Mild Traumatic Brain Injury (MTBI)

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Mild Traumatic Brain Injury Articles

	Vestibular Dysfunction in Acute Traumatic Brain Injury J Neurol 2019 (Oct); 266 (10): 2430–2433 ~ FULL TEXT Central and peripheral vestibular dysfunction — often in combination — is common in acute TBI. Prospective studies are required to assess whether acute intervention improves patient outcomes.
	Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification J Chiropractic Medicine 2015 (Sep); 14 (3): 169–175 ~ FULL TEXT This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the SCAT3 as a sideline assessment tool. Manual therapy is considered by many chiropractors to be an appropriate treatment for concussion patients. Future research on concussion management is needed to understand the efficacy of manual therapies as components of multidisciplinary concussion management strategies.
	Management of Mild Traumatic Brain Injury Symptoms in a 31–Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report J Chiropractic Medicine 2015 (Sep); 14 (3): 220–224 ~ FULL TEXT A 31–year-old woman had acute neck pain, headache, dizziness, nausea, tinnitus, difficulty concentrating, and fatigue following a fall. She was diagnosed at an urgent care facility with mTBI immediately following the fall. Pharmaceutical intervention had been ineffective for her symptoms.   The patient was treated with chiropractic adjustments characterized as high velocity, low amplitude thrusts directed to the cervical spine and local acupuncture points in the cervical and cranial regions. The patient received care for a total of 8 visits over 2.5 weeks with resolution of concussive symptoms.
	Beyond the Spine: A New Clinical Research Priority J Can Chiropr Assoc. 2015 (Mar); 59 (1): 6–12 ~ FULL TEXT Over the past two decades, clinical research within the chiropractic profession has focused on the spine and spinal conditions, specifically neck and low back pain. However, there is now a small group of chiropractors with clinical research training that are shifting their focus away from traditional research pursuits towards new and innovative areas. Specifically, these researchers are now delving into areas such as brain injury, work disability prevention, undifferentiated chest pain, hip osteoarthritis, and prevention of pain in children and adolescents to name a few. In this paper, we highlight recent research in these new areas and discuss how clinical research efforts in musculoskeletal areas beyond the spine can benefit patient care and the future of the chiropractic profession.
	A Case Report on the Management of a Patient Presenting With Post-concussion Syndrome and Post-traumatic Stress Disorder, Using the Upper Cervical Chiropractic Technique Topics in Integrative Health Care 2015 (Mar 31); 6 (1) ~ FULL TEXT A 42 year old man presenting with symptoms of post-concussion syndrome, and diagnosed with post-traumatic stress disorder and depression. The Kale Upper Cervical Procedure was utilized to assess, monitor, and correct the effects of an upper cervical subluxation in a patient over an 8 week period. The patient reported significant improvement in symptoms of post- concussion syndrome, and small positive improvements in PTSD symptoms. Follow up at 11 months showed continued improvement in most symptoms.
	Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S132–151 ~ FULL TEXT Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.   Common subjective symptoms after MTBI are not necessarily caused by brain injury per se, but they can be persistent in some patients. Those with more initial complaints and psychological distress recover slower. We need more high-quality research on these issues.
	Population-based, Inception Cohort Study of the Incidence, Course, and Prognosis of Mild Traumatic Brain Injury After Motor Vehicle Collisions Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S278–285 ~ FULL TEXT There are few population-based studies of the incidence, course, and prognosis of MTBI after traffic collisions. This study provides this information. MTBI was found to affect 24% of all injured persons in the population, and recovery took 100 days on average. At 12 months, 23% of the participants viewed themselves as not recovered. Potential prognostic variables included a mix of baseline biopsychosocial factors, including older age, lower education, poor expectations for recovery, depressive symptoms, arm numbness, hearing problems, possible confusion, and pain in the head, mid back, and low back. MTBI is a fairly common consequence of traffic collisions that can occur with other soft-tissue injuries, and it can result in a prolonged recovery.
	Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S286–294 ~ FULL TEXT In this first population-based inception cohort study of individuals who have experienced a mild traumatic brain injury (MTBI) during a car collision, we found a high prevalence of multiple symptoms and pain at several body sites. In addition, care-seeking from multiple providers continued throughout the first year postinjury. Studies investigating how clusters of symptoms interact and affect prognosis are needed. Most urgently however, high-quality clinical trials investigating the effectiveness and cost-effectiveness of the many kinds of treatments given to these patients are needed.
	Development of the 2012 American Chiropractic Board of Sports Physicians Position Statement on Concussion in Athletics J Chiropractic Medicine 2013 (Dec); 12 (4): 269–273 The American Chiropractic Board of Sports Physicians (ACBSP) developed guidelines regarding the management of concussion in sport, recommendations for qualifying DCs to make return-to-play decisions, and clarification of common care pathways pertaining to evaluating and managing concussion in sport.
	Chiropractic Management of Post-concussion Headache and Neck Pain In a Young Athlete and Implications For Return-To-Play Topics in Integrative Health Care 2011 (Oct 7); 2 (3) ~ FULL TEXT Each year there are an estimated 1.6 to 3.8 million sports-related brain injuries; 136,000 of which occur in young athletes in the course of high school sports. The purpose of this article is to discuss the management and outcome of a post-concussive headache and neck pain in a young athlete and implications for return to play.

MTBI Reference Materials

	Consensus Statement on Concussion in Sport - The 5th International Conference on Concussion in Sport Held in Berlin, October 2016 Br J Sports Med. 2017 (Apr 26) [Epub ahead of print] Since the 1970s, clinicians and scientists have begun to distinguish sport-related concussion (SRC) from other causes of concussion and mild traumatic brain injury (mTBI), such as motor vehicle crashes. While this seems like an arbitrary separation from other forms of TBI, which account for 80% of such injuries, [44, 45] it is largely driven by sporting bodies that see the need to have clear and practical guidelines to determine recovery and safe return to play for athletes with an SRC.   In addition, sports participation provides unique opportunities to study SRC and mTBI, given the detailed SRC phenotype data that are typically available in many sports. [46] Having said that, it is critical to understand that the lessons derived from non-sporting mTBI research informs the understanding of SRC (and vice versa), and this arbitrary separation of sporting versus non-sporting TBI should not be viewed as a dichotomous or exclusive view of TBI.
	Updated Mild Traumatic Brain Injury Guideline for Adults Centers for Disease Control and Prevention CDC and the American College of Emergency Physicians (ACEP) convened an expert panel to develop an Updated Mild Traumatic Brain Injury Management Guideline for Adults. This management guideline is based on ACEP’s 2008 Clinical Policy for adult mild traumatic brain injury (MTBI), which revises the previous 2002 Clinical Policy. The policy focuses on identifying neurologically intact patients who have potentially significant intracranial injuries, and identifying patients with risk for prolonged postconcussive symptoms to ensure proper discharge planning.
	Traumatic Brain Injury & Concussion Centers for Disease Control and Prevention CDC defines a traumatic brain injury (TBI) as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Everyone is at risk for a TBI, especially children and older adults. CDC’s research and programs work to prevent TBIs and help people recognize, respond, and recover if a TBI occurs.
	Traumatic Brain Injury The Christopher Reeve Foundation Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.

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Updated 11-23-2022