Traumatic Brain Injury

Recommendations

1. Return to work is determined by injury severity/classification, symptom duration/type, penetration of dura, and seizure risk.
2. For any classification of traumatic brain injury (TBI), if there are abnormalities on imaging studies, the LEO needs to be assessed for seizure risk.

Mild TBI/Concussion with Resolved Clinical Symptoms that Lasted Less than 2 Weeks

LEOs with mild TBI/concussion with resolved clinical symptoms that had lasted less than 2 weeks can be cleared for unrestricted duty once all the following criteria have been met:

• Resolution of symptoms for at least 48 hours
• Successful completion of a graduated return to physical activity pathway (see Section 3 – Return to Activity below) demonstrating no evidence of vestibulo-ocular dysfunction or functional impairment during activity.
• If imaging studies had been done and showed any abnormality the LEO should be assessed as having symptoms lasting greater than 2 weeks.

Mild TBI/Concussion with Resolved Clinical Symptoms that Lasted Longer than 2 Weeks

LEOs with mild TBI/concussion with resolved clinical symptoms that had lasted greater than 2 weeks can be cleared for unrestricted duty once all the following criteria have been met:

• Resolution of symptoms for at least 48 hours
• Successful completion of a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction or functional impairment during activity.
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.

Mild TBI/Concussion with Resolved Clinical Symptoms that Lasted Longer than 2 Weeks Except for Persistent Mild Headache

LEOs with mild TBI/concussion with resolved clinical symptoms that had lasted longer than 2 weeks, except for persistent mild headache can be cleared for unrestricted duty once all the following criteria have been met:

• Resolution of symptoms other than headache for at least 48 hours
• The treatment for headaches itself is not a disqualification (see LEO chapter on Medications).
• Successful completion of a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction, worsening headache or functional impairment during activity.
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.

Mild TBI/Concussion with Multiple Resolved Vestibulo-ocular Symptoms Regardless of Duration

LEOs with mild TBI/concussion with multiple resolved vestibulo-ocular symptoms, regardless of their duration, can be cleared for unrestricted duty once all the following criteria have been met:

• Resolution of symptoms other than headache for at least 48 hours
• Successful completion of a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction, worsening headache or functional impairment during activity.
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.
• Neuropsychological evaluation should be considered if there are subjective complaints or social or occupational impairment issues (defined as deficits in complex attention, executive function, learning and memory, language, perceptual-motor, and/or social cognition).

Moderate TBI without Penetrating Head Injury with or without Seizures within 7 Days of Injury

LEOs with moderate TBI without penetrating head injury and with or without early seizures can be cleared for unrestricted duty once all the following criteria have been met:

• Resolution of symptoms other than headache for at least 48 hours
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.
• Successful completed a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction or functional impairment during activity.
• Neuropsychological testing and job performance demonstrate adequate cognitive function to perform essential job functions.

Moderate TBI without Penetrating Head Injury and with Seizures Later than 7 Days after Injury

LEOs with moderate TBI without penetrating head injury and with seizures later than 7 days after the injury can be cleared for unrestricted duty once all the following criteria have been met:

• A 10-year seizure-free interval (see Appendix B and the LEO chapter on Seizure Disorders).
• Resolution of symptoms with the exception of mild headache (self-reported).
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.
• Successful completion a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction, worsening headache or functional impairment during activity.
• Neuropsychological testing and job performance demonstrate adequate cognitive function to perform essential job functions.

Severe TBI without Penetrating Head Injury

LEOs with severe non-penetrating TBI can be cleared for unrestricted duty once all the following criteria have been met:

• Based on the increased risk of late seizures in patients with a confirmed diagnosis of non-penetrating severe TBI, the LEO Task Group recommends a minimum 2-year restriction period for these LEOs. If the LEO has had a seizure, see LEO chapter on Seizure Disorders.
• Resolution of symptoms with the exception of mild headache (self-reported).
• Evaluation by a health care provider with expertise in TBI who agrees with return to unrestricted duty.
• Successful completion a graduated return to physical activity pathway (see Section 3 – Return to Activity) demonstrating no evidence of vestibulo-ocular dysfunction or functional impairment during activity.
• Neuropsychological testing and job performance demonstrate adequate cognitive function to perform essential job functions.

Penetrating Head Injury

It is unlikely that the LEO with a penetrating TBI (penetration of the dura mater) will be able to be cleared for unrestricted duty due to the lifetime increased risk of seizure.