Treatment

Lt Col Reynolds
Because mild TBI has become known as one of the “signature wounds” of recent overseas conflicts, medical personnel at field hospitals are more aware of the symptoms of traumatic brain injury and the value of early battlefield assessment and treatment. If the injury is recognized and treated early, most patients can recover normal or near normal brain function. The earlier a mild TBI is diagnosed, the sooner proper medical treatment can begin. Dr. Green, can you tell us more about the treatment plan for a mild TBI?

Dr. Green
Of course, Dr. Reynolds. Treatment of mild TBI or concussion is symptom-based, meaning that a provider will recommend a treatment solution for each TBI symptom, such as headaches or sleep disturbance. Other aspects of treatment include:

• Providing the patient and their family with information about the symptoms and expectations of recovery
• Education on preventing further injuries, and
• Guidance about sleep hygiene, relaxation techniques, monitoring progress, and returning to duty

Providers may prescribe medications to address some symptoms of mild TBI. They might also make the following suggestions:

• Get plenty of downtime and rest, including a mandatory 24-hour rest period immediately following the injury
• Get sufficient sleep at night, which for most people is six to eight hours
• Stay well hydrated by drinking plenty of water
• Avoid alcohol, tobacco, and caffeine
• Talk to a provider before taking any medications or sleep aids 
• Avoid activities that increase risk for another concussion, including contact sports and some military training activities, until symptoms are controlled
• Limit activities that require intense concentration, and
• Stretch to keep the body moving, but avoid physical work such as heavy lifting or exercise until cleared by a provider

In many cases, due to the importance of the unit’s mission, cutting back on duties and “taking it easy” are not possible in a combat setting. However, steps are being taken to make certain that service members get the best possible treatment in theater. This includes medical supervision and monitoring of the patient’s symptoms, and reducing the risk for additional head injury by limiting exposure to common causes of brain injury.

Patients who have no symptoms should be physically tested before returning to duty. This testing may include sit-ups, push-ups, or running in place for five minutes. If the TBI symptoms return after testing, then continued observation and retesting in 24 to 48 hours is suggested. A patient with mild TBI should not return to full duty until all symptoms of the injury are resolved.

In most cases, the brain will fully recover from mild traumatic brain injury in a relatively short timeframe, typically within seven to 10 days. In other cases, full recovery can take up to 30 to 90 days. A second TBI before the brain has recovered completely can cause a snowball effect, making the symptoms worse and the recovery more difficult. For patients whose symptoms persist after 90 days, providers may collaborate with a TBI specialist and case manager for continuing treatment.