learn to do things in a different manner than they did them before. For example, one with memory issues can learn to keep notes and make lists as reminders. Essentially, the goal of the treating neuropsychologist is to teach the patient a new way to solve the issues that their brain struggles with now. With many patients, a return to a functional lifestyle is possible.
What is Post-Traumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) is an emotional disorder affecting the way a person copes with things after having suffered a life-threatening or horrifying event. This may include depression, anxiety or any number of emotional disturbances that follow a traumatic event. It may last only a short time or it may be permanent. Typically, PTSD is treated by psychiatric counseling to assist the patient in coping with the disorder. This type of treatment is commonly required to deal with things such as depression and/or anxiety that flow from the event that produced the TBI.