What Constitutes a “Mild” Traumatic Brain Injury?

Traumatic brain injuries (TBIs) are all potentially serious and usually require rehabilitation or specialized rehabilitation at some time on the recovery continuum of care. They can have far-reaching implications and effects upon an individual’s independence. However, distinctions are made between and among them. The distinctions are based, in part, upon causation, whether they are open- or closed-head injuries, whether they result in loss of consciousness (and if so, for how long) and upon various objective measures.

An individual who is said to have sustained a “mild” traumatic brain injury (MBTI) may experience all, some or none of the following:

• Brief loss of consciousness, usually measured in seconds, but sometimes in minutes;
• Sense of being dazed or confused;
• Either a normal or somewhat abnormal brain scan.

A diagnosis of a “mild” traumatic brain injury is typically made when there has been a change in mental status, such as when the individual is dazed, confused or loses consciousness. Often, this mild form of traumatic brain injury is called a “concussion.” Although characterized as “mild” a traumatic brain injury of this type may be attended by physiological and related changes to the brain and to other structures of one or more of the following types:

• Because a concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change, the blood vessels in the brain may stretch and cranial nerves may be damaged;
• A concussion may have discernable physical consequences, some to such a degree as to be disclosed on a CAT scan;
• There may be a brief loss of consciousness;
• There may or may not be a fracture of the skull;
• A concussion can cause diffuse axonal injury resulting in temporary or permanent brain damage.
• It may take several months for a concussion to heal. Although the concussion is seemingly minor, the after-effects of this type of trauma may necessitate clinically relevant services geared toward rehabilitation in order to achieve the best possible outcome for the individual[1].

The “dazed” element of the diagnosis is usually made immediately upon first contact by medical personnel with the individual. However, there are other, more objective measures that are used in the traumatic brain injury assessment that allow for the creation of a Client Goal Plan and the implementation of clinically relevant services. One of the measures that may be appropriate is the Glasgow Coma Scale (GCS). It is a well-known and widely used scoring system that is used to measure and to evaluate the consciousness of a person who has sustained a traumatic brain injury. It is one of several scales that are utilized for essentially the same purposes: to evaluate coma for rapid hospital assessment and triage, disease severity, and for the prognosis of morbidity and mortality.

GCS scoring is a numerical evaluation based on a score 3–15. It consists of three parameters: eye response, verbal response and motor response. In turn, the parameters are individually scored and the scores are added. The parameters are as follows:

• Eye Response. Within this parameter, four scorings are possible:

1. No eye opening;
2. Eye opening in response to pain;
3. Eye opening to verbal command; and
4. Eyes open spontaneously.

• Verbal Response. Within this parameter, five scorings are possible:

1. No verbal response;
2. Incomprehensible sounds;
3. Inappropriate words;
4. Confused; and
5. Oriented.

• Motor Response. Within this parameter, six scorings are possible:

1. No motor response;
2. Extension to pain. This is sometimes called “decerebrate posture.” It is evidenced by rigidity, arms and legs held straight out, toes pointed downward and the head and neck arched backward;
3. Flexion to pain. This is sometimes called “decorticate posture” which is evidenced by rigidity, clenched fists, legs held straight out and arms bent inward toward the body, with the wrists and fingers bent and held on the chest;
4. Withdrawal from pain;
5. Localizing pain; and
6. Obeys commands.

A score of 13 or higher on the Glasgow Coma Scale is considered to be indicative of a mild traumatic brain injury.

Even if the traumatic brain injury is considered to be “mild,” it can have long-term implications. Researchers at the University of Glasgow studied more than 2,000 individuals who sustained mild traumatic head injuries. While the incidence of early death of those who had had severe head injuries was already well known, the researchers found that there was also a higher incidence of early death in the group who had mild injuries. Specifically, they found that those who sustained mild head injuries died at the rate of 2.45% per year rate, those with non-head injuries died at the rate of 1.96% per year. Overall, the community’s rate of death was 1.34% per year. This suggests that even those with so-called “mild” traumatic brain injuries have difficult and challenging diagnoses that require post-acute care and a plethora of clinically relevant services such as those provided by NeuLife[2].

The professionals at NeuLife, including its team of psychologists, psychiatrists neurologists, RNs and therapists are expert in the provision of innovative, clinically relevant services, including the creation of a Client Goal Plan and delivery of neurobehavioral and neurorehabilitative services. NeuLife’s goal is to provide post-acute rehabilitation to its clients to achieve the best possible outcome for those who have even the most difficult and challenging diagnoses.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve maximized, sustained outcomes that exceed the expectations of all persons served. 

NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] Brain Injury Alliance Utah, http://biau.org/types-and-levels-of-brain-injury/

[2] Journal of Neurology, Neurosurgery and Psychiatry, online March 12, 2014; www.reuters.com/article/2014//03/28/us-head-injuries-idUSBREA2RIV820140328