Interdisciplinary rehabilitation of mild TBI and PTSD: A case report

Background: Prevalence of mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a 'signature injury'. Civilian studies have shown that negative expectations for recovery may lead to worse outcomes. While there is concern that concussion screening procedures in the Veteran's Affairs Healthcare System and the Department of Defence could fuel negative expectations, leading to negative iatrogenic effects, it has been difficult to document this in clinical settings. The aim of this report is to describe the case of a veteran with comorbid mTBI/PTSD with persistent symptoms of unknown aetiology and the effects of provider communications on the patient's recovery. Methods: Case report of a veteran with reported mTBI, including provider communications, neuropsychological test results and report of functioning after changes in provider messages. Results: Two-years post-mTBI, the patient attributed cognitive difficulties to his brain injury, but neuropsychological assessment found that his cognitive profile was consistent with psychological rather than neurological dysfunction. After providers systematically emphasized expectations of recovery, the patient's daily functioning improved. Conclusions: This case illustrates difficulties in mass screening for and treating mTBI. Recommendations for improvement include clinician training in effectively communicating positive expectations of recovery after concussion.