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Mild Traumatic Brain Injury - Diagnosis and Treatment Developments
According to the U.S. National Library of Medicine, mild traumatic brain injury (mTBI), also known as concussion, is the most prevalent category of traumatic brain injuries. However, there is no standard definition of mTBI. Although it is such a common condition, mTBI has a wide variability relative to its acute medical management. In a report on 41 guidelines which relate to mTBI management, Peloso and his colleagues categorized three guidelines/procedures as "being evidence-based," while concluding that based on the "absence of clear evidence, experts frequently disagree" on issues surrounding mTBI definitions, diagnosis, and treatment.
DEVELOPMENTS REGARDING THE DIAGNOSIS OF MTBI
- A plethora of scholarly publications attest that there is an insufficient amount of information contained in "civilian literature"/publications on the diagnosis of mTBI.
- Some experts believe the symptoms of mTBI include headaches, depression, fatigue, anxiety, and irritability, and an impaired cognitive function. Symptom resolution seemingly occurs within three months post-injury, except for a small ratio of individuals who experience the persistent post-concussion syndrome.
- Blostein and Jones recently conducted a study of 35 level-I trauma treatment centers across the United States. Based on the "evaluation and discharge" of people suspected to be suffering from mTBI by the facilities, Blostein and Jones found out that less than half of surveyed centers "had a standardized protocol in place" for the evaluation of all patients suspected of having mTBI.
- Although most mTBI diagnostic centers lack standardized protocols, some health care providers are likely to use one or more tests to assess a patient's physical injuries. The tests also brain as well as "nerve functioning, and level of consciousness."
- Some tests typically used for diagnosis of TBI include Glasgow Coma Scale (GCS), measurements to determine the level of TBI. Others include speech and language tests, cognition and neuropsychological tests, imaging tests, and tests for assessing TBI in a military setting.
- Health care providers are likely to rank a patient's level of TBI as mild TBI (mTBI), moderate TBI, or severe TBI. The ranking is based on the level of consciousness, memory loss, and GCS score.
- Experts believe that persisting post-concussive symptoms of mTBI remain controversial as researchers attempt to determine an etiology of related symptoms.
- A person is said to be suffering from mild TBI mTBI if the person is unconscious or stayed unconscious for over 30 minutes. Also, a person that has suffered from memory loss that lasted "less than 24 hours" or has a GCS rating between 13 to 15.
- According to the National Institutes of Health Directory, the diagnosis of mild TBI (concussion), utilizes inconsistent criteria and relies predominantly on "patients' self-reported symptoms."
- A TBI is said to be moderate if the patient was unconscious for over 30 minutes or up to 24 hours. Also, TBI is moderate if the memory loss duration was anywhere between 24 hours and seven days, or has a GCS rating between 9 to 12.
- A TBI is said to be severe if the patient was unconscious for over 24 hours. Or if the memory loss lasted over seven days or the GCS ranking was 8 or below.
- According to Traumatic Brain Injury, a patient may look normal and move normally despite not "feeling or thinking normal." This makes mTBI diagnosis easy to miss.
DEVELOPMENTS REGARDING THE TREATMENT OF MTBI
- There is an insufficient amount of information contained in civilian literature/publications on mTBI, and most methodical/systematic reviews do not support "cognitive rehabilitation interventions" in the treatment or management of the cognitive symptoms of mTBI. "Civilian literature" focused on mTBI is substantially limited.
- Some studies reveal that mTBI is more likely to affect the "frontal and temporal lobes of the brain," these parts of the brain are linked to learning, executive function, and memory. Due to the fact the affected regions of the brain are continually developing within the early twenties, student-athletes are more vulnerable to adverse effects when they experience mTBI.
- A more troubling issue is the repercussions that can result if a second concussive injury occurs in a patient before the resolution of the first mTBI instance. This situation leads to a phenomenon known as a second-impact syndrome.
- Each mTBI incidence that occurs after the first instance causes more significant cognitive decrement and longer recovery times.
CONCLUSION
- Experts have concluded that "proper identification" (diagnosis) and "treatment of mTBI" along with post-concussive syndrome is very challenging. This challenge exists because of a lack of consensus within the health care system on mTBI diagnosis as well as management.