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Nathan D. Zasler
and
Michael F. Martelli

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.

in AMA Guides® Newsletter
Nathan D. Zasler
,
Michael F. Martelli
, and
Mark C. Bender

Abstract

Traumatic brain injury (TBI) usually is described in terms of the severity of the initial neurologic insult and is defined by the Glasgow Coma Scale (GCS) score; the presence and duration of amnesia (retrograde and anterograde); and the presence and duration of alteration in or loss of consciousness. According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the evaluating physician should consider the following: narrative history; most recent clinical evaluation; assessment of current clinical status; plans for future treatment; diagnosis and clinical impressions; and estimated time for full or partial recovery. Individuals who present with brain disease or damage also may experience impairments in several parts of the body or nervous system. Physicians who evaluate TBI must be familiar with numerous relevant sections in Chapter 13, The Central and Peripheral Nervous System, as shown in a table in the article. Individual impairments can be combined using the Combined Values Chart in the AMA Guides. Also, the AMA Guides requires the examiner to grade mental status impairment based on the individual's ability to perform activities of daily living and may require neuropsychological testing. The evaluation of TBI impairment and disability is by no means a simple undertaking for any clinician, and evaluators must familiarize themselves with disability and impairment evaluation protocols and their limitations.

in AMA Guides® Newsletter