Mild Traumatic Brain Injury (MTBI)
Physicians can play a key role in helping to prevent mild traumatic brain injury (MTBI or concussion) and in appropriately identifying, diagnosing, and managing it when it does occur. Physicians can also improve patient outcomes when MTBI is suspected or diagnosed by implementing early management and appropriate referral. MTBI symptoms may appear mild, but can lead to significant, life-long impairment affecting an individual's ability to function physically, cognitively, and psychologically. Appropriate diagnosis, referral, and patient and family/caregiver education are critical for helping patients with MTBI achieve optimal recovery and to reduce or avoid significant sequelae.
The Heads Up! tool kit was developed to provide physicians with a more individualized assessment of MTBI and to help guide the management and recovery of patients with MTBI.
The tool kit includes:
- A patient assessment tool, titled "Acute Concussion Evaluation;"
- An information sheet for patients who recently sustained a concussion, titled "Acute Concussion Evaluation Care Plan (work and school versions);"
- A palm card with information about the on-field management of concussion, titled "Concussion in Sports;"
- A general fact sheet for patients, titled, "Heads Up: Preventing Concussion (in English and Spanish);" and
- A CD-ROM with downloadable tool kit materials and additional resources.
Definition of Mild Traumatic Brain Injury (MTBI)
The term mild traumatic brain injury (MTBI) is used interchangeably with the term concussion. An MTBI or concussion is defined as a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. MTBI is caused by a blow or jolt to the head that disrupts the function of the brain. This disturbance of brain function is typically associated with normal structural neuroimaging findings (i.e., CT scan, MRI). MTBI results in a constellation of physical, cognitive, emotional and/or sleep-related symptoms and may or may not involve a loss of consciousness (LOC). Duration of symptoms is highly variable and may last from several minutes to days, weeks, months, or even longer in some cases.1,2
Magnitude of TBI and MTBI
- An estimated 75%-90% of the 1.4 million traumatic brain injury (TBI)-related deaths, hospitalizations, and emergency department visits that occur each year are concussions or other forms of MTBI.3-6
- Approximately 1.6 - 3.8 million sportsand recreation-related TBIs occur in the United States each year.7 Most of these are MTBIs that are not treated in a hospital or emergency department.
- Blasts are an important cause of MTBI among military personnel in war zones.8
- Direct medical costs and indirect costs such as lost productivity from MTBI totaled an estimated $12 billion in the United States in 2000.9
- Individuals with a history of concussion are at an increased risk of sustaining a subsequent concussion.10
- Duration of symptoms is highly variable and may last from several minutes to days, weeks, months, or even longer in some cases. Research shows that recovery time may be longer for children and adolescents.11,12
- Symptoms or deficits that continue beyond three months may be a sign of post-concussion syndrome.13 (See the list of common signs and symptoms of MTBI.)
- With proper diagnosis and management, most patients with MTBI recover fully.14,15
- Motor vehicle trauma;
- Unintentionally struck by/against events;
- Assaults; and
- Infants and children (ages 0 to 4);
- Children and young adults (ages 5 to 24); and
- Older adults (ages 75 or older).
Leading causes of MTBI (seen in emergency departments)16
Groups at highest risk for MTBI16
Neuropathophysiology of MTBI
Unlike more severe TBIs, the disturbance of brain function from MTBI is related more to dysfunction of brain metabolism rather than to structural injury or damage. The current understanding of the underlying pathology of MTBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events. Clinical signs and symptoms of MTBI such as poor memory, speed of processing, fatigue, and dizziness result from this underlying neurometabolic cascade.17
Become an ImPACT® Client:
One of the keys to ImPACT's approach to concussion management is to compare an athlete's post-concussive performance and symptoms to a baseline (pre-concussion) level for that athlete. In order to do this, athletes must take a baseline ImPACT measurement prior to sustaining a concussion.
Typically, this can be done with a 20-minute online test at the beginning of preseason training or even a few months prior to season training. This user-friendly computer program can be administered by a coach, athletic trainer or physician with minimal training. It is important to have athletes complete the ImPACT test before they start any type of contact that might result in a concussion (e.g., drills, scrimmages, etc.). The online test is designed to measure cognitive functions, including: attention span, working memory, non-verbal problem solving and reaction time.
More About ImPACT®
Headquartered in Pittsburgh, Pennsylvania, ImPACT Applications, Inc., is a provider of computerized neurocognitive assessment tools and services that are used by medical professionals to assist them in determining an athlete's fitness to return to play after suffering a concussion. At the current time, ImPACT is being used for concussion management services at more than 1,000 high schools, colleges, sports medicine centers, and professional teams throughout the world.