Although symptoms following mTBI generally resolve with time, active treatment is centered on symptom management, supervised rest, recovery, and patient education. Medical specialty care, ancillary services, and other therapeutic services may be required.
Full Answer
What medications are used for traumatic brain injury?
The most common types of antispasticity drugs for TBI patients are:
- Tizanidine hydrochloride (Zanaflex). Tizanidine is an oral muscle relaxant. One dose of 8 mg reduces muscle tone in spasticity patients for several hours.
- Baclofen. Baclofen works by activating GABA B receptors, which produce a calming effect on the central nervous system. ...
- Botox. Botox blocks the nerve signals that cause muscles to contract. ...
What should I watch for after a head injury?
In today's Health Check, the symptoms doctors say you should watch for after a head injury, plus how to keep your heart healthy while watching all the big game.
What are the treatments for Traumatic Brain Injury (TBI)?
- Maintenance of adequate oxygenation and normocapnia
- Close monitoring of systolic blood pressure and mean arterial pressure
- Maintenance of normal body temperature (normothermia)
- Providing patients with pulmonary issues needs lung-specific parameters. ...
- Electrolytes goals must be kept within the normal range. ...
What is the best treatment for head injury?
So if you have a family history of Alzheimer’s that does increase your chances a bit, in the same way that, say, smoking increases your chances a bit, or head injuries increase ... “The drug treatments that we have at the moment don’t stop the ...
How long does it take to recover from a mTBI?
Most individuals who sustain a mTBI spontaneously recover fully within the first few weeks or months, but a significant minority continue to experience persistent symptoms for months or years following injury [39,40]. A small but significant body of research has addressed the question of whether psychoeducational and supportive interventions in the acute phase after mTBI can prevent progression to persistent PCS. These interventions are based on the theory that persistent PCS is associated with attribution of symptoms to the mTBI and negative expectations about recovery [41]. Such interventions typically involve education on post-concussive symptoms, reassurance and education on the expectation for complete recovery, and guidance regarding rest and gradual resumption of typical activities. Psychoeducational early interventions have the strongest empirical support of any post-mTBI interventions, with several systematic reviews concluding they are well supported [42,43,44]. One recent systematic review with stringent methodological exclusion criteria [45] found that only two studies in the entire corpus of research on mTBI treatment met its standards; one supporting telephone-based early educational intervention [46], and one supporting recommendations for bed rest in the acute recovery phase [47].
How long do you have to be asymptomatic after a mTBI?
While the majority of patients with mTBI history are asymptomatic within a couple of weeks post-injury, a small minority (10%–20%) of patients continue to report detrimental symptoms for months and even years post-injury [5]. This group of patients with unfavorable outcomes following mTBI is sometimes termed the “miserable minority” [26] (p. 551), and the condition is termed post-concussive syndrome (PCS). The outcomes of this patient group have generated much controversy, with the emergence of two polar opinions among professionals as to whether these persisting symptoms are the result of neurogenic factors (e.g., neurological residuals of the original mTBI) or psychogenic factors (e.g., pre-morbid psychopathology or personality characteristics) [5,27,28]. Others take the more balanced perspective that these two opinions are “complimentary and capable of being integrated” [27] (p. 1120).
What is cognitive rehabilitation?
Cognitive Rehabilitation: Cognitive rehabilitation comprises an eclectic set of therapeutic approaches that are tailored to the individual’s neuropsychological profile and functional goals [50]. The first step in treatment planning is a thorough neuropsychological assessment. Based on this assessment, the clinician may draw from a number of therapeutic approaches, incorporating not only strictly cognitive interventions but also emotional, behavioral and social interventions as needed. Broadly, cognitive rehabilitation interventions can be categorized as “bottom-up” interventions, which build or restore basic skills using rote practice, or “top-down” interventions, which use metacognitive skills, or “thinking about thinking,” to promote effective self-management of cognitive difficulties. Top-down approaches can be further subdivided into internal strategies, such as self-monitoring and self-regulation, and external strategies, such as reminders and organizational systems. In clinical practice, treatment typically involves a combination of these approaches. The following paragraphs provide a brief overview of cognitive rehabilitation interventions relevant to mTBI and PCS. Clinicians are advised to refer to the ACRM Cognitive Rehabilitation Manual [51] for more comprehensive guidelines on the interventions outlined here.
What are the cognitive deficits after a mTBI?
After a mTBI, cognitive dysfunction is often seen in the domains of attention, processing speed, executive functions, and/or memory, although there is differential recovery across these domains over time [23,27]. The observed deficits can be relatively subtle and are influenced by numerous factors, including injury severity, time since injury, and the specific neuropsychological measures used [36]. With regard to the influence of time since injury, Karr and colleagues conducted a systematic review of meta-analyses and found that multiple studies report a return to cognitive baseline by 90 days post-injury [37]; however, some patients who have developed a more chronic PCS continue to show neuropsychological impairments on testing [25,33]. There is also great variability across neuropsychological tests with regard to their ability to capture cognitive deficits secondary to mTBI [37].
What are the symptoms of mTBI?
During the acute and subacute phases of recovery from a mTBI, patients generally report symptoms that fall into one of three symptom clusters: somatic (e.g., physical and/or sensory), cognitive, and affective (e.g ., emotional). Commonly reported somatic symptoms include headache, sleep disruptions, dizziness, nausea, visual disturbance, photophobia, and phonophobia. Common cognitive symptoms include problems with attention and memory, slow processing speed, difficulty multitasking, increased distractibility, losing one’s train of thought, and feeling foggy. Affective symptoms often reported by patients with mTBI include increased irritability, emotional lability, anxiety, and depression [17,18]. Fatigue is a frequent complaint after mTBI. Research regarding fatigue suggests that it is a multidimensional symptom, with many factors contributing to and exacerbating fatigue, including somatic symptoms, sleep disturbance, cognitive exertion, chronic situational stress, and mental health [19,20,21,22].
Is mTBI a standard definition?
In addition to the lack of a standard definition of mTBI, there is much variability in acute medical management of this common condition. In their evaluation of 41 guidelines related to mTBI, Peloso and colleagues [9] only categorized three as being evidence-based and reported that “in the absence of clear evidence, experts frequently disagree” [9] (p. 111). Blostein and Jones [10] surveyed 35 level I trauma centers in the United States regarding their evaluation and discharge of patients with suspected mTBI. They found that less than half of the centers had a standardized protocol in place for evaluating all patients with suspected mTBI. Foks and colleagues [11] found a similar lack of consistency in mTBI evaluation and management when they surveyed 71 neurotrauma centers in Europe and Israel. Powell and colleagues [12] found that over half of the 197 patients identified as having a mTBI by study personnel were not documented with that diagnosis by medical personnel in the ED. Within the Veteran population, Pogoda and colleagues [13] showed that clinical judgment differed from ACRM-based criteria for mTBI history in 24% of the cases seen for a comprehensive TBI evaluation, with the majority of these disagreements indicating that clinician judgment on mTBI diagnosis was inconsistent with ACRM-based criteria (Clinician N/ACRM Y). This outcome of Clinician N/ACRM Y reportedly occurred more often when veterans reported higher affective symptoms accompanied by lower reported cognitive and physical symptoms. The lack of consistent guidelines regarding acute ED evaluation and management of patients suspected as having sustained a mTBI likely contributes to the estimates that “50%–90% of patients with mTBI often go unidentified or undiagnosed in the hospital ED” [14] (p. 272). Patients who go undiagnosed may be at a higher risk for a “complicated recovery” [12] (p. 1554) because they are not provided with psychoeducation regarding possible consequences of mTBI and the expected recovery trajectory [12].
Is mild traumatic brain injury a PCS?
Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.
Agenda
I’m going to do a quick introduction then a brief review of the etiology and overview of the symptoms of mild traumatic brain injury, along with an interpretation of evaluation results and motivational interviewing.
Etiology of mTBI
I always like to start by saying that even though it's called mild TBI, I've found that mild TBI is one of the most complex diagnoses to treat. It is definitely not mild. It is an onion with multiple layers that we are digging through.
Overview of mild Traumatic Brain Injury Symptoms
Following a mild TBI, the patient or client might have a headache, fatigue, balance and vision issues, nausea, and vomiting. This could be immediate or some of these, headaches and fatigue in particular, maybe longer-term.
Cognitive-Communication Symptoms
Specific cognitive-communication symptoms include issues with attention, memory, executive functioning, verbal fluency, complex problem-solving, and occasionally stuttering. These are the most common areas of difficulty in individuals with mTBI.
Guiding Principles of Therapeutic Intervention
Before we get into the principles of therapeutic intervention, I am assuming you have already evaluated your patient and you have determined which symptoms they may be presenting. You've already completed a thorough case history and interview of your patient. You know how they sustained their injury or injuries.
Interpretation of Evaluation
I talked about this in Part 1, but the evaluation is made up of informal results, screenings, observations, and formal results. I mentioned the Rivermead Behavioral Memory Test, the Boston Naming, the Test of Everyday Attention. The qualitative evaluation is important, as are the quantitative standardized pieces.
Treatment: Attention
There are a couple of different treatment options for attention. The first one is Attention Process Training, which is Sohlberg and Mateer's model. We mentioned the attention model earlier, but they also have a whole training. The training starts with focused attention and builds in a hierarchical manner up to divided attention.
What is the best way to recover from a TBI?
Sleep. Sleep is a restorative state that allows your brain to recover from stress and injury. This makes sleep one of the most important parts of mild TBI recovery.
How to speed up TBI recovery?
Methods to Speed Up Mild TBI Recovery Time. Mild TBI recovery can take some time. However, there are some proven ways to reduce total recovery time. These include: Sleep. Sleep is a restorative state that allows your brain to recover from stress and injury.
How long does a TBI last?
Last updated on October 13, 2020. Mild traumatic brain injuries (TBIs) are more serious than many people realize. If the proper steps are not taken, patients can experience symptoms for months, sometimes years, after their injury. That’s why it is crucial to take the right approach to mild TBI recovery from the beginning.
How to recover from a TBI?
Mild TBI recovery can take some time. However, there are some proven ways to reduce total recovery time. These include: 1 Sleep. Sleep is a restorative state that allows your brain to recover from stress and injury. This makes sleep one of the most important parts of mild TBI recovery. 2 Exercise. Studies show that low impact exercise, such as low intensity walking, contributes to a reduction of symptoms in mild TBI patients and shortens recovery time. 3 Hydrate. Dehydration impairs the brain’s ability to repair itself. Therefore, to promote a healthy recovery from mild TBI, try to drink at least half of your body weight in ounces every day. 4 Avoid Alcohol. Avoid consuming alcohol for the first few days after your concussion. Alcohol contains neurotoxins that damage your brain cells and hamper your brain’s healing process. 5 Eat healthy. Make sure you consume foods that heal the brain after a concussion, such as foods rich in omega-3 fatty acids and antioxidants. These will stimulate your brain’s production of new nerve cells and accelerate the healing process.
What is mild TBI?
A mild TBI refers to a bump or a blow to the head that disrupts brain function and results in a loss of consciousness for less than 30 minutes. On the Glasgow Coma Scale, a mild TBI corresponds to a score of 13 or higher. Some of the most common signs and symptoms of mild traumatic brain injury are: Poor concentration. Light sensitivity.
What are the symptoms of a TBI?
Some of the most common signs and symptoms of mild traumatic brain injury are: Poor concentration. Light sensitivity. Memory problems. Headaches. Dizziness/loss of balance. Depression. Confusion. These signs and symptoms are a normal part of mild TBI injury and are not necessarily signs of permanent damage.
Why is cognitive rest important after a concussion?
That’s because, after a concussion, the brain devotes most of its energy towards healing itself . This leaves fewer cognitive resources to perform other actions. Therefore, practicing cognitive rest is one of the best things you can do to promote recovery from mild TBI.
What is the box for traumatic brain injury?
Box 1. Diagnostic criteria for mild traumatic brain injury from the American Congress of Rehabilitation Medicine
What is clinical practice guideline?
A clinical practice guideline was developed to aid health care professionals in implementing evidence-based, best-practice care for the challenging population of individuals who experience PPCS following MTBI.
What are duty restrictions after mTBI?
Duty restrictionsafter mTBI vary among the services. RTD status should be based upon the service members symptoms and allow for progressive return to full duty.9The service member may need to restrict some work and other activities to allow for healing and to decrease risk of further injury. When a service member has recovered from symptoms that
What is a TBI in the military?
INTRODUCTION Traumatic brain injury (TBI) is a widely recognized injury resulting from the current conflicts in Afghanistan and Iraq. TBI occurs when a trauma-induced external force results in temporary or permanent neurologic dysfunction. TBI severity ranges from mild to severe; TBI may be classified as a closed or penetrating injury. The majority of combat-related TBI within the U.S. Armed Forces fall in the mild TBI (mTBI) range, which is commonly known as concussion.1The overall Department of Defense (DoD) approach to TBI care follows a continuum of care. This continuum includes the prevention, surveillance, screening/assessment, diagnosis, case manage- ment, treatment, rehabilitation, and reintegration of service members who have suffered a TBI.2This article focuses spe- cifically on the screening, diagnosis, and treatment aspects of mTBI within the military community. SCREENING Approximately77% ofTBIcasesseenwithintheU.S. military population areclassifiedasmTBI.1Aggressivescreeningmea- sures were instituted in 2006 to ensure that the mTBI popula- tion is captured by military TBI surveillance.3TBI screenings occur in-theater, at Landstuhl Regional Medical Center (LRMC) in Germany, at military treatment facilities (MTFs), at home duty stations after deployment, and within the Vet- erans Affairs (VA) system. From the year 2000 through November 15, 2011, there have been 233,425 medically diag- nosed TBIs worldwide within the DoD, of which 178,961 were classified as mild.4Reliance on service member self- report,5,6and co-occurring conditions7,8can make TBI screen- ing very challenging. If a service member has been exposed to an external force or mechanism of injury that could potentially cause TBI(i.e.,blast exposure, vehicularcrash and/orrollover, blunt trauma, fall, sports-related injury, gun-shot wound above the neck, or a combination of these entities), immediate screening is indicated.9
What is the DVBIC website?
Many free educational resources are offered online. The Defense and Veterans Brain Injury Center (DVBIC) website, dvbic.org,46offers resources about mTBI and include symp- tom management for memory, sleep, mood changes, and headache difficulties. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE),47
Why is acute assessment of concussion important?
Acute assessment of concussion is very important on the battlefield as it may lead to better outcomes and increased rates of return to duty (RTD). 12Medics must determine which level of care is required next for the service member based on the Concussion Management Algorithms for the deployed setting (discussed in the “Treatment” section).10
When was the Concussion Management Algorithm updated?
The Concussion Management Algorithm for deployed set- tings (CMA) was recently updated in 2012 (Table II). A copy of the updated CMA can be requested online: http://www .dvbic.org/material/concussion-management-algorithm-cma- pocket-.cards. Important updates to the CMA are included (Table II). All service members exposed to a blast or other mechanism of injury, including those who screened nega- tive, are mandated to rest for 24 hours before returning to duty. The commander/commanding officer, however, has the right to waive the rest period if the service member is deemed vital to the mission.10
Is AGCS a TBI?
aGCS is not part of the official DoD definition for TBI but is commonly used in practice.
What to do after a concussion?
After sustaining a concussion it is very important to avoid any activity that places the individual at risk of sustaining another concussion. Assure the individual that he or she will be okay and that symptoms will reduce soon if he or she follows a recovery plan that balances rest and activity.
How to recover from a concussion?
On the Road to Recovery 1 After sustaining a concussion it is very important to avoid any activity that places the individual at risk of sustaining another concussion 2 Assure the individual that he or she will be okay and that symptoms will reduce soon if he or she follows a recovery plan that balances rest and activity 3 Since most individuals will recover completely, accommodations will be temporary 4 Evaluation by healthcare professionals trained in the care of concussion is important 5 It is just as important that those professionals who are selected to diagnose specific symptoms have expertise in managing those symptoms, such as headache or dizziness
How to prevent long term disability?
The good news is that research shows that early identification, education and management of symptoms can prevent long-term difficulties and disability. Managing the symptoms through a balance of rest and activity is the key to recovery.
How long does it take for a concussion to go away?
Most people can expect their symptoms to diminish after 2-3 weeks. If symptoms continue beyond 14 days, it is important to consult with a healthcare professional trained in concussion management.