Skip main navigation

Military Health System

Hurricane Milton & Hurricane Helene

Emergency procedures are in place in multiple states due to Hurricane Milton & Hurricane Helene. >>Learn More

Updated tools and training improve TBI and concussion recovery

Image of A group of military personnel wearing face mask working on laptop computers. Air National Guard service members from the 119th Civil Engineer Squadron take a baseline neuro-cognitive assessment known as an Automated Neuropsychological Assessment Metric as part of their pre-deployment training at the North Dakota Air National Guard Base, Fargo North Dakota, Feb. 6, 2021. This assessment can be repeated and used by medical professionals in the event of a suspected traumatic brain injury or concussion (Photo by: Air National Guard Tech. Sgt. Nathanael Baardson).

Up-to-date clinical tools help military health care providers diagnose and manage traumatic brain injury (TBI) on and off the battlefield. And an increased focus on training providers to use these tools is improving patient outcomes and mission readiness, according to research by the Traumatic Brain Injury Center of Excellence.

TBICoE recently conducted research on the Department of Defense Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury clinical recommendations for managing headaches, as well as the Military Acute Concussion Evaluation 2, known as MACE 2.

TBICoE assessed the effectiveness of the return-to-activity guidelines after offering on-site training to providers. Using a similar study design, TBICoE also reported on the effectiveness of a post-traumatic headache management clinical recommendation. At the end of 2020, TBICoE published results of a study on the usability and utility of its MACE 2 screening tool when used in the field.

"We are applying what began with the (return to activity guidelines) a few years back to other TBICoE products," said TBICoE Division Chief, Navy Capt. (Dr.) Scott Pyne. "By training providers in how to use our state-of-the science tools and rehabilitation strategies, patients get better faster, and this contributes to our mission goals of better health and readiness."

TBICoE is a division of the Defense Health Agency Research and Development Directorate.

Based on a study at Army, Navy, and Marine installations, TBICoE researchers found training providers on the return-to-activity guidelines expanded their knowledge, leading to changes in concussion management, and in turn, a positive impact on patient outcomes. The researchers gave providers standardized training on the content and how to clinically apply return-to-activity guidelines for service members with acute concussion. The clinical recommendation describes how to gradually increase patient activity through six stages. The study assessed providers' approach to patient progression through the stages before and after the training.

“Providers who are directly trained in return-to-activity guidelines are more likely to provide effective patient education, ultimately helping their patients to recover more rapidly,” wrote Mark Ettenhofer, a TBICoE research neuropsychologist at Naval Medical Center San Diego, in an article authored with TBICoE colleagues at Fort Bragg, North Carolina; Camp Pendleton, California; and TBICoE headquarters in Silver Spring, Maryland. Recently, TBICoE revised the return-to-activity recommendations to align with the latest scientific literature findings.

TBICoE also assessed the effectiveness of its headache management clinical recommendation, and found instructing providers in its use also improved outcomes. Like the return-to-activity study, providers learned about the headache management clinical recommendation, which provides tools for assessing post-traumatic headaches and contains both drug and non-drug interventions for decreasing their frequency, severity, and duration. The researchers assessed the providers’ treatment approaches before and after instruction, and found, after training, providers scheduled follow-up visits more frequently, which led to better patient monitoring.

"The results presented in this study demonstrate the potential of the Management of Headache Following Concussion (Clinical Recommendation) to promote provider knowledge and confidence in treating (post-traumatic headaches) in a military setting. This in turn may translate to timely return to duty," wrote Camp Pendleton Research Scientist Rosemay Remigio-Baker and colleagues.

In another study published in 2020, TBICoE researchers showed primary care managers and medics could use the MACE 2 screening tool effectively. Designed by TBICoE in conjunction with the TBI Advisory Committee and the military services, the MACE 2 enables users in the field to screen for common symptoms, cognitive deficits, and neurological signs following concussion. Revised in 2018 to improve accuracy, the newer tool now assesses balance and eye motion, increasing screening time.

Bilal Khokhar, an epidemiologist at TBICoE, and his colleagues surveyed 28 active duty primary care managers and 22 Army combat medics. They were asked to rate, on a scale from strongly disagree to strongly agree, whether they could use the tool, whether various tests were helpful, and whether they were confident about those tests.  When the individual responses were averaged by category of question, the response was positive, and no overall average score fell below the neutral rating.

"Despite the increased complexity and duration of the MACE 2 compared with the previous version of this tool, military providers and Army medics found the new MACE 2 very useable and had a high degree of confidence in its performance," wrote Khokhar and colleagues. However, the researchers cautioned that future studies may result in additional revisions.

"Work must be performed in perpetuity to deliver a product usable by clinicians that offers the greatest validity," said Seth Kiser, the study's senior author and a research scientist at TBICoE.

All these studies demonstrate how TBICoE draws on its expertise in research, clinical affairs, and education to continually update its products and facilitate training, so providers will always "Be TBI ready," based on the latest science. Providers can get the most current information on these tools from TBICoE’s publications, and obtain training on their use from regional education coordinators.

To learn more about Brain Injury Awareness Month, check out the BIAM page on Health.mil.

You also may be interested in...

Publication
Oct 8, 2024

Nov. 14, 2024, TBICoE QES Event: Optimizing Hearing and Vision Recovery Care

.PDF | 114.74 KB

Join TBICoE as we explore point of injury testing to help identify vision and hearing problems after a TBI. Subject matter experts will discuss available tools, therapy options, and current resources to maximize a patient's recovery of sensory systems.

Video
Aug 30, 2024

New Warfighter Brain Health Provider Toolkit App

New Warfighter Brain Health Provider Toolkit App

Looking for a one-stop shop for TBI-related assessments and resources? Now, on any device, you can find one. Access numerous provider and patient resources with the new Warfighter Brain Health Provider Toolkit app. Developed for MHS providers, the app features a wide array of products from the Traumatic Brain Injury Center of Excellence, the DOD, the ...

Topic
Sep 3, 2024

TBICoE Podcasts

TBICoE produces multiple podcast series focused on various TBI-related topics. Listen to, subscribe to or download episodes on DVIDS or wherever you listen to podcasts.

Fact Sheet
Aug 29, 2024

Low-Level Blast: Fact Sheet for DOD Providers

.PDF | 817.46 KB

Low-level blast is defined as blast generated from firing heavy weapon systems or explosives in combat or training environments. Exposure to low-level blast does not typically result in a clinically diagnosable concussion, also known as mild traumatic brain injury. TBICoE developed this fact sheet for DOD health care providers.

Report
Aug 29, 2024

2000-2023 DOD TBI Worldwide Numbers At-A-Glance

.PDF | 837.04 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. The "DOD TBI Numbers At-A-Glance" provide a high-level overview of TBI's sustained since 2000 and also show the data by severity and service branch.

Report
Aug 29, 2024

2023 DOD Worldwide Numbers for TBI

.PDF | 998.97 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 2023. The data is also broken down by each branch of the armed services.

Report
Aug 29, 2024

2024 Q1 DOD Worldwide Numbers for TBI

.PDF | 995.78 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 the first quarter of calendar year 2024. The data is also broken down by each branch of the ...

Skip subpage navigation
Refine your search
Last Updated: January 22, 2024
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery