Chapter 37.Multidisciplinary Assessment and Treatment

A careful and complete clinical history provides important information that helps guide the physical examination and aids in the identification of the pathophysiology underlying persistent symptoms after mild traumatic brain injury (mTBI; Haider et al. 2017). Initial injury details include the mechanism of injury, the presence of loss of consciousness, posttraumatic amnesia or seizure, the symptoms experienced at the time of injury, and medical management of the injury. Preexisting medical conditions that may have an impact on recovery and symptom duration include a history of previous injuries, nonspecific or migraine headaches, attention-deficit/hyperactivity disorder or learning disorders, psychiatric conditions such as depressive or anxiety disorders, previous cervical spine injuries, and preexisting neuro-ophthalmological conditions such as strabismus or convergence insufficiency. A history of other disorders that can account for presenting or persisting symptoms that can influence recovery decision making includes a history of seizure disorders, structural brain abnormalities (e.g., Chiari malformations, arachnoid cysts), hematological conditions (i.e., anemia or platelet disorders), and infectious diseases (e.g., sinusitis, mononucleosis). In our clinical experience, a family history of psychiatric disorders and migraine headaches may predispose patients to certain persistent posttraumatic symptoms (Ellis et al. 2015).