Assessing Mild Traumatic Brain Injury
Nathan D. Zasler
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Michael F. Martelli
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Abstract

Mild traumatic brain injury (MTBI) accounts for approximately 80% of the estimated 373000 traumatic brain injuries that occur annually in the United States. MTBI typically occurs in males 15 to 24 years of age, and postconcussional sequelae may impede physical, emotional, social, marital, vocational, and avocational functioning. Usually the severity of the initial neurologic injury is defined according to the Glasgow Coma Score, the presence and duration of amnesia (retrograde and anterograde), and the alteration of loss of consciousness and its duration. MTBI is a traumatically induced physiological disruption of cerebral function manifested by at least one of the following: loss of consciousness no longer than 20 minutes; any loss of memory; any alteration in mental status at the time of the accident; physical symptoms that potentially are related to the brain; and development of posttraumatic cognitive deficits not accounted for by emotional factors. When a patient presents with multisystem trauma, impairments may involve several parts of the body, including the nervous system. Individual impairments of other systems should be calculated separately and their whole person values combined using the Combined Values Chart in AMA Guides to the Evaluation of Permanent Impairment. At present, no ideal system can rate impairment following MTBI, and physicians must thoroughly understand both the underlying disease process and the associated injuries.

  • 1.

    Kraus JF, McArthur DL. Epidemiology of Brain Injury. Los Angeles: University of California, Los Angeles, Department of Epidemiology. Southern California Injury Prevention Research Center; 1995.

    • Search Google Scholar
    • Export Citation
  • 2.

    Zasler ND. Prognostic indicators in medical rehabilitation of traumatic brain injury: a commentary and review. Arch Phys Med Rehabil. 1997;78:8 (suppl 4),12-16.

    • Search Google Scholar
    • Export Citation
  • 3.

    Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993;8(3);86-87.

    • Search Google Scholar
    • Export Citation
  • 4.

    Williams DH, Levin HS, Eisenberg HM. Mild head injury classification. Neurosurgery. 1990;27:422428.

  • 5.

    Culotta VP, Sementilli ME, Gerold K, Watts CC. Clinicopathological heterogeneity in the classification of mild head injury. Neurosurgery. 1996;38(2).245250.

    • Search Google Scholar
    • Export Citation
  • 6.

    Zasler ND. Physiatric assessment in traumatic brain injury. In: Rosenthal M, Griffith ER, Kreutzer JS, Pentland B (eds). Rehabilitation of the Adult and Child with Traumatic Brain Injury. 3rd ed. Philadelphia, PA: FA. Davis; in press.

    • Search Google Scholar
    • Export Citation
  • 7.

    Dodrill CB. Myths of neuropsychology. Clin Neuropsychol. 1997;11:1-17.

  • 8.

    Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment. Neuropsychological testing of adults. Neurology. 1996;47:592-599.

    • Search Google Scholar
    • Export Citation
  • 9.

    Zasler ND. Neuromedical diagnosis and management of post-concussive disorders. In: Horn LJ and Zasler ND (eds). Medical Rehabilitation of Traumatic Brain Injury. Philadelphia, PA. Hanley and Belfus, Inc; 1996: 133-170.

    • Search Google Scholar
    • Export Citation
  • 10.

    Zasler ND, Martelli MF. MMPI profile differences in persons with and without chronic pain symptoms following presumptive mild TBI. Poster presented at the International Brain Injury Association annual meeting, Seville, Spain, 1997.

    • Search Google Scholar
    • Export Citation
  • 11.

    Packard RC, Ham LP. Impairment rating for post-traumatic headache. Headache. 1993;33:359-364.

  • 12.

    Zasler ND. Impairment and disability evaluation in post-concussive disorders. In: Rizzo M and Tranel D (eds). Head Injury and Post-Concussive Syndrome. New York: Churchill Livingstone; 1996.

    • Search Google Scholar
    • Export Citation
  • 13.

    Martelli MF, Zasler ND, Grayson RL. Forensic evaluation in neurologic disability. In: Shiffman MA (ed). Ethics in Forensic Science and Medicine. New York: John Wiley & Sons; in press.

    • Search Google Scholar
    • Export Citation
  • 14.

    Martelli MF, Zasler ND, MacMillan P. Mediating the relationship between injury, impairment and disability: a vulnerability, stress and coping model of adaptation following brain injury. Neurorehabilitation. 1998;11(1):5166.

    • Search Google Scholar
    • Export Citation
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