Future of traumatic brain injury in adults

The previous articles in this compendium reviewed the past, present, and future status of the diagnosis, prognosis, treatment, and prevention of mild traumatic brain injury in the adult population. This article will discuss the issue of when an individual should initiate the return-to-play (or class or work) protocol. The clinical criterion to initiate the return-to-play protocol consists of neuropsychological performance that returns to baseline and is stable, with no reported symptoms. Recent functional magnetic resonance imaging (fMRI) studies raise serious questions about these clinical criteria. fMRI results in individuals with concussion are different from those of normal controls. Does this difference represent cortical reorganization and/or cortical dysfunction? If the imaging results reflect neuroplastic reorganization, then the initiation of the return-to-play protocol is acceptable. However, if the imaging differences indicate cortical dysfunction, then initiation of the return-to-play protocol would not be advised. This article will describe the problem, the data available to address this problem, and future research needs.