Chapter 2.Medical Evaluation
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Comprehensive medical evaluation is a prerequisite to the treatment of the cognitive, psychiatric, sensorimotor, and functional problems experienced by individuals with traumatic brain injury (TBI). The evaluation necessarily entails characterizing the injury to the brain, other co-occurring injuries, and the care needs attendant on them. However, a thorough evaluation also must address many other issues. As Sir Charles P. Symonds (1937), the acclaimed British neurologist, cautioned in his exposition to the Royal Society of Medicine in 1937, “The later effects of head injury can only be properly understood in light of a full psychiatric study of the individual patient, and in particular, his constitution. In other words, it is not only the kind of injury that matters, but the kind of head” (p. 1092). More recent formulations emphasize the combined influences of preinjury factors, injury factors, and postinjury factors on symptom development and resolution following TBI and encourage consideration of all of these factors when assessing persons with such injuries (Arciniegas and Silver 2013; Silver et al. 2009) (Figure 1-).
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