Regarding PCS recovery and TBI recovery:

The main stream medical community holds to these statistics.

85% of concussion patients will recover fully.

15% will suffer from long term dysfunctions and struggles of varying intensities.

At first observation, these statistics look promising.

When these statistics are viewed through the lens of those who do more in-depth analysis, they mean something entirely different.

The 85% need to be redefined as to their recovery limitations. The vast majority of these 85% recover to a condition that appears similar to their before concussion condition. This full recovery is limited to their functional capacity during non-stress efforts.

The simple fact that the subject can walk, talk and chew gum is often considered a full recovery. The other subjective complaints such as cognitive and memory problems are left just that way, subjective. This is easy to understand as who among us has not had cognitive or memory struggles during an illness or head ache, even before any concussion?

Some doctors appear to take a position of, "If I can't image it or treat it, then there must be nothing wrong."

It is only when there are neuro-psychological assessments done that these subjective complaints get objective support.

This is a very rare situation due to the cost of a full neuro-psych assessment. Mini-neuro-psych evaluations are sometimes done but are often discounted. This may be due to the evaluator being a 'plain Jane' psychologist without neuro-psychologist credentials.

Of the three psychologists that have evaluated me, the one non-neuro had the best understanding of my condition. Go figure?? The two neuro-psych credentialed evaluators both diagnosed dysfunctions but labeled them as psychological, not physiological/concussion caused. They both were oblivious to my mentioned struggles caused by the testing environment (sensory overload). The 'plain Jane' was quick to make a few minor accommodations.

Many in the 85% are considered fully recovered due to a basic neurological exam that does not include any neuro-psychological assessments.

It is not uncommon for neurologists to perform only the motor function tests. The Mini Mental Status Exam is often not performed unless the patient is in latter years with cognitive complaints. The excuse is, "The patient is too young to have cognitive/memory difficulties."

Many of these neurologists are getting paid by a personal injury liability insurance company. They get continued work with these insurance companies by being cautious about their diagnoses that can negative impact the payer. They are not outright lying. They are just tweaking the evaluation to fit their biased opinion.

There is a large industry in the USA of specialists who work for insurance companies and their attorneys. They have very streamlined report writing organizations that leverage the few minutes of the M.D. or Ph.D. into reports that can be voluminous.

Of those 85% who appear to recover to high levels, this can often be attributed to their concussion history. If this was their first concussion, their level of recovery is often greater. The more concussions in the subjects history, the more problematic the recovery. The subject will likely be more susceptible to relapse/decompensation during times of stress of all varieties.

There is also an 'assumed recovery' when the concussion subject does not seek follow-up treatment. As I mentioned in an earlier post, any later complaints are often discounted due to a lack of a specific diagnosis of concussion in the original medical record using the ICD-9 or ICD-10 code 854. Often the subject does not understand that their later complaints are tied to the prior concussion, especially when these later complaints are not noticed until weeks later.

Accurate diagnosis/prognosis of concussion subjects will continue to be unreliable until the post concussion diagnosticians start to use stress as a factor in their diagnostic evaluations.

The TBI population is an entire different group from a long term perspective. I know many who have been comatose for weeks and months after their injury, including many who had closed head injuries. The rehabilitation parameters for this group tend to set lower recovery standards. The goal is often a return to ambulatory function and ability to maintain basic Activities of Daily Living (ADL's). Many, if not most, cannot live totally without access to support at some level

One could categorize them as recovered to the level of the 15 % of concussion subjects during their worst period. They may exhibit: a tendency to over-react, poor decision making/judgment, communication difficulties, sensory overload, problems with balance and coordination, vision difficulties, behavioral abnormalities ( schizoid, gullibility, ambivalence, apathy, depression, etc.)

Of the TBI subjects I know, once they are accepted for their behavioral idiosyncrasies, they tend to be much more tolerant of their own and others struggles. The PCS subjects, especially those in denial or rejection of their current condition, tend to be the most difficult in behavioral areas.

This whole problem can in some sense be tied to funding. Why should the health care system do any better at diagnosing concussion when those subjects can "Walk, Talk, and Chew gum" when there are people with treatable conditions lining up at the door?

Time to get on my Soap Box

Those with PCS are not dismissed without a cost to society. They overpopulate our prisons, homeless shelters, and other social welfare programs. Society loses their productivity by dismissing them. We will gladly use resources to help the obviously disabled but not the invisible wounded.