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A special set of dynamics applies to mild TBI (see Chapter 15, Mild Brain Injury), which deviates somewhat from some of the principles outlined in this chapter. Mild TBI refers to injuries with brief or no loss of consciousness, no long-term focal neurological abnormalities, usually normal computed tomography scans and magnetic resonance imaging studies, and a constellation of symptoms, including headache, irritability, fatigue, sleep disturbance, depression, anxiety, poor self-esteem, general inability to function, and poor attention, concentration, and memory (Kay 1986). Psychological overlay can accumulate with time and increases dysfunction, which usually reflects a complex interaction among organic, personality, and environmental factors. In many cases, a legitimate, if subtle, brain injury underlies and drives the dysfunction, which is layered over with maladaptive psychological reactions, many of which result from inappropriate environmental responses (Kay 1992).

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