What You Need To Know About a “Mild” Traumatic Brain Injury

Concussions are a serious injury, even if they are considered “mild” on the spectrum of brain injury severity. Of the 1.5 million TBIs that occur annually, it is estimated that about 80 percent are mild. This data comes from hospital emergency rooms. Since most people with mild traumatic brain injury (mTBI) consult a primary care physician or seek no care at all in the days after the injury, the incidence of the condition is underdiagnosed.

How are you possibly making your kids’ concussion worse?

A survey by UCLA Health showed that parents are not always listening to medical advice when it comes to dealing with concussions. If a child shows symptoms of a concussion after one week, 77 percent of parents said they are likely to wake their child up throughout the night. Professional advice recommends getting a full night of sleep for a full recovery. Headache, mood, and memory will all be worse without a good night’s sleep.

84 percent of parents said they would make their kids refrain from any physical activity. In reality, a bit of physical activity, if it’s safe, after the first few days is good for recovery.

64 percent said they would take away electronic devices, but remaining social is an important part of recovery from brain injury. It’s good for them to interact with their peers.

Getting the right advice early on reduces your risk may reduce the risk of postconcussion syndrome.

Retrograde and Anterograde Amnesia

Amnesia can be caused by a concussion when a bump to your head or body causes your brain to move around in your skull, causing damage to delicate tissue. The sloshed around neurons in the brain are really fragile, which can lead to post-traumatic amnesia. For more information, see the page “Post-traumatic Amnesia.”

There are two kinds of amnesia that a person can experience, both possible in concussions. Retrograde amnesia is where you forget things in your past. Anterograde amnesia is where you can’t make new memories. The length of amnesia can help doctors understand the severity of brain injury.

What are the outcomes of mTBI?

“The term ‘‘mild’’ continues to be a misnomer for this patient population and underscores the critical need for evolving classification strategies for TBI for targeted therapy…For these patients, mTBI is anything but mild,” says the study “Symptomatology and Functional Outcome in Mild Traumatic Brain Injury” published in the Journal of Neurotrauma.

In this study, at both six and 12 months after mTBI, 82 percent of patients reported at least one postconcussion syndrome symptom. At six and 12 months, 44.5 and 40.3 percent of patients had significantly reduced satisfaction with life scores, respectively. After three months, one-third were functionally impaired. About 20 percent were still below functional status after one year. Functional status was measured by being greater than or equal to seven on the Glasgow Outcome Scale-Extended score, which means either lower good recovery (seven) or upper good recovery (eight).

Another study measured the outcomes of mTBI patients on average six years after the injury. In the study, 33 mTBI patients were matched with 33 healthy controls. The injured individuals had significant impairments in all cognitive domains compared to healthy individuals. The cognitive domains included learning, recall, working memory, attention and executive function.

“Primarily, well-recovered individuals who had sustained a minor trauma more than half a decade ago continue to have long-term cognitive and emotional sequelae relevant for everyday social and professional life,” the study says. See “MTBI Requires Serial Follow-ups” for more information.

What is an mTBI?

A mild traumatic brain injury presents a diagnostic challenge in part because there is no universally agreed upon definition of an mTBI. The American Congress of Rehabilitation Medicine (ACRM) advocated for four specific criteria, and more recently the World Health Organization (WHO) maintained the same four criteria with two modifications.

The ACRM definition is reprinted below.

A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:
1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the
accident;
3. any alteration in mental state at the time of the accident (eg, feeling
dazed, disoriented, or confused); and
4. focal neurological deficit(s) that may or may not be transient;
but where the severity of the injury does not exceed the following:
loss of consciousness of approximately 30 minutes or less;
after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13–15; and
posttraumatic amnesia (PTA) not greater than 24 hours.

The WHO definition agrees but on two points. It drops the word “dazed” from its definition, just including disoriented or confused. The point is to evaluate the confusion or disorientation from the biomechanical force to the head not the emotional shock of a traumatic event. “Dazed” may have been more of an emotional word, which could have been why it was dropped. For more information on identifying confusion, see this page: http://braininjuryhelp.com/confusion-and-amnesia-thing/.

The second difference is that it says “transient neurological abnormalities;” but, the ACRM says the deficits “may or may not be transient.” Since diagnosis should happen right after the injury, doctors may not know whether or not the symptoms are transient or persistent; therefore, the ACRM definition may be more accurate in this case. For more information on mTBI pathology, please visit: http://braininjuryhelp.com/mild-brain-injury-neuropathology/.

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Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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