Brain injury, revisited

I recently reviewed articles about concussions and other types of brain injuries, and it got me thinking. So, here are some background basics and some takeaways about what to do when a worker’s injury involves a concussion, including vestibular and balance rehabilitation.

Some medical basics

First things first. No matter how mild or severe a concussion is, it's a type of a brain injury. In most cases, the injury is temporary and should resolve.

When traumatized, the brain can become inefficient and inaccurate at performing normal, everyday functions. The results can include headaches, dizziness, difficulty focusing and a “swimmy” or “foggy” feeling and imbalance. There is now an understanding that in true mTBI (mild Traumatic Brain Injury) a neurometabolic cascade occurs. This results in changes in brain metabolism, connectivity and neurotransmission. These all impact a person's ability to return to work. 

Research shows that physiologic impairments coupled with vestibular, vision and cervical deficits can complicate and prolong concussion recovery. Migraines, anxiety and avoidance behaviors can also lead to persistent symptoms. Concussion and vestibular rehabilitation can often completely eliminate or at least significantly reduce symptoms and facilitate a return to work.  

Structural changes or abnormalities noted on CT and MRI can indicate a worse prognosis and slowed/incomplete recovery. Measurable cognitive impairments early on is possible.

We've written a couple of blog posts with more about handling concussions and Traumatic Brain Injury (TBI) from a claims perspective. Here’s one post, and here's another. We identify the “Miserable Minority,” a small percent or subgroup of patients who suffer from chronic, associated complaints or have an unfavorable outcome. 

Recovery from brain trauma

Even a relatively small impact to the head, neck or body can cause a concussion, it's important to note that even though many will recover independently and be symptom-free within two to twelve weeks. However, a small amount of individuals with a concussion will have multiple levels of sensory involvement leading to persistent symptoms. These persistent symptoms typically respond well to a specialized physical therapy program.

A comprehensive treatment approach can optimally address persistent symptoms and help an injured worker with functional and work-related task training.

Do's and don'ts

Here are a few top issues it's important to flag…

●    The vast majority of mTBI patients exhibit a gradual and full recovery.

●    In uncomplicated mTBI, lingering complaints and delayed recovery can be associated with non-injury influences such as demographic, motivational, underlying psychosocial and medical factors. Exaggerated symptoms should be ruled out in persistent cases as again the influences may be multifactorial.

●    Amnesia and brief unconsciousness is not necessarily a true predictor of outcomes and recovery time for mTBI.

Finally, recovery and rehab should be focused on a wide variety of resources in an effort to maximize worker and patient outcomes.

KARI