BINSA Information on Mild Traumatic Brain Injury

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1 Mild traumatic brain injuries (MTBI) occur through sporting, car and workplace accidents. Mild brain injury is not easily diagnosed. This fact sheet explains how it may be recognised and assessed, and the chances of recovery. Diagnosing Mild Traumatic Brain Injury MTBI) Undiagnosed Injury Many people with a mild traumatic brain injury do not come into contact with a hospital. In an emergency department, the subtlety of the symptoms may sometimes cause the condition to go undiagnosed, particularly if there are other more obvious injuries such as fractures. The patient may be sent home with a list of possible early complications to watch out for and are advised to return to the hospital if they become evident. For many people, the condition may then go undiagnosed until they seek help for what have become bewildering problems and changes in behaviour. Concussion and Mild Traumatic Brain Injury (MTBI) The traditional definition of concussion describes an injury with transient effects (i.e. without permanent brain damage). In recent years however, it has been suggested that concussive injury may result in microscopic damage to the brain. Neuropsychological research has indicated that in some cases of concussive injury in motor vehicle accidents, residual problems with attention and speed of thinking may be experienced. Problems may emerge later. Sometimes problems become more evident when the person returns work or study. This is particularly noticeable in activities requiring concentration, dealing with large amounts of information, decisionmaking and planning. Page 1 of 5

2 Compensation The person with a mild traumatic brain injury (MTBI) may not be diagnosed at the time of the injury. As a result, the causal link to the injury may not be established and it may be classified as non-compensable. Measuring Brain Injury Post Traumatic Amnesia (PTA) A standard measure of the severity of the injury is the length of time in which the patient has altered consciousness. A period of unconsciousness of less than 30 minutes and PTA of less than 24 hours is typically defined as a mild traumatic brain injury. PTA is the period of time after a loss of consciousness when a person may appear conscious but is confused, disorientated and day to day memory is unreliable. However, as mild traumatic brain injury may not be observed immediately, it may not be possible to reliably establish the length of PTA. Some patients with a mild traumatic brain injury (MTBI) are admitted to hospital and undergo surgery for other injuries. They may be in PTA but this is not recognised and therefore not recorded. Consequently a key symptom of brain injury may go undiagnosed. Types of Mild Traumatic Brain Injury (MTBI) Diffuse Brain Injury A blow to the head leading to temporary loss of consciousness can result in stretching and tearing of nerve fibres diffusely throughout the brain. When the head is hit or shaken violently or strikes something stationary, the mechanical force of the motion is transmitted to the brain. The brain matter moves, twists and rebounds on sudden impact. The fine threadlike Page 2 of 5

3 brain nerves can become stretched, especially in places where rotational forces are likely to produce the most strain. This stretching can temporarily alter the electrochemical functioning of the cells. Most stretched nerve cells will return to normal but some may be permanently damaged, either functioning abnormally or not functioning at all. It is the non-functioning of these cells that causes the loss of a range of abilities, sometimes temporarily, which may be experienced after mild diffuse brain injury. There is evidence that with repeated mild traumatic brain injury (MTBI), the severity of the ability losses (known as deficits) increases, presumably because there is an increase in the number of dysfunctional or non-functional brain cells. These disruptions of nerve processes cannot always be seen microscopically. CT scans and neurological examinations may reveal no damage to the brain that can be localised to a particular region. The symptoms may have an organic basis. The major effects of diffuse mild traumatic brain injury are an overall reduction in a person s capacity to process, integrate and organise information and to recall new information. Focal Brain Injury Focal mild traumatic brain injury (FMTBI) is localised damage to a part of the brain. Focal injury may occur when the brain collides with the inside of the skull, for example, in a motor vehicle accident. Injury can occur around the site of the impact (coupé) or at a site away from the impact (contre-coupé). The frontal and temporal lobes are the regions of the brain which appear to be most vulnerable in motor vehicle accidents. The typical effects of focal brain injury to these areas are deficits in learning, memory, planning, organisation, attention and variable emotional control. Symptoms of Mild Traumatic Brain Injury Mild traumatic brain injury results in cognitive, physical and emotional difficulties. However, there can be a variety of causes for all the symptoms listed below. The best way to establish whether someone has a mild traumatic brain injury is to undergo specialist neuropsychological testing on the advice of a medical practitioner. Page 3 of 5

4 Cognitive Indicators reduced concentration difficulty focusing attention reduced ability to absorb information, and slower processing forgetfulness tiredness from effort planning and decision-making difficulties recent memory affected whilst remote memory is intact reduced capacity to screen out unimportant information difficulty in finding appropriate words Physical Signs headaches hypersensitivity to light (photophobia) sensitivity to noise and to crowded or busy places dizziness and nausea tiredness ringing in the ears reduced co-ordination Emotional Factors emotional irritability reduced emotional control person may be more self-centred If symptoms persist you should seek medical attention. One option is to request an appointment at the neurosurgical clinic at the hospital you attended immediately following the accident. A neurological assessment may be conducted to assess your orientation, the extent of your short-term memory and the extent to which you may have mild traumatic brain injury. You may be admitted for observation if you show persistent symptoms such as sleeplessness or disorientation. Alternatively you could go to your GP and request a referral to a neuropsychologist. The neuropsychologist can conduct a cognitive screening test to establish whether or not you have had mild traumatic brain injury. The test will look at your problem-solving and decision-making abilities, the rate at which you process information, your attention, concentration, memory functioning, balance reaction time and personality changes. The test may take about two hours. Recovery from brain injury is slow compared to recovery from other injuries. In the first six months after injury recovery can be rapid, with slower progress over the next few years. With good support it is common for a person Page 4 of 5

5 with a mild traumatic brain injury to make a full recovery. For those who do not recover function fully, reduced concentration may persist at a level noticeable only to the injured person. The good news about mild traumatic brain injury is that if you manage the symptoms properly there may be minimal long term effects. You can develop strategies for coping with symptoms. For example: if noise is an irritant, then reduce the level of noise in your environment if fatigue affects decision-making, make important decisions when you are fresh if memory is faulty, use a diary and reminder notes Ease your return to work or normal activities by returning for half a day at first. Pace yourself and take rest breaks. Contact the Brain Injury Network of South Australia Inc. (BINSA) for information regarding self-help strategies, peer support groups and advocacy in relation to possible compensation or other issues. Brain Injury Network of South Australia Inc. (BINSA) 70 Light Square Adelaide SA 5000 P F CC E W Page 5 of 5

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