Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

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...

Article Around MHS
Nov 29, 2023

Green Beret Teams Up with the US Southern Command Warrior Care Program Care Coalition Competes in Department of Defenses Warrior Games Challenge and International Invictus Games

U.S. Army Sgt. 1st Class Jacob “Jake” Anthony competing in the 2023 Invictus Games held in Dusseldorf, Germany. (Courtesy photo)

Green Beret U.S. Army Sgt. 1st Class Jacob "Jake” Anthony was deployed to Afghanistan in 2005 on a mission to find a target. His team was breaching a door that turned out to be booby-trapped, resulting in an explosion that killed his teammate in front of him. Anthony would take shrapnel to the right frontal lobe to his brain and had to be initially ...

Publication
Nov 29, 2023

TBICoE's Low-Level Blast Research Efforts Infographic

.PDF | 2.12 MB

This infographic illustrates TBICoE's work to better understand how low-level blast influences warfighter brain health. These efforts directly support Line of Effort 2 of the Warfighter Brain Health Initiative.

Video
Nov 6, 2023

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training video is an essential resource for enhancing the Department of Defense's Warfighter Brain Health Initiative. It empowers military leaders with strategies for preventing, protecting against, and managing brain injuries. Additionally, the video enhances leaders' abilities to assess and recognize symptoms ...

Fact Sheet
Nov 6, 2023

Warfighter Brain Health After TBI: Guidance for Leaders

.PDF | 895.85 KB

This TBICoE fact sheet, Warfighter Brain Health After TBI: Guidance for Leaders, condenses the basics of recognizing, reporting, and preventing TBI in service members. It updates and supersedes the Line Leader Policy Guidance fact sheet and includes a list of what the DOD has defined as potentially concussive events and outlines leaders’ ...

Publication
Sep 29, 2023

Mild TBI and PTSD Clinical Pearls

.PDF | 924.82 KB

TBICoE's "Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Clinical Pearls," is a new supplemental product to the detailed research review. This resource is designed to be brief and provide key actionable “clinical pearls” that should be considered in the treatment of service members with comorbid mild TBI and PTSD.

Publication
Sep 29, 2023

TBICoE Research Review: Mild TBI and PTSD

.PDF | 435.28 KB

This research review provides an in-depth summary of the available clinical research on the topic of co-morbid mild traumatic brain injury and posttraumatic stress disorder. Specifically, this review will address symptoms, anatomy, diagnosis, and treatment of mild TBI, PTSD, and the unique circumstances associated with the presentation of both.

Video
Sep 21, 2023

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

This educational video, produced by the Traumatic Brain Injury Center of Excellence, focuses on the effects of low-level blast and traumatic brain injury. Its purpose is to provide supplemental information on low-level blast to health care providers and beneficiaries.

Technical Document
Jul 20, 2023

Infographic: What is the Acute Concussion Care Pathway?

.PDF | 714.95 KB

TBICoE developed this infographic as a quick reference tool that demonstrates application of the standardized acute concussion assessment and care process. By adhering to this established pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated, standardized system of readiness and ...

Fact Sheet
Jul 18, 2023

Low-Level Blast: Fact Sheet for Providers

.PDF | 1.26 MB

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. Both providers and service members should be aware of the potential effects of low ...

Fact Sheet
Jul 18, 2023

Low-Level Blast: Fact Sheet for Service Members

.PDF | 867.41 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. Both providers and service members should be aware of the potential effects of low ...

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