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Traumatic Brain Injury Resources for Medical Providers

TBICoE develops practical, easy-to-use clinical recommendations and tools to support health care providers in assessing and treating service members who have sustained a TBI. Clinical recommendations address common symptoms associated with mild TBI, such as headache, sleep disturbances, and vision problems. Most clinical recommendations have related patient resources to help educate patients through recovery.

Interested in learning more about the potential effects of low-level blast exposure? Discover which occupations and heavy weapon systems are associated with increased risk of LLB exposure and learn how to best document, manage, and care for your patients—to optimize warfighter brain health.

Need training on any of the clinical tools? Email us to schedule a training with our TBI educators, network dissemination specialists. Supplemental "Provider Education" materials are also available.

Acute Concussion Care Pathway

In order to standardize acute concussion assessment and care across the MHS, DHA established the Acute Concussion Care Pathway as part of the FY21 Quadruple Aim Performance Plan.

The goal of the ACC Pathway is to improve recovery times and outcomes by utilizing a multi-modal assessment tool at the time of injury—the Military Acute Concussion Evaluation 2—and to ensure timely access to repeat evaluations with personalized treatment protocols in alignment with a progressive return to activity process.

Supporting the goal of the ACC Pathway, the DHA Procedural Instruction 6490.04, titled “Required Clinical Tools and Procedures for Assessment and Clinical Management of Mild Traumatic Brain Injury/Concussion in Non-Deployed Setting,” establishes the required clinical tools and procedures for management of mild TBI, or concussion, in a non-deployed setting. Specifically, the use of the MACE 2 and a PRA framework for the assessment, management, and rehabilitation of all patients with a mild TBI.

The ACC Pathway—a standardized assessment and treatment plan for acute concussion, mandates:

  1. Use of the MACE 2 for acute assessment at the initial appointment 
  2. Follow-up within 72 hours after diagnosis of mild traumatic brain injury
  3. Completion of a progressive return to activity process prior to return to full duty

This fact sheet and educational video focus on standardizing the nomenclature for the ACC Pathway, delineating how each element intertwines to meet the objective of improving concussion outcomes across the MHS. 

 Thumbnail image of the downloadable fact sheet on the acute concussion care pathway. What is the Acute Concussion Care Pathway?

Download the ACC Pathway Fact Sheet

TBICoE offers a quarterly "Acute Concussion Care Pathway: MACE 2 & PRA" virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

The DOD published the DODI 6490.11, "DOD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting" establishing policy, assigning responsibilities, and providing procedures on the management of mild TBI in the deployed setting.

TBICoE's MACE 2, PRA clinical recommendation, Recurrent Concussion Evaluation, and ICD-10 Coding Guidance for TBI support the ACC Pathway, the DHA-PI 6490.04, and the DODI 6490.11.

 

Military Acute Concussion Evaluation, Version 2

The 2018 MACE 2 is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The clinical tool incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening.

Download the MACE 2 and supporting materials.

 

Progressive Return to Activity

The 2021 Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/TBI clinic providers.

Download the Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation and Patient and Leadership Guide.

Recurrent Concussion Evaluation

The Recurrent Concussion Evaluation is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.

Clinical Recommendations and Support Tools for Mild Traumatic Brain Injury

TBICoE optimizes clinical care by combining evidence from medical literature, health care research, and expert opinion to develop and provide clinical recommendations and tools to help providers deliver evidence-based treatment and address the challenges associated with mild TBI.

  • Clinical recommendations provide guidance on assessing and managing mild TBI symptoms.
  • Clinical support tools offer an algorithmic approach to evaluating, managing, and referring mild TBI patients for specialty care.
  • Training material to show providers how to identify and treat patients with mild TBI-related symptoms.
  • Fact sheets and patient guides that provide tips and tools to help service members and veterans cope with a mild TBI.

UPDATED! Assessment and Management of Headache Following Concussion Clinical Suite

Thumbnail image of the downloadable assessment and management of headache following concussion clinical recommendation.This is a major revision of the 2016 clinical recommendation. Some key changes to new “Assessment and Management of Headache Following Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager” include:

  • Expansion of both non-pharmacologic and pharmacologic treatment of the most common types of post-traumatic headaches.
  • Inclusion of three additional post-traumatic headache subtypes—trigeminal, occipital neuralgia, and vestibular migraines, as well as increased focus on medication overuse headache.
  • Addition of considerations and precautions for preventive treatment options and treatment efficacy criteria to help primary care managers ensure optimal and effective treatment.

The revised patient education fact sheet on managing headache after concussion helps patients understand behavioral and pharmacological strategies their primary care manager may use to manage their PTH.

The all-new fact sheet on medication overuse headache should be reviewed with the patient, as it has space for clinicians to outline a treatment plan. It explains the basics of MOH, as well as treatment and prevention strategies.

 

Neuroendocrine Dysfunction Screening Following Concussion/Mild TBI

 

Neuroimaging Following Concussion/Mild TBI

 

Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

 

Sleep Disturbances Following Concussion/Mild TBI

 

Cognitive Rehabilitation Following Mild to Moderate TBI

 

Neurocognitive Assessment Tool (NCAT) Testing Following Concussion/Mild TBI

 

Additional Clinical Support Tools

Check out the latest resource, "Medical Devices for Assessment of Traumatic Brain Injury." This fact sheet defines the different regulatory terms and pathways of medical devices, provides an overview on what devices are currently FDA approved for assessing TBI, and provides some considerations for clinicians and researchers before using a device.

Thumbnail image of the downloadable medical devices and TBI fact sheet.

Additional tools to assist in the identification, treatment, and management of patients with mild TBI in deployed and non-deployed settings are also available. Click below to download copies of the Glasgow Coma Scale, Epworth Sleepiness Scale, Insomnia Severity Index, Neurobehavioral Symptom Inventory, and a number of other evaluation tools.

Find and download the additional tools here.

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Publication
Jun 16, 2023

Neurodegenerative Diseases and Traumatic Brain Injury Information Paper

.PDF | 310.80 KB

The long term effects of TBI are unknown, but there is concern that there may be an association with neurodegenerative diseases years after the injury. The intention of this information paper is to summarize the available evidence for or against an association of TBI with three of the more common neurodegenerative diseases.

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Apr 7, 2023

2022 TBICoE Publication Catalog

.PDF | 577.80 KB

TBICoE publication citations and summaries are organized by category, or overarching research topic. The purpose of this document is to (1) summarize key findings and potential clinical implications of calendar year 2022 TBICoE publications, (2) increase awareness, and (3) assist in planning of future efforts.

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Mar 17, 2023

TBICoE Research Review: Chronic Traumatic Encephalopathy

.PDF | 1.87 MB

The purpose of this Research Review is to summarize current peer-reviewed scientific literature and expert assessment regarding the pathology, genetic pre-disposition, causes, clinical manifestations, and neuroimaging of chronic traumatic encephalopathy.

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Mar 16, 2023

Back to School: A Guide to Academic Success After Traumatic Brain Injury

.PDF | 1.40 MB

Back to School: A Guide to Academic Success After Traumatic Brain Injury is a free resource, developed by the Traumatic Brain Injury Center of Excellence that is tailored to help service members and veterans who have sustained a TBI and are pursuing higher education. Those who have sustained a TBI may face unique challenges, and this guide provides ...

Publication
Mar 15, 2023

INFORMATION PAPER: The Impact of Mild Traumatic Brain Injury on the Autonomic Nervous System

.PDF | 381.19 KB

The purpose of this information paper by TBICoE is to provide a general overview of the current evidence related to the impact of concussion/mild traumatic brain injury (mTBI) on the autonomic nervous system (ANS). This paper will focus on heart rate variability (HRV), pupillary light reflex (PLR), and hyperhidrosis within the military and civilian ...

Publication
Oct 21, 2021

Improving Relationships after TBI

.PDF | 110.05 KB

Flier for the Interactive Relationship Building Workshop for Active-Duty Military and Veteran TBI Caregivers and Families: This flier provides information on TBICoE's educational session for caregivers of active-duty service members and veterans who have sustained a TBI. In addition to sharing caregiver resources and current research initiatives, ...

Publication
Jul 23, 2021

PRA Case Study Workbook

.PDF | 23.51 MB

This workbook, paired with corresponding PRA Training Video 8, is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity. We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion.

Publication
Feb 23, 2021

Progressive Return to Activity Following Acute Concussion/Mild TBI Provider Training

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The TBICoE revised the Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation (PRA) and this updated provider training slide deck. The trainings objectives will help providers to identify the key changes to the updated 2021 PRA; explain the rationale for using a PRA protocol for service members ...

Publication
Jan 28, 2021

2020 DOD Worldwide Numbers for TBI

.PDF | 427.58 KB

TBICoE is the Defense Department's office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you'll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in calendar year 2020. The data is also broken down by each branch of the armed services.

Publication
Sep 30, 2020

2000-2019 DoD Worldwide Numbers for TBI

.PDF | 586.61 KB

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis from 2000-2019.

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Aug 10, 2020

2012 DoD Worldwide Numbers for TBI

.PDF | 2.93 MB

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

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Aug 10, 2020

2011 DoD Worldwide Numbers for TBI

.PDF | 3.34 MB

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

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Aug 10, 2020

2016 DoD Worldwide Numbers for TBI

.PDF | 3.30 MB

DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

Last Updated: May 20, 2024
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