Recovery from Mild Traumatic Brain Injury in Previously Healthy Adults

Abstract

This prospective longitudinal study reports recovery from mild traumatic brain injury (MTBI) across multiple domains in a carefully selected consecutive sample of 74 previously healthy adults. The patients with MTBI and 40 orthopedic controls (i.e., ankle injuries) completed assessments at 1, 6, and 12 months after injury. Outcome measures included cognition, post-concussion symptoms, depression, traumatic stress, quality of life, satisfaction with life, resilience, and return to work. Patients with MTBI reported more post-concussion symptoms and fatigue than the controls at the beginning of recovery, but by 6 months after injury, did not differ as a group from nonhead injury trauma controls on cognition, fatigue, or mental health, and by 12 months, their level of post-concussion symptoms and quality of life was similar to that of controls. Almost all (96%) patients with MTBI returned to work/normal activities (RTW) within the follow-up of 1 year. A subgroup of those with MTBIs and controls reported mild post-concussion-like symptoms at 1 year. A large percentage of the subgroup who had persistent symptoms had a modifiable psychological risk factor at 1 month (i.e., depression, traumatic stress, and/or low resilience), and at 6 months, they had greater post-concussion symptoms, fatigue, insomnia, traumatic stress, and depression, and worse quality of life. All of the control subjects who had mild post-concussion-like symptoms at 12 months also had a mental health problem (i.e., depression, traumatic stress, or both). This illustrates the importance of providing evidence-supported treatment and rehabilitation services early in the recovery period.

Long-term mental fatigue after traumatic brain injury and impact on employment status

“…Fatigue was also found to uniquely contribute to disability after a TBI, after controlling for injury severity, executive functions, and depression status (17). A prospective longitudinal study with previously healthy adults, showed that most individuals with a mild TBI had returned to work 1 year later, but a sub-group still had difficulties with fatigue, other post-concussion symptoms and depression, and the authors highlight the importance of rehabilitation at an early stage after mild TBI (18).…”

Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion

“…16 This study expounds on previous literature that links depression to chronic illness such as with chronic pain and post-traumatic stress disorder. 46 …”

“…A study of previously healthy adults without psychiatric pre-morbidities at time of study enrollment who sustained mild traumatic brain injury indicated that 62.5% of patients with persistent post-concussive symptoms 1 year after injury had a modifiable psychological risk factor (i.e., depression, possible PTSD, and/or low resilience) at 1 month. 16 Given the frequency of co-occurring mood symptoms, depressive symptoms are commonly included amongst the constellation of post-concussive symptoms. 17 …”

Sports-related concussions — media, science and policy

“…The diagnosis and management of concussion are based primarily on self-report of subjective symptoms, such as headache, irritability and nervousness, many of which are highly prevalent in the general population even in the absence of recent head trauma. The vast majority of patients who sustain a sport-related concussion recover quickly and completely within weeks 14 ; however, a notable minority of patients — as many as 30% in some studies — experience persistent symptoms after concussion, sometimes referred to as ‘post-concussion syndrome’ (REFS 15,16). The cause and neurobiological correlates of these persistent symptoms are not known.…”