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Industry: Email Alert RSS FeedMild traumatic brain injury in persons with multiple trauma: the problem of delayed diagnosis
Journal of Rehabilitation, Jan-March, 1997 by Andrea D. Clements
The primary concern resulting from the findings of this study is that initial diagnosis of MTBI seems to lag behind diagnoses in other areas in persons with multiple traumatic injuries. Although there are limits to MTBI treatment, just an understanding of the origin of new deficits, and a physical rather than purely psychological explanation, can be comforting. Kay et al. (1992) found that some individuals develop psychological problems after MTBI in response to the frustration and failure they experience because of functional deficits caused by the undiagnosed brain injury. The functional limitations are exacerbated by psychological reaction and result in a more debilitating syndrome than might have otherwise occurred. Earlier diagnosis also enables the person to begin treatment such as cognitive retraining (generally provided by specialized rehabilitation professionals) earlier to regain as much function as possible (Prigatano, 1990; Prigatano & Klonoff, 1990).
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Although a sample of three is quite small, the consistency among cases and with previous literature points to an area in need of further investigation. An implication for medical practice in the treatment of persons with traumatic injuries could be that screening for symptoms of MTBI be incorporated into post traumatic diagnostic routines. This could be accomplished fairly easily even if treatment for such deficits was not performed in the acute phase after injury. It is important that MTBI not be overlooked as an explanation for ongoing problems experienced by these individuals beyond the acute phase of treatment.
Even if persons with traumatic injuries are not screened for MTBI during the acute stage after sustaining their injury(ies), they will often have contact with rehabilitation professionals before they leave the healthcare system entirely. In the process of post traumatic rehabilitation, rehabilitation professionals could incorporate a brief MTBI screening instrument into the intake process, or include a neuropsychological evaluation into whatever assessment battery is performed. Rehabilitation professionals are in the unique position of being able to catch those cases of MTBI that have filtered through the system without being identified.
References
Alves, W., Macciocchi S. N., & Barth, J. T. (1993). Postconcussive symptoms after uncomplicated mild head injury. Journal of Head Injury Rehabilitation. 8, 48-59.
Bigler, E. D. (1990). Neuropathology of traumatic brain injury. In Traumatic Brain Injury: Mechanisms of Damage. Assessment. Intervention. and Outcome pp. 13-50. Edited by Erin D. Bigler. Austin, TX: Pro-Ed.
Bigler, E. D. (1987). Neuropathy of acquired cerebral trauma. Journal of Learning Disabilities. 20, 458-473.
Brown, S. J., Fann, J. R., & Grant, I. (1994). Postconcussional disorder: Time to acknowledge a common source of neurobehavioral morbidity. The Journal of Neuropsychiatry. and Clinical Neurosciences. 6, 15-22.
Cullum, C. M., Kuck, J., & Ruff, R. M. (1990). Neuropsychological assessment of traumatic brain injury in adults. In Traumatic Brain Injury: Mechanisms of Damage. Assessment. Intervention. and Outcome pp. 129-164. Edited by Erin D. Bigler. Austin, TX: Pro-Ed.
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