Apathy/poor motivation

Blurred vision

The most striking aspect of this expanded definition is not its inclusion of potential outcome statements, which is an important consideration and should be part of any clinical definition, but the fact that the general criteria for mild head injury are applied to a new term—mild traumatic brain injury. There is an obvious distinction between "head injury'' and "brain injury.'' The research definition for mild head injury implies some temporary alteration in consciousness at the time of the accident, which also suggests the possibility of some brain impairment but not necessarily persistent functional or neurologic deficits. The ACRM definition, though it is somewhat more specific and directly addresses possible outcomes, is entirely consistent with the research definition of mild head injury. In contrast, it espouses the use of the words brain injury as more accurate terminology since an altered state of consciousness, even if momentary, is required. The use of the term mild traumatic brain injury with this definition has had a secondary, and perhaps profound, effect on society and the medical/ neurological sciences, the forensic system, and the patient. Just as Jellnick did in the 1960s when he proposed the disease concept of alcoholism, the ACRM has sensitized the health care community and society to the potential "medical" seriousness of mild head injury and its possible, real underlying neuro-pathology. Its focus on brain injury has thus established and promoted the disease concept of mild head injury. In addition, the term brain injury to the layperson, or perhaps a jury in a personal injury case, can have an emotionally laden meaning. This meaning may include the perception that there is either a permanent lesion or functional disability, when this may or may not be the case with an appropriately defined mild traumatic brain injury. Although no studies have directly focused on this issue, it stands to reason that patients and families may well have different reactions to being told that they have suffered a mild head injury versus a mild traumatic brain injury. This again speaks to the issue of emotionally laden terms, societal labels, and a sense of permanence and perhaps hopelessness. There is no consensus regarding the appropriate use of these terms; therefore, mild head injury and mild traumatic brain injury are often used interchangeably. Most researchers and clinicians agree, however, that these two definitions address the most important mild head injury classification criteria, even though they do not offer suggested guidelines for assessing the vague lower limits of mild head injury.

Ronald Ruff and Paul Jurica suggested a unified definition of mild traumatic brain injury that incorporates the classic research and ACRM criteria Diagnostic and Statistical Manual of Mental Disorders (4th ed.) as well as the suggested criteria for mild traumatic brain injury. Under their definition of postconcussion disorder, three categories of mild traumatic brain injury were created to address issues of loss of consciousness, posttraumatic amnesia, and neurological symptoms. A type I traumatic brain injury refers to individuals experiencing an altered or transient loss of consciousness, 1-60 sec of posttraumatic amnesia, and one or more neurological symptoms. A type II injury requires a definite loss of consciousness of less than 5min or unknown duration, 1min to 12 hr of post-traumatic amnesia, and one or more neurological symptoms. A type III injury includes loss of consciousness of 5-30 min, posttraumatic amnesia that persists more than 12 hr, and one or more neurological symptoms. This definition is broad and allows subclassification that highlights the fact that mild traumatic brain injury is multifactorial and reflects a spectrum from very mild and perhaps simple to more severe and complex.

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