Diagnosis and Treatment for Concussions and Mild Traumatic Brain Injuries

A concussion is defined as a traumatic brain injury (“TBI”) that affects brain function. TBI’s are considered “mild” when there are no skull fractures or brain lacerations.

A recent Journal of the American Medical Association study found that a large proportion of patients with mild traumatic brain injuries do not receive proper follow up treatment.[1]

I often see clients who have headaches, dizziness, lightheadedness, visual and hearing disturbances, emotional distress, and changes in cognitive abilities after a trauma. Some experience confusion and must repeat questions due to processing delays and memory deficits. Some have delayed speech and word finding capacity. Others forget phone numbers, names, and even faces. Concentration deficits and increased irritability can lead to anxiety and depression. Concussion symptoms can be subtle and sometimes take time to manifest.

Many clients hit their heads into a stationary object during motor vehicle accidents or falls. With whiplash injuries, however, the brain can be damaged even if an individual’s head does not come into contact with an object. With a sudden acceleration and deceleration movement, the brain impacts the skull. An analogy is shaking a tomato in a glass jar. Just as the tomato can become bruised, brain tissue can be damaged on a cellular and chemical level.

Severe brain damage and bleeding on the brain is easily detectable with CT scans, MRI’s, the Glasgow Coma Scale, and other testing. When individuals sustain a milder trauma, it is sometimes overlooked and often challenging for clients to receive proper medical care.

The IMPACT (Immediate Post-Concussion Assessment and Cognitive Test) test is widely used for student athletes. It was approved by the FDA and released for use in the early 2000s. Individuals take a 25 minute computerized test that measures attention, processing speed, verbal and visual memory, visual motor speed, and multi-tasking ability. Many student athletes complete a baseline test prior to any injury, which can then be compared to new test results to track progress and assist with treatment protocols. Some of my motor vehicle accident clients complete the IMPACT test as well.

Treating physicians should perform clinical motor and neurological exams that test vision, hearing, strength, sensation, balance, coordination, and reflexes. With abnormal findings, clients should be referred to concussion specialists, neurologists, and possibly even vestibular, speech, cognitive, visual, and physical therapists. Compensatory strategies, home therapy, patience, and a gradual return to normal activities are often necessary.

Recent decades have brought greater awareness, better prevention protocols regarding concussions, and medical advancements in diagnosing and treating concussions. The earlier the diagnosis and treatment, the better the outcome for the patient.

[1] Seth A. Seabury, PhD, et al., Assessment of Follow-Up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion, (JAMA Network Open. 2018; 1(1):e180210.doi:10.1001/jamanetworkopen.2018.0210).