Early management mild traumatic brain injury

1. Uncomplicated Concussion managed in CONCUSSION CLINIC These clients will have sustained an injury resulting in post concussive injury but with no significant radiological signs and a Post Traumatic Amnesia Score (PTA) of less than 1. Current usual care which includes assessment, provision of information and advice will be provided to these individuals. They will normally be discharged from the clinic within 8 weeks according to reduction or cessation of symptoms. If significant symptoms remain at 8 weeks they will be referred to the mild TBI Clinic for ongoing management. 2. Complicated Concussion/mildTBI managed in BRAIN INJURY mTBI EARLY REHABILITATION PROGRAM. EMMBIRS will commence early after injury (on referral) and be offered up to 6 months post-accident. It will have a remedial focus on the treating of participant’s specific symptoms and /or impairments that may be acting as barriers to the person returning to their pre-existing roles and activities. Intervention will be primarily impairment focused, designed according to each individuals needs and may include o Management of emotional, cognitive and behavioural issues resulting from frontal lobe or other damage o Management of subtle memory, cognitive-communication difficulties and activities of daily living o Vestibular rehabilitation o Metabolic and physiologic rehabilitation to support physiological recovery from mild TBI. The delivery of the intervention to the program will include use of technology whenever appropriate. Tele-rehabilitation (including provision of tablets) and use of therapeutic apps (standard and rehabilitation specific) and use of low cost, off the shelf and bespoke rehabilitation software will be trialed and evaluated. The intervention team will consist of a Rehabilitation Physician or doctor experienced in working with patients following an ABI, Occupational Therapist, Physiotherapist, Social Worker, Speech Pathologist and Psychologist. Patients will be seen 1-4 times a week (in person or via telerehabilitation) depending on need and up to 6 months depending on progression towards reaching their goals. Rehabilitation will be provided according to each patients' individual needs and according to best practice principles. This is a pragmatic trial; however records of all interventions will be kept in terms of type, content and duration. Telerehabilitation will be accessed by Cisco Jabber for videoconferencing. Therapy apps will be provided according to need and what is available at the time; therapy apps change and are updated frequently and hence so will the type of apps provided. Apps used will be those that are freely available to public but assessed by the therapy team regarding usefulness and according to level of security provided.