Pearl Chung and Fary Khan
Objective: To provide an overview of literature on the diagnosis and rehabilitation of adults following traumatic
brain injury (TBI).
Method: A comprehensive systematic search identified current literature in TBI diagnosis and rehabilitation
interventions. Included studies were examined to identify current standards for diagnostic criteria for TBI in clinical
and research contexts, and to present evidence for rehabilitation treatments in TBI.
Results: Strong agreement exists for a diagnosis of TBI in the presence of post traumatic amnesia (PTA) following
head trauma; and that Glasgow Coma Score (GCS) of 9-12 is moderate TBI, and GCS of 3-8 is severe TBI. There
is no agreement for whether GCS of 13 should be mild or moderate TBI; which GCS to use to grade TBI severity;
which clinical feature (aside from PTA) indicates a diagnosis of mild TBI; and whether imaging findings should be
incorporated into diagnostic criteria for TBI and for severity grading. Nomenclature for TBI type in the literature remains
disorganised, which is problematic for TBI research. There is strong evidence for effectiveness of psychological
interventions such as attention training and cognitive interventions after TBI; nutritional support for improved survival
and disability outcomes and hyperbaric oxygen therapy for reduction of risk of death after TBI. There is moderate
evidence for cognitive behaviour therapy for managing stress after mild TBI. For all other interventions the evidence
is limited or insufficient due to lack of studies in the area.
Conclusion: Clear diagnostic criteria for TBI could improve management using targeted therapies. More robust
trials in TBI treatments are needed to build evidence for effectiveness of rehabilitation.
