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Special CommunicationVolume 106, Issue 10p1615-1619October 2025

New Diagnostic Criteria for Mild Traumatic Brain Injury: Medical-Legal Considerations

Affiliations & Notes
aDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
bDepartment of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA
cHome Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA
dMass General for Children Sports Concussion Program, Boston, MA
eDepartment of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
fDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
gDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
hBritish Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
iBC Neuropsychiatry Program, Vancouver, British Columbia, Canada
jDepartment of Health and Exercise Science, Colorado State University, Fort Collins, CO
kMolecular Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO
lMinnesota Neurorehabilitation Institute, PLLC, Plymouth, MN
mDepartment of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
nCenter for Traumatic Brain Injury Research, Kessler Foundation, NJ
oDepartment of Physical Medicine and Rehabilitation, New Jersey Medical School Rutgers, the State University of New Jersey, NJ
pDepartment of Rehabilitation Science, University at Buffalo, Buffalo, NY
qGoldberg Migraine Program, Department of Neurology, University of California Los Angeles, Los Angeles, CA
rSteve Tisch BrainSPORT Program, Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA
sDepartment of Psychology, University of British Columbia, Vancouver, Canada
tRehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Vancouver, Canada
uDjavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
Article Info
Publication History:
Received August 15, 2024; Revised June 13, 2025; Accepted June 20, 2025; Published online July 5, 2025
Footnotes:
Disclosures: Grant Iverson, Ph.D. serves or has served as a scientific advisor for NanoDX®, Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received past research support or funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He receives royalties from the sales of one neuropsychological test 3 (WCST-64). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation, ImPACT Applications, Inc., National Rugby League, the Heinz Family Foundation, Boston Bolts, and the Schoen Adams Research Institute at Spaulding Rehabilitation. None of the above entities were involved in the study design, analysis, interpretation, the writing of this article, or the decision to submit it for publication. Kristen Dams-O'Connor, Ph.D. has provided expert testimony, consultation, and independent examinations involving cases pertaining to brain injury. William J. Panenka, M.D. reports academic grants unrelated to this work, including funds from the Canadian Institute of Health Research, the Vancouver General Hospital Foundation, and British Columbia Ministry of Health. Jaclyn A. Stephens, Ph.D., OTR/L has received research funding as a principal investigator from the National Institutes of Health (NIH), serves as a Chair of a Data Safety Monitoring Board for an NIH R01 study focused on sports-related concussion, and is a Co-Chair of the Athlete Development Sports Rehabilitation Task Force of the American Congress of Rehabilitation Medicine. None of the above entities were involved in the study design, analysis, interpretation, the writing of this article, or the decision to submit it for publication. Steven D. Lockman, M.D. has received payment for expert testimony. Zainab Al Lawati, M.D., M.Ed., FRCPC, FAAPMR has no disclosures. Anthony H. Lequerica, Ph.D. reports a grant from the New Jersey Commission on Brain Injury Research and expert testimony fees. Jacob I. McPherson, DPT, Ph.D. has no disclosures. Joshua Kamins, M.D. serves as a consultant for Lundbeck Pharmaceuticals and he has also been a member of their speakers bureau. He is a clinical neurologist and has provided expert testimony on legal cases involving mild TBIs. Noah D. Silverberg, Ph.D. reports grants from the Canadian Institutes of Health Research, Canadian Foundation for Innovation, VGH+UBC Hospital Foundation, and WorkSafeBC, and clinical consulting fees from the National Hockey League and Major League Soccer, and expert testimony fees.
Copyright: © 2025 by the American Congress of Rehabilitation Medicine.
Linked Articles
Cover Image - Archives of Physical Medicine and Rehabilitation, Volume 106, Issue 10

Abstract

The new American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) were published in 2023. The criteria are designed to be used across clinical settings. This article discusses some medical-legal issues and implications relating to the use of the new ACRM diagnostic criteria. First, the new criteria differ from previously published definitions. Second, the criteria can be applied weeks, months, or years after an injury through a clinical interview and review of records. Third, when there is diagnostic uncertainty, and the “suspected” mTBI classification is used, this is not meant to convey a level of diagnostic certainty, from a medical-legal perspective. Fourth, the diagnostic process could be influenced by subjectivity or biases on the part of the person or the examiner. Finally, the new criteria are diagnostic, not prognostic. They are designed to determine whether a person sustained an mTBI, but they are not designed to determine if a person’s health problems months or years after an injury are related to that injury.

Keywords

  1. Brain injury
  2. Concussion
  3. Diagnostics
  4. Legal issues
  5. Rehabilitation

List of abbreviations

  1. ACRM (American Congress of Rehabilitation Medicine)
  2. LOC (loss of consciousness)
  3. mTBI (mild traumatic brain injury)
  4. PTA (posttraumatic amnesia)
  5. TBI (traumatic brain injury)
  6. WHO (World Health Organization)

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References

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Silverberg, N.D. ∙ Iverson, G.L. ..., ACRM Brain Injury Special Interest Group Mild TBI Task Force members
The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury
Arch Phys Med Rehabil. 2023; 104:1343-1355
2.
Silverberg, N.D. ∙ Iverson, G.L., ACRM Mild TBI Definition Expert Consensus Group and the ACRM Brain Injury Special Interest Group Mild TBI Task Force
Expert Panel survey to update the American Congress of Rehabilitation Medicine definition of mild traumatic brain injury
Arch Phys Med Rehabil. 2021; 102:76-86
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Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury
J Head Trauma Rehabil. 1993; 8:86-87
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Holm, L. ∙ Cassidy, J.D. ∙ Carroll, L.J. ...
Neurotrauma Task Force on Mild Traumatic Brain Injury of the WHO Collaborating Centre. Summary of the WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury
J Rehabil Med. 2005; 37:137-141

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