Seeing mTBI Through a Different Lens: It's the Start of a Chronic Condition, Not a Single Event

I’ve written about this before.

Symptom improvement after a mTBI (concussion) doesn’t mean that things are ever going back to the status quo.

The brain is permanently impacted. That’s why the risk of a bad outcome after a mTBI is higher if it is not your first.

I’ve compared mTBI to other injuries to try to explain this fact. And I think that’s part of the problem. It’s the wrong reference point.

mTBI isn’t a single event. It’s the start of a chronic condition with future health impacts.

This “disease process” formulation isn’t mine. It’s the product of a group called TRACK TBI, which includes doctors from Harborview and other leading teaching hospitals.

It’s more than nomenclature. It’s key to understanding what the future holds for people who have sustained mTBIs.

TRACK TBI took a longitudinal look at people who suffered mTBIs. Most studies talk about how people are doing at the six month or one year marks. This one followed people for seven years.

The study yielded a lot of data. But—at the risk of over-simplification—the key take-away is that seven years after a mild TBI 26 percent of people have symptoms or functional outcomes that are getting worse (not staying the same or improving).

I’ve made the mistake of thinking and telling people that after a year, most people are as good as they’re going to get. But Statistically that’s correct.

But what it obscures is the fact that over a quarter of the people who suffer mTBIs are actually going to get worse after the first year. If you add that group of people who are getting worse to the people who have persistent but stable symptoms/impairments, it shows that mTBI has a life-long effect on the majority of people who suffer injuries.

Everyone who suffers a mTBI wants to recover. And most people say they’ve recovered.

But for many people, saying that they’ve “recovered” is an expression of (1) optimism bias, (2) challenges perceiving deficits and (3) mistaking adaptation for recovery.

Here’s the URL for the study in case you’re interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437015/