What are the symptoms and treatment options for Mild Traumatic Brain Injury (mTBI)?

From the Guidelines

Mild traumatic brain injury (mTBI) treatment should focus on nonpharmacological interventions, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and spine, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment, as recommended by the 2021 JAMA Network Open guideline 1.

Key Considerations

• The treatment approach should prioritize physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as symptoms allow.
• Warning signs requiring immediate medical attention include worsening headache, repeated vomiting, increasing confusion, seizures, or unusual behavior.
• Recovery involves limiting screen time, avoiding alcohol, getting adequate sleep, and gradually resuming physical activity under medical guidance.

Nonpharmacological Interventions

• Early information and advice: providing patients with accurate and timely information about their condition and treatment options.
• Graded physical exercise: gradually increasing physical activity to help patients return to normal functioning.
• Vestibular rehabilitation: treating balance and dizziness problems through specialized exercises and therapy.
• Manual treatment of neck and spine: using physical therapy and manipulation to address neck and spine issues.
• Oculomotor vision treatment: treating vision problems related to eye movement and coordination.
• Psychological treatment: addressing emotional and behavioral symptoms through counseling and therapy.
• Interdisciplinary coordinated rehabilitative treatment: a team-based approach to rehabilitation, involving multiple healthcare professionals.

Importance of Proper Rest

• The brain is vulnerable during recovery, and proper rest is essential to allow neural pathways to heal and prevent prolonged symptoms or second impact syndrome from occurring before full recovery.
• Chemical imbalances and energy deficits occur during recovery, making rest crucial for optimal healing.

Guideline Recommendations

• The 2021 JAMA Network Open guideline provides evidence-based recommendations for nonpharmacological interventions in adults with persistent postconcussion symptoms (PPCS) 1.
• The guideline emphasizes the importance of a comprehensive and multidisciplinary approach to treatment, involving healthcare professionals from various specialties.

From the Research

Definition and Symptoms of Mild TBI

• Mild Traumatic Brain Injury (TBI) is associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation 2
• These symptoms usually resolve within 3 months, but 5%-15% of patients are left with chronic symptoms 2

Diagnosis and Management of Mild TBI

• New diagnostic criteria for mild TBI have been developed by the American Congress of Rehabilitation Medicine through the Delphi method to standardize assessment, diagnosis, and treatment 3
• Treatment of mild TBI should be patient-centered and may require subspeciality referral and coordinated, inter-disciplinary, or multi-disciplinary treatment 3
• Cognitive rehabilitation is effective for mild-to-severe injuries and beneficial at any time post-injury, aiming to improve a person's ability to perform cognitive tasks by retraining previously learned skills and teaching compensatory strategies 4

Rehabilitation and Recovery

• Cognitive rehabilitation begins with a thorough neuropsychological assessment to identify cognitive strengths and weaknesses and the degree of change in cognitive ability following a brain injury 4
• Key rehabilitation recommendations include education, physical rehabilitation, integrated computer-based management, repetitive task-specific practice in daily living activities, safe equipment usage, cognitive/behavioral feedback, compensatory memory/visual strategies, swallowing/communication, and psychological input for TBI survivors 5
• A self-help website for patients with mild TBI has been developed, based on neurorehabilitative and cognitive behavioural therapy principles, offering information, tips and tools to guide recovery: www.headinjurysymptoms.org 2