Predicting Outcome After Mild Traumatic Brain Injury
Assessing the outcome of a concussion or mild traumatic brain injury (mTBI) can be a controversial subject, with the assessment of symptoms being mostly reliant on the patient's self-report. Past research has identified several contributing factors to outcome after mTBI, including prior psychiatric or psychological history, prior concussion, or the extent of social support. Some people who experience an mTBI develop persistent concussion disorder-in which chronic headaches, fatigue, mood changes, and sleep problems persistent for several months after the injury.
The challenge for clinicians is to more accurately predict the factors involved in the long-term outcome after mTBI, so that they can adequately plan, treat, and follow up with those at most risk for developing persistent symptoms. A recent study used the Mayo-Portland Adaptability Inventory-Fourth Edition (MPAI-4) to investigate risk factors associated with mTBI outcome. The MPAI-4 uses both patient and staff ratings of three indices: Participation, Adjustment, and Ability.
The researchers found that patient ratings for Adaptability were lower than the ratings given by staff, at both the beginning of treatment and at discharge. When determining predictor factors for rating scores, they found that patients having a history of psychiatric illness were more likely to rate themselves low in Adjustment. Additionally, patients with higher Trail Making Test Part B scores were more likely to rate themselves higher in Ability.
By assessing both patient and staff scores across three different indices, clinicians can better determine the self-perceptions of the patient and the factors that might influence recovery.
Leininger S, Strong C-A, Donders J, et al. Predictors of outcome after treatment of mild traumatic brain injury: A pilot study. Journal of Head Trauma Rehabilitation. (April 2014).