Traumatic Brain Injury: Advances in Treatment and Care

Traumatic brain injury (TBI) has been described as one of the most complex and heterogenous conditions affecting the most complex organ in the body. There is no way we can address everything clinicians and scientists need to know in this issue, but we’ve put together an exciting list of topics covering key areas.

In children and adolescents, TBI is among the most common causes of death, severe disability, and emergency department care. In their article, Drs. Friess, Hartman, and Giza present an overview of Pediatric TBI, including epidemiology and management in multiple care settings.

Top of mind for many people when they think of TBI is sports concussion. Drs. Carpenter-Thompson and Kutcher provide a unique perspective in their article, Update on Sport-Related Concussion, from their vantage point at a large, well-established specialty clinic. They point out that there are two distinct questions facing clinicians: the first is triage, the second is diagnosis.

Drs. Albrecht and Gardner provide an expert update on TBI in Older Adults. They point out that older adults have the highest incidence of TBI, and this continues to grow as our population ages. TBI in older adults is mainly due to falls, and the authors provide excellent recommendations for prevention of repeat fall-related injuries as well as other important aspects of care specific to this age group.

Not all forms of TBI involve concussion; severe forms of TBI continue to be far too common. Drs. Ciryam and Badjatia provide a thoughtful review in their article ICU Care for Severe TBI, covering metabolic mismatch, treatment of elevated intracranial pressure, and management of the myriad systemic complications that accompany severe TBI.

After severe TBI, the next step for many is rehabilitation. Drs. Katta-Charles, Ivanhoe, Russell, and Reed present a detailed overview in their article on Inpatient Rehabilitation Following TBI. Inpatient rehabilitation provides at least 15 hours per week of interdisciplinary professional therapies that can benefit individuals with disorders of consciousness as well as those with significant behavioral disturbances.

Next, Dr. Leddy presents an insightful overview in his article Return to School, Work, and Sport after Sport-Related Concussion. He notes that recent studies indicate that prolonged rest after concussion can be harmful and that a supervised progressively increasing aerobic exercise program can reduce the likelihood of prolonged symptoms. Cocooning is definitely “out”, and active management is “in.”

In the decades since the global war on terror began, we have learned a tremendous amount about TBI associated with military service. Drs. Bayuk and Craig provide an overview of Care for Military Service Members with Mild TBI, which includes a discussion of the importance of structured policies and guidelines for acute care. Following up, Drs. French, Brickell, and Lange review the Chronic Effects of TBI in Military Service Members in their article, in which they acknowledge how the combination of TBI, PTSD, pain, and other mental health conditions can make for a level of complexity that can be daunting. Nonetheless, a multidisciplinary approach seems to be the way forward.

The most common class of symptoms related to concussion is headache. Drs. Schwedt and Dodick have put together a review of this topic in their article on Posttraumatic Headache Asssociated with Mild TBI, with practical suggestions for diagnosis and treatment.

Lastly, Drs. Rao and Roy provide a much-needed overview of Mood Disorders Following TBI, including major depressive disorder and anxiety disorders.

It has been a great pleasure working with the authors and editorial team on this collection. I appreciate their dedication and expertise. I have certainly learned a lot, and I hope you will too. Enjoy!