There is exciting landmark news in traumatic brain injury (TBI) evaluation right now. According to The Lancet, a coalition of experts in the field of brain injuries from the United States and 13 other countries have proposed a new way to evaluate TBI patients that can help improve classification, diagnosis and ultimately treatment. The system framework is called CBI-M.
The group, put together by the National Institute of Neurological Disorders and Stroke, have introduced a classification system that proposes a new framework for the characterization of acute TBIs using four pillars for a more complete injury assessment:
- Clinical measurements
- Biomarker (blood-based measurements)
- Imaging (pathoanatomical measurements)
- Modifier measurements (features influencing outcomes)
Called the CBI-M framework, this classification system provides a multidimensional view into each TBI that allows physicians to create more informed, individualized management programs for each patient.
For five decades, doctors have used something called the Glasgow Coma Scale to evaluate patients’ consciousness after a head injury, which assesses a person’s eye-movement, verbal and motor responses using a scoring method. The brain injuries are categorized as mild, moderate, or severe. According to The New York Times, the old system is insufficient, lacking in both modern technological advances and more meaningful levels of categorization. Having a system like the new CBI-M framework will impact millions of lives. From the Times:
Traumatic brain injuries are typically caused by auto accidents, falls and assaults. They kill more than 69,000 people a year in the United States. More than 5.3 million Americans who have survived a traumatic brain injury live with a lifelong or long-term disability as a result.
What Will the CBI-M Framework Mean for Concussion and TBI Patients?
“At MAC Concussion Care, we are glad to see efforts being made to more clearly classify TBI’s. Better classification will allow more accurate diagnosis and better plan of treatment,” says Dr. Vincent Schaller, MD, DABRM, CIC, medical director of Mid-Atlantic Concussion Alliance. “It must be stressed that all concussions are TBI’s.”
Currently concussions are classified as mild TBIs (mTBIs) because of this misperception, which can lead to them being ignored or overlooked. “Hopefully with a new CBI-M classification system, concussions with symptoms and deficits lasting over three months, or even as long as a year, have their own classification,” says Dr. Schaller. “This more-detailed classification would be one that clearly shows how health deficits can be prolonged if untreated, and they can be severely disruptive to patients personal, professional, academic and athletic lives.”
If deficits are lasting over a year or become permanent, they are hardly “mild,” cautions Dr. Schaller. “Here at MAC, we hope this new classification system corrects this misperception that concussions are no big deal. Every concussion must be thoroughly evaluated, and some concussions could be a big deal.”
Better TBI Classification Means Better Concussion Treatment for Athletes
According to Dr. Schaller, athletes are still paying the price for an inaccurate statement from the 4th International Conference for Concussion in Sports held in Zurich in 2012 which said that 90% of concussions are fully recovered without treatment within seven to 10 days. “Concussions were then erroneously thought to be mild and not in need of much treatment—patients should just simply wait for recovery. This was not sound advice,” says Dr. Schaller.
It should be noted that the chairman of the 2012 Zurich International Concussion Committee was Dr. Paul McCrory, a board certified neurologist. The organization utilized seven papers that Dr. McCrory published in the British Journal of Sports Medicine to make the statement that “90% of concussions heal within seven to 10 days with just rest.” However in 2022, it was discovered that in his research Dr. McCrory plagiarized and falsified data resulting in all seven research papers being redacted by the British Journal of Sports Medicine.
It is unfortunate that there are still medical professionals and sports leagues that continue to go by the Zurich Statement in their concussion protocol guidelines. This is allowing far too many athletes to return to play before they have truly recovered and are ready. “In 2014, the first of several TRACK-TBI studies proved with peer reviewed research and objective measurements that 33% of concussions are not recovered in 3 months, and 22% are not recovered in a year,” says Dr. Schaller. “As soon as two years after the Zurich statement, evidence was contesting Dr. McCrory’s advice on concussions.”
The TRACK-TBI studies proved that patients often have ongoing deficits in vital functions, including:
- Vision
- Cognitive skills
- Tolerance to light (photophobia)
- Attention
- Balance
These same patients also are usually struggling long term with post-TBI symptoms, including:
- Headaches and/or migraines
- Anxiety and/or depression
- Insomnia
- New onset ADHD/ADD
It’s Wrong to Call Concussions “No Big Deal”
“Unfortunately, the perception that still permeates all levels of medicine, sports and society is that concussions are minor and most resolve on their own with just rest and no treatment. That is simply not true,” says Dr. Schaller.
Hopefully the medical and sports communities will soon update their guidelines using the TRACK-TBI studies to treat concussions aggressively. It is important to follow the 33% of cases still struggling after three months and 22% still struggling after a year. “We hope that this new TBI classification system can help clarify the severity of each concussion and other types of TBIs, and provide better guidelines for proper diagnosis,” says Dr. Schaller. “We now have the technology to assist us in properly diagnosing and treating TBIs. There is no excuse not to do this correctly.”
Monitoring and Treating Concussion Symptoms
MAC Alliance is a concussion specialty clinic, and we have advanced testing technologies that can be easily repeated at each visit. This means that we can map out a recovery plan, and then make sure each patient is having positive results with ocular, vestibular and/or cognitive therapies. It also means we can adjust programs as needed based on objective test results. When needed, we can direct patients to any additional specialists they might need in addition to MAC Alliance concussion care.
Dr. Schaller and his team utilize the latest in brain-health and concussion technologies to screen, diagnose, monitor and treat patients, including:
- BrainScope One EEG analysis
- Brain SPECT Scan 3-D metabolic imaging
- Creyos (formerly Cambridge Brain Sciences) neurocognitive testing
- ImPACT neurocognitive testing systems
- RightEye infrared eye-tracking assessment
- Sway Balance System mobile-app-based vestibular screening for cell phones and tablets
Find a MAC Concussion Specialist Near You
MAC Alliance certified concussion specialists are able to help traumatic brain injury (TBI) patients in the Mid-Atlantic region through our network of practitioners in:
- Delaware
- Maryland
- New Jersey
- New York
- Pennsylvania
- Virginia
To find a MAC Center near you, click here.
