The Evaluation and Treatment of Mild Traumatic Brain Injury

Varney and Roberts’ book is presenting something which is rare indeed – an actual treatment approach to traumatic brain injury and more specifically mild traumatic brain injury. Most books of this kind concentrate on the diagnosis and academic aspects of major brain injuries. This book concentrates on amelioration of minimal brain dysfunction, an area frequently neglected. This is strange since most injuries to the brain are minimal rather than maximal. They cannot be identified on the whole without the use of psychological techniques including tests for memory, both visual and auditory, and otherwise. The authors and those who contributed to the book use the term “mild head injury” (MHI). The former term used was “minimal brain dysfunction” (MBD) or “minimal brain damage” (MBD). The book consists of 23 chapters with an author and subject index following this. The first chapter by Uzzell has an intriguing title “Mild Head Injury: Much Ado About Something”. Mild brain injury has been ignored for many years as of little importance when compared with major damage to the brain. This book points out some of the areas of deficit which occur, often over long periods, if not permanently, due to accidents or injuries suffered by the brain which are hard to identify but nevertheless present. The second chapter covers areas such as the scope of the problem. The next chapter deals with car accidents and the resultant brain injuries often of a minimal type. This is followed by another chapter which concentrates on “low velocity impact”, causing brain injury. Chapter 6 is dedicated to sporting activities and the injuries which frequently result, especially in such competitive sports as football, basketball, boxing and similar activities wherein brain dysfunctions can occur. It is good to see a chapter dealing with post-traumatic anosmia and orbital frontal injury. This frequently results in behavioural as well as cognitive problems. Another chapter deals with neuro-psychiatric evaluations of closed head injuries of the transient type (CHIT). Epilepsy, a common accompanying disorder, is also covered in one of the chapters dealing with mild traumatic brain injury. The important subject of malingering and the use of the MMPI with mild closed injury, is covered by two chapters which follow. A very common result of minimal brain dysfunction is post-traumatic headache and this is covered by Hines. In the treatment approach, pharmacologic approaches as well as other forms of therapy are suggested. The final chapter deals with mild traumatic brain injury in children and adolescents. The book concentrates on evaluation of minimal brain dysfunction but most importantly the problems that such injuries create through certain incapacitating conditions as well as behavioural changes. Facts obtained through research and clinical experience are the basis of the book. The authors Varney and Roberts are well experienced both in the clinical setting and in research papers written on the subject of neuropsychology. Roberts has worked with post-traumatic stress disorders and with human emotional responding or lack of responding in combat-related injuries. Predominant symptoms frequently encountered in those suffering from mild traumatic brain injuries are headache, anxiety, insomnia, dizziness, irritability, memory losses, concentration losses, fatigue, depression and hypo-sexuality as well as alcohol intolerance. Most of the authors acknowledge the fact that maybe some individuals are malingerers but certainly not most of them. There is often little evidence of physical injury but symptoms result from acceleration of head movement and impact of the head on some object. Other reasons for mild head injuries are contusions, Medico-Legal Journal (2000) Vol.68 Part 2, 68-69 Medico-Legal Society 2000 68