|
Management
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).2, 8 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.2
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:2, 8
- 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, occupational/vocational, or adaptive strategy training;
- Providing copies of the enclosed patient materials,
Heads Up: Preventing Brain Injury and Facts about Concussion and Brain
Injury, when appropriate.
More detailed information about clinical management of patients with MTBI can be found
in the resources of this brain injury tool kit, including several journal publications and a 1998 National Institutes of Health
(NIH) Consensus Development Conference Statement outlining approaches to recovery and rehabilitation for the full spectrum of traumatic brain injuries,
available on the NIH
website.
For in-depth information about treating children, physicians can refer to the 1999 recommendations of the American Academy Family Physicians and the American Academy of Pediatrics
(AAP), available on the AAP
website. Encourage parents to be vigilant in observing small children who may have sustained even a slight bump on the head, and instruct them about signs and symptoms to watch
for.2
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:12
- Returning to high-risk sports participation (i.e., horseback riding, snowboarding, skiing, roller blading, cycling);
- Driving a motor vehicle; and
- 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. The
Management of Concussion in Sports palm card provided in this brain injury tool kit may be suitable for sharing with school and coaching personnel.
|
