Mild Traumatic Brain Injury (MTBI)

The symptoms of mild traumatic brain injury are very difficult to detect and is often unrecognized by conventional MRI, CAT scan, or other tomographic diagnostic tools. Therefore, it is particularly important to assess for this condition by looking at behavior. The symptoms of MTBI generally fall into four major categories that involve cognitive, perceptual, physical, and behavioral/emotional symptomatology or behavior. When the person experiences mild head injury, the symptoms might be so obscure or minimal and they can be very easily go unnoticed by the patients themselves.  The following symptoms are associated with the four mentioned categories. 

They are as follows.

1.       Difficulty in processing information.
2.       Shortened attention span.
3.       Impaired decision-making ability.
4.       Inability to shift tasks or multitask.
5.       Following multi step directions.
6.       Mild memory loss or impairment.
7.       Dysnomia (inappropriate word selection).
8.       Changes in vision.
9.       Difficult with spatial arrangements.
10.     Difficulty with organizing, planning, and scheduling.
11.     Disorders of taste or smell.
12.     Altered balance.
13.     Persistent headaches.
14.     Poor focus of concentration.
15.     Sensitivity to light.
16.     Sleep impairment.
17.     Extreme mental or physical fatigue.
18.     Irritability.
19.     Low tolerance for stress.
20.     Isolation.
21.     Dependent on others for activities of daily living.
22.     General lack of motivation.

When assessing for MTBI, the patient is asked a series of questions. According to the response of these questions, the therapist is able to look at the four lobes of the brain functioning. The four lobes are frontal, occipital, temporal, and parietal.  Each brain lobe is responsible for specific functioning of behavior within the body/mind. Therefore when we assess for behaviors, we can see directly any symptoms that have a deficit. As you locate the symptoms, they can be matched with the appropriate behavior functioning of a specific brain lobe. For eg:  A person who has a mild head injury might be having difficulty with numbers or mathematic skills.

As we assess for behavior in these categories of numbers and mathematical skills, we could say that there is a possibility of the parietal lobe being compromised resulting in a decreased functioning level, while behaviors are governed by the parietal lobe. If a person has difficulty organizing and planning, balancing their moods, having emotional outbursts after a mild head injury, we can say that these symptoms are correlated with the part of the brain that governs the functioning level of those appropriate behaviors. 

So as we search behaviors, deficits begin to become apparent, which would lead to a general conclusion of which part of the head was compromised in a mild head injury. One does not have to have an object hit to the head directly. There is an indirect axonal injury. This is generally caused by the impact of “whiplash like movement of the head” causing the brain to accelerate or decelerate in the direction causing it to hit the interior part of the skull. 

The result can cause any of the four lobes to be compromised in terms of level of functioning and behaviors.  When the brain is exposed for mild head injury, there is tearing, fraying, and twisting of the brain fibers. These fibers are so small that they are not seen by a typical x-ray, CAT scan, or MRI.  We can tell the damages by locating the deficits and behaviors.  For eg: When a person has experienced a slip and fall auto accident they often feel that their thoughts are unclear and have many of the above symptoms. 

This can be caused by even a 5 mile an hour bump or fender bender car accident. If a person experiences a whiplash like movement, there occurs a counter-coo movement, which is responsible for the brain accelerating forward and coming backwards with a deceleration hitting both frontal and parietal lobe to the inside of the skull. In addition to the cognitive effects of mild head injury, there is always the addition of emotional. 

A person can experience anxiety, depression, or panic attacks due to the trauma or event that caused the head injury. According the VSM for diagnostic criteria manual written by the American Psychiatric Association under the diagnostic code of 310.1 Personality Change due to a generalized medical condition. When the person meets the emotional criteria of disturbance evidenced by history, physical, as well as psychiatric mental status examination, we can say that we have met the expected ratio of categories in the VSM manual diagnosing their personality change or anxiety due to any medical condition. 

There are several conditions on codes of 293.0 through 293.89 that would involve anxiety, dementia, sleep disorder, sexual dysfunction, anxiety disorder, and mood disorder due to this condition. The patient can be treated both emotionally and cognitively and through biofeedback, hypnotherapy and psychotherapy to alleviate the symptoms.