Traumatic Brain Injuries: Patient Outcomes
Outcomes for moderate to severe TBIs are usually guarded at best and normally tethered to factors such as patient age, initial clinical findings using rating scales, motor function deficits, and computed tomography (CT) or magnetic resonance imaging (MRI) evidence of brain injury (e.g., subarachnoid hemorrhage, microhemorrhages, midline shift, etc.). However, neuropsychological/neuropsychiatric testing is often used, and normally necessary, to diagnose and document evidence of neurocognitive trauma. Neuropsychological/neuropsychiatric tests are based on the ability of patients to perform specific tasks used to measure a psychological function linked to a particular brain structure or pathway, which cannot be observed via brain imaging. In fact, such tests are virtually required to diagnose residual effects from most mild TBIs.
One commonly administered neuropsychological test is the Trail Making Test of visual attention and task switching, which consists of two parts where the patient is instructed to connect a set of 25 dots as quickly as possible with the goal of maintaining accuracy. Below is part of a sample:
The test can assess visual search speed and especially the executive functioning which is tied into the frontal lobe of the brain. Poor performance is associated with many types of brain impairment.
Symptoms caused by mild traumatic brain injuries generally resolve within a few weeks or months. Behavioral symptoms, if present, are usually most prominent immediately after a patient sustains a mild traumatic brain injury but typically resolve soon thereafter. However, some mild traumatic brain injury patients demonstrate persistent cognitive, behavioral, and psychological symptoms, including irritability, fatigability, depression, anxiety, hostility or apathy. In fact, even mild traumatic brain injuries can cause prolonged or incomplete recoveries especially in older adults (over age 40). Accordingly, if such symptoms persist, then further diagnostic testing is warranted, which could result in the diagnosis of a more significant brain injury.