Managing and Treating Mild Traumatic Brain Injury
Clinical Management of MTBI
Because the effects of MTBI can be so diverse, no standard treatment exists. But physicians can take many actions to improve outcomes for patients with MTBI. Treatment outcome is dependent on the appropriate diagnosis of factors potentially responsible for persistent symptoms such as psychiatric problems and post-injury conditions (for example, post-traumatic migraine among persons with family history of migraine). Management of patients with MTBI may include a spectrum of approaches, beginning with patient and family education and possibly encompassing medical treatment, physical-psychiatric therapies and occupational interventions.
Soliciting the Right Information from Patients
Following these tips will help you solicit information to make an accurate diagnosis and ensure an effective treatment and recovery.
- Observe the patient closely to check for physical, cognitive or behavioral changes that might signal MTBI.
- Question your patient and/or the caregiver closely. When possible, ask questions to elicit more details about the injury, such as "Tell me about," or "Describe."
- Listen carefully for information the patient or caregiver may give you about difficulties in physical, cognitive or behavioral status.
- Provide additional printed information to patients about the condition and expectations, appropriate referrals and available community resources.
- Write out clear instructions for the patient and/or caregiver to take home and, as appropriate, to share with workplace supervisors or school staff.
- Refer patients to physicians who specialize in brain injury, as necessary.
- Steer patients to available community resources that may provide additional support.
- Follow up with patients to ensure that any MTBI-related problems are addressed in a timely fashion. Flag charts or otherwise make note of the need to follow individuals who have possible MTBIs.
Management Approaches
Consideration of physical, emotional and/or behavioral signs and symptoms will guide management plans. Those plans may include some or all of the following approaches:
- Evaluating and treating patients who present early for somatic complaints and documenting baseline neurological findings, including cognitive and emotional state
- Assessing the ability of the patient to return to everyday activities, such as sports, work or operating motor vehicles
- Educating patients and their families about the treatment plan and expected outcomes
- Prescribing medication, as appropriate, for significant anxiety or depression
- Referring patients, as appropriate, to neurologists and/or psychiatrists when emotional or cognitive symptoms interfere with normal routines and relationships
- Referring patients to specialized multidisciplinary cognitive therapy programs, as appropriate. Such programs may include psychotherapy, neuropsychologist/neuro psych testing, occupational/vocational or adaptive strategy training
Preventing Secondary Injury
MTBI is associated with diminished reaction time and risk for secondary injury. Providing written instructions on a patient's discharge sheet regarding timing for return to regular and high-risk activities may help prevent this type of injury, especially in regard to the following:
- Returning to high-risk sports participation (i.e., horseback riding, snowboarding, skiing, roller blading, cycling)
- Driving a motor vehicle
- Operating machinery
Written instructions also may be used by families to provide information to teachers and coaches of children and young adults in school and college settings.