Mild Traumatic Brain Injury Information

What is Mild Traumatic Brain Injury?

"It is a good idea to consult an attorney very soon after injury. Even if there are no grounds for a lawsuit, an attorney who knows about disability can set a course to ensure all avenues are explored, evidence is preserved, medical and public records are collected, and appropriate benefits are available when necessary. He or she will review all insurance policies in force at the time of injury, including auto and homeowners policies, to identify all possible funds to support medical and rehabilitation needs. He or she can also help you make plans for the future."

Carolyn Rocchio,
nationally recognized advocate, author and speaker
in the field of brain injury.

Traumatic brain injury is frequently referred to as the silent epidemic because the problems that result from it often are not visible. These injuries may cause long-term or permanent impairments and disabilities. Many people with mild traumatic brain injuries have difficulty returning to routine, daily activities and may be unable to return to work for many weeks or months. In addition to the human toll of these injuries, mild traumatic brain injuries cost the nation nearly $17 billion each year, according to the Report to Congress on Mild Traumatic Brain Injury in the United States.

According to the Centers for Disease Control and Prevention, each year in the United States approximately 1.5 million Americans sustain traumatic brain injuries, ranging from mild to severe. As many as 75 percent of all brain-injured people sustain mild traumatic brain injuries. An unknown proportion of those who are not hospitalized may experience long-term problems, such as:

Persistent headache
Confusion
Pain
Cognitive and/or memory problems
Fatigue
Changes in sleep patterns
Mood changes
Sensory problems such as changes in vision or hearing (post-concussion syndrome).

Approximately 30 percent of mild traumatic brain injuries (MTBI) will develop disabling symptoms at three months after the injury from post-concussive syndrome, which is a set of symptoms that a person may experience for weeks, months, or occasionally years after a mild traumatic brain injury. Up to 15 percent of those who suffer mild traumatic brain injuries will continue to be disabled at one year. Another report suggests 50 percent of patients with mild traumatic brain injury suffer from post-concussive syndrome.

Despite the prevalence and impact of mild traumatic brain injury, little is known about how it affects nerve cells and connections in the brain, and therefore clinical outcomes after injury.

Definitions for Mild Traumatic Brain Injury

In a report to Congress in September 2003, the Centers for Disease Control and Preventional conceptual definition of mild traumatic brain injury is an injury to the head as a result of blunt trauma or acceleration or deceleration forces that result in one or more of the following conditions:

Any period of observed or self-reported:

Transient confusion, disorientation, or impaired consciousness;

Dysfunction of memory around the time of injury;

Loss of consciousness lasting less than 30 minutes.

Observed signs of neurological or neuropsychological dysfunction, such as:

Seizures acutely following injury to the head;

Among infants and very young children: irritability, lethargy, or vomiting following head injury;

Symptoms among older children and adults such as headache, dizziness, irritability, fatigue or poor concentration, when identified soon after injury, can be used to support the diagnosis of mild traumatic brain injury, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness. Research may provide additional guidance in this area.

Earlier Definitions of Mild Traumatic Brain Injury
In 1993, the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine (ACRM) defined Mild Traumatic Brain Injury.

Patients with mild traumatic brain injury experienced a traumatically induced physiological disruption of brain function as manifested by at least one of the following:

Any loss of consciousness
Any loss of memory for events immediately before or after the accident
Feeling dazed, disoriented of confused at the time of the accident
A focal neurological deficit -- a problem in brain function -- that may or may not be transient, but where the severity of the injury does not exceed the following:

Post-traumatic amnesia not greater than 24 hours
After 30 minutes, an initial Glasgow Coma Scale of 13-15
Loss of consciousness of 30 minutes or less.

The trauma that causes the injury can be the head being struck, the head striking an object or whiplash -- sudden acceleration and deceleration.

The definition acknowledges that CT scans; MRI, EEG, or routine neurological evaluations may be normal. And the definition also recognizes that due to inadequacies of some medical systems some of the above factors are not documented during the acute phase.

The definition does not include strokes, anoxia, tumors, encephalitis, or other such conditions.

"Early MTBI symptoms may appear mild, but they can lead to significant, life-long impairment in an individual’s ability to function physically, cognitively, and psychologically."

Centers for Disease Control and Prevention

In 2004, a comprehensive review of the literature on mild traumatic brain injury was published in the Journal of Rehabilitation Medicine. The World Health Organization Collaborating Center Task Force on Mild Traumatic Brain Injury provided the following definition:

Mild traumatic brain injury is an acute brain injury resulting from mechanical energy to the head from external physical forces. Operational criteria for clinical identification include

One or more of the following: confusion or disorientation, loss of consciousness for 30 minutes or less, post-traumatic amnesia for less then 24 hours, and/or other transient neurologic abnormalities such as focal signs, seizure, and intracranial lesion not requiring surgery

Glasgow Coma Scale score of 13 to 15 at 30 minutes post-injury or later upon presentation for health care.

These manifestations of mild traumatic brain injury must not be due to drugs, alcohol, medication, other injuries (eg, systemic injuries or intubation), other problems (eg, psychologic trauma, language barrier, or coexisting medical conditions), or penetrating craniocerebral injury.

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