Rehabilitation interventions after mild head injury.
OBJECTIVE
This review examines current management and rehabilitation strategies for mild traumatic brain injury, with emphasis on the need to address multiple potential causative factors in order to enhance outcomes and to conduct more controlled efficacy studies.


RESULTS
Whilst most individuals who sustain mild traumatic brain injury make a good recovery, a proportion experience significant ongoing disability. In some cases this is due to diffuse axonal injury and cognitive impairment, but in others symptoms are exacerbated by factors such as pain, stress, personality issues or litigation, or in children, previous head injury, behavioural or learning difficulties. Provision of information early after injury results in reduced symptom reporting in adults and children. There is also a need, however, to address these other factors in treatment. Psychological therapy using a cognitive behavioural approach may be helpful, but controlled evaluations of such interventions have been lacking. Recent uncontrolled studies have examined the impact of computer-mediated interventions to remediate visual and verbal processing and oculomotor problems and the impact of quantitative electroencephalography. More rigorous efficacy studies of these approaches are needed. Guidelines for management of sports-related concussion and timing of return to play also require a more solid scientific basis.


CONCLUSIONS
The evidence base for management of mild traumatic brain injury is still very limited. There is a need to conduct more carefully controlled prospective studies and examine the influence of factors not directly related to the brain injury as a basis for formulating more uniform management guidelines.
Ponsford
Jennie
J
School of Psychology, Psychiatry and Psychological Medicine, Monash University and Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia. jennie.ponsford@med.monash.edu.au
D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation*; D006259:Craniocerebral Trauma / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D011613:Psychotherapy; D012046:Rehabilitation / Q000379:methods*; D016896:Treatment Outcome