Mild Traumatic Brain Injury in the Occupational Setting

The evaluation and management of mild traumatic brain injury (mTBI) in the occupational setting may pose significant challenges for even the most-seasoned practitioner. Providers must simultaneously address the clinical management of mTBI and be familiar with the systematic and administrative requirements related to the management of injured workers with mTBI who are covered by workers' compensation insurance, including causation, return to work, and the potential of permanent impairment. Given the primarily subjective nature of many mTBI symptoms, an injured worker with a delayed recovery may raise the question, if not suspicion, of symptom magnification and secondary gain. This review discusses the evaluation and treatment of the injured worker with mTBI, and focuses on the medicolegal issues that are present in the workers' compensation system, especially the role of neuropsychological evaluations. Although significant differences exist regarding classification schema, for the purposes of this discussion, mTBI is used to encompass the terms concussion, postconcussive syndrome, and persistent postconcussive syndrome. PM R 2011;3:S387-S395