mTBI – a controversial field

A response to an interview in our July edition.

Neuropsychology is a relatively young discipline, and it can rightly be proud of progress made and of how research has conferred clinical benefits to patients and families. One challenging area has been, and to some extent remains, mild traumatic brain injury (mTBI), although substantial progress has been made. Michael McCrea and colleagues, in their helpful 2009 review paper in The Clinical Neuropsychologist, used the term ‘maturity point’ to describe the state of science in mTBI.

It was therefore with great interest that we read Dr Priyanka Pradhan’s comments in her interview (July 2018). The article highlights a number of current issues and areas of controversy relevant to the fields, for example the question of whether we can identify microscopic damage after mTBI and the relationship between this level of damage and neuropsychological deficits.

Although Dr Pradhan makes some very sensible and valid points, hers is largely a selective representation of the current science on mTBI and effort/symptom validation testing. There are a number of contentious points in this article, particularly in relation to effort testing, but the statements on brain imaging stand out.

As neuropsychologists in the field, we encourage a healthy discussion around the area of mTBI, its assessment and management. As with most contentious areas there is always going to be a range of opinions, which we feel should be heard and understood. In particular, we invite those working, and interested in the field, to employ their skills as psychologists in the critical evaluation of research studies the careful evaluation of the body of research and practice evidence, and caution against only looking at the data that supports their own perspective and point of view.

Dr Steven Kemp
Professor Gus A. Baker
Dr Bonnie-Kate Dewer

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