Traumatic Brain Injury

sec_arr Medical Evaluation
SECTIONS

Medical Evaluation

There are varying recommendations for the medical evaluation for fitness-for-duty determinations after TBI (see Table 1).1,2,3,4 It is the consensus of the LEO Task Group NOT to require specific testing by diagnosis. Rather, the police physician should ensure that the LEO has had appropriate evaluation based on her/his symptoms (i.e., vestibular therapy evaluation for balance symptoms, vision therapy for visual complaints).

Table 1. Examples of Required Medical Evaluation for Fitness-for-Duty Determination after TBI

Agency

Evaluation

FMCSA1

Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological test.

U.S. Air Force2

All aircrew must be asymptomatic, no neurological deficit that might interfere with flight operations, meet aircrew standards for neurocognitive testing, no history of seizure, a sleep-deprived EEG that does not demonstrate paroxysmal activity, no significant abnormality (undefined) on computed tomography or MRI.

NFPA3

Normal neurological exam (“the neurologist must indicate that the member’s cognitive function and neurological exam are normal”), normal imaging (CAT or MRI scan) studies.

California POST4

Physicians should thoroughly question candidates regarding the severity of the injury, nature of the resulting symptoms, and their duration. A complete neurological exam should be performed, including tests for nystagmus. Document severity of injury and confirm that there have been no post-traumatic seizures. Tests can include visual/auditory evoked potentials, electronystagmography, and/or neuropsychological testing.

The LEO Task Group recommends that the police physician document the following information as part of the fitness-for-duty determination.

  1. Documentation of the injury AND mechanism of injury (motor vehicle collision, fall, struck by object, etc.) including any concomitant injuries at the time of the event
  2. Documentation of clinical evaluation and findings (e.g., imaging) that led to the diagnosis and the location where the initial and subsequent care has been delivered. If available, document duration of loss of consciousness, pre-/post traumatic amnesia, and best Glasgow Coma Scale (GCS) score in the first 24 hours
  3. Timeframe from initial injury to current evaluation – most if not all rehabilitation pathways are time-dependent for increasing activities
  4. Initial symptoms versus current symptoms
  5. Documentation of treatment of injury and other evaluations (physical therapy, vestibular rehabilitation, neuro-ophthalmology, cognitive testing)
  6. Neurological screening and physical exam with documentation of vestibulo-ocular function
  7. Medication assessment (see LEO chapter on Medications)
  8. Documentation of immediate, early and/or late seizures