An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will conduct a study to review the latest published research and science and produce a report based on published evidence (to the extent possible) and professional judgment (where published evidence is lacking) addressing the diagnosis, prognosis, recovery, and late effects of traumatic brain injury (TBI) in children and adults. In addressing the following objectives, the committee will focus their report on TBIs that cause more than a minimal impact on long-term functioning but that are not so severe as to result in a persistent vegetative state or a similar permanent, complete, and obviously observable loss of functional abilities.

The committee’s report will:

1. Describe the current healthcare landscape for the diagnosis and treatment of TBI and its symptoms for adults and children, including traditional or emerging uses of imaging, biomarkers, diagnostic signs, physical and mental rehabilitation therapies, alternative or self-guided treatments, and recent changes in best practices;
2. Explain the classification of TBIs (e.g., mild, moderate, or severe), the variation within those classifications, and the implication of classification on prescribed medical care, prognosis, and rehabilitation potential;
3. Describe the typical course of medical care and recovery after a TBI, including diagnosis and categorization of the injury, prognosis, rehabilitation, release from care, and long-term follow up;
4. Explain, for each phase of TBI recovery, the typical symptoms, signs, complications, and functional impact seen during the phase and the implications those findings have for the patient’s future medical and functional status;
5. Explain how TBI affects the long-term trajectory of an individual’s mental and physical functioning, including:
   1. Impact on the acquisition of normal age-appropriate skills in children;
   2. Impact on the progression of normal age-related functional decline in adults; and
   3. Changes in sensitivity to subsequent injuries or illnesses;
6. Describe any limitations or exacerbations associated with the late effects of TBI that are uncommonly experienced or not consistently recognized by medical providers as causally linked to a previous TBI, and what evidence the medical community uses to show such a connection;
7. Describe any special considerations or alterations in long-term recovery expectations for:
   1. Mild TBIs (or concussions) compared to severe or life-threatening TBIs;
   2. A one-time TBI compared to repeated TBI events experienced by a single person; and
   3. Individual’s receiving rehabilitation services when provided immediately after recovery from acute injury compared to when provided in a delayed fashion (more than one month after recovery from acute injury);
8. Explain current approaches to the identification and diagnosis of chronic traumatic encephalopathy (CTE) or traumatic encephalopathy syndrome (TES) in living individuals and special implications such a diagnosis has for prognosis and care;
9. Describe the durability of functional improvements seen from rehabilitation in an individual with TBI and what characteristics of the individual or their injury contribute to that durability; and
10. Describe the circumstances in which deficits resulting from a TBI can return or worsen following completion of prescribed rehabilitation services, including signs, symptoms, and laboratory values commonly observed in proximity to such late exacerbations.

The report will include findings and conclusions but not recommendations.