Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

DHA Centers of Excellence collaborate to improve TBI care

Image of Medical personnel holding a model of the inner ear. Elizabeth Kirkpatrick, the physical therapist for the Fort Drum Traumatic Brain Injury Clinic at Fort Drum, New York, uses a model of the inner ear to show how a concussion can lead to dizziness and other problems. (Photo by Warren Wright Jr., Fort Drum MEDDAC.)

When a rocket-propelled grenade struck her helicopter in Afghanistan in 2011, Army Staff Sgt. Beth King sustained a traumatic brain injury and was later diagnosed with post-traumatic stress disorder. Following the event, she experienced headaches, difficulty concentrating, and problems moving around.

King’s story in the A Head for the Future video series shares how she overcame balance issues and learned to pedal a recumbent bicycle and went on to win a gold medal in cycling at the 2019 Warrior Games.

King’s story illustrates the critical role collaboration plays among the Defense Health Agency’s centers of excellence in improving recovery from a traumatic brain injury (TBI).

“Patients often have comorbid conditions such as headache, vertigo, dizziness, and visual disturbances. The joint efforts of the TBI, Psychological Health, Vision, and Hearing Centers of Excellence allow us to cover all aspects of care and management with these unique cases,” said Gary McKinney, chief of clinical practice and clinical recommendations at the Traumatic Brain Injury Center of Excellence (TBICoE) in Silver Spring, Maryland. The centers of excellence are divisions of the Defense Health Agency Research and Development Directorate.

Military soldier looking through a pair of colored glasses A TBI patient at the Intrepid Spirit Center on Fort Bragg, North Carolina, uses colored glasses as part of vision rehabilitation, Dec. 15, 2017. (Photo by Army Sgt. Paige Behringer.)

Dizziness, for example, touches the work being done at several DHA centers of excellence, as damage to different parts of the brain or vestibular system in the inner ear can affect balance, vision and hearing.

According to one study, vestibular complaints were reported by half of TBI patients five years after injury. In 2018, TBICoE revised its clinical screening tool, now called the Military Acute Concussion Evaluation 2, to aid in assessing balance. Recently, TBICoE began revising its 2012 recommendation on dizziness, in collaboration with both the vision and hearing centers. The earlier recommendation was also a collaborative endeavor, based on the results of a 2011 conference consensus.

Vision problems related to TBI also provide opportunities to collaborate.

“It has been estimated that between 43% and 75% of people experiencing TBI events will also experience some form of vision dysfunction, which is why it is beneficial to have eye care professionals assess vision in patients who are involved in a TBI event,” said Dr. Michael Pattison, an optometrist and program manager at the Vision Center of Excellence (VCE). TBICoE participated in developing VCE’s clinical recommendations for treating vision dysfunction in TBI patients. TBICoE staff, including Division Chief Navy Capt. (Dr.) Scott Pyne, served on VCE’s working group, along with vision specialists and other subject matter experts.

TBICoE also worked closely with DHA’s Psychological Health Center of Excellence (PHCoE) to address TBI and PTSD for military health care providers. TBICoE produced a research review on these often co-occurring conditions.

Pattison also pointed out how collaboration contributed to DHA’s mission of satisfied patients and mission readiness.

“With these centers of excellence working together, we can utilize our biggest strengths, the variety of perspectives and experiences we all possess, to provide those that we are entrusted to take care of with the best possible solutions for assisting them to return to full duty and their highest quality of life,” he added. “It has to be a collaborative team approach to meet that mission.”

You also may be interested in...

Publication
Feb 23, 2024

Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

.PDF | 1.03 MB

This clinical recommendation provides medical staff with a single, comprehensive reference for the assessment and management of dizziness and visual disturbances following mild TBI/concussion. Dizziness and visual disturbances often present with overlapping symptoms and should prompt a provider to perform a visual and dizziness—or vestibular—assessment.

Publication
Feb 23, 2024

Progressive Return to Activity: Primary Care for Acute Concussion Management

.PDF | 472.50 KB

This clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury clinic providers. The PRA is a six-step approach that begins after the provider performs the MACE 2 (Military Acute Concussion Evaluation 2) and the patient is diagnosed with a concussion, also known as a mild TBI.

Report
Feb 22, 2024

2000-2023 Q3 DOD Worldwide Numbers for TBI

.PDF | 1.47 MB

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 from calendar year 2000 through the third quarter of calendar year 2023. The data is also broken ...

Report
Feb 22, 2024

2023 Q3 DOD Worldwide Numbers for TBI

.PDF | 1.29 MB

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 third quarter of calendar year 2023. The data is also broken down by each branch of the ...

Report
Feb 22, 2024

2022 DOD Worldwide Numbers for TBI

.PDF | 1.19 MB

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 calendar year 2022. The data is also broken down by each branch of the armed services.

Calendar Event
Feb 16, 2024

Virtual Reality, "Walk and Talk" Therapy, and Reconsolidation of Traumatic Memories: How Novel Interventions Can Improve the Care of Post-traumatic Stress

A NICOE educational offering with a guest speaker on Virtual Reality, "Walk and Talk" Therapy, and Reconsolidation of Traumatic Memories - part of 2024 BIAM event lineup.

Topic
Feb 8, 2024

Centers of Excellence

Military Health System Centers of Excellence were established to provide the Department of Defense with the ability to speed the advancement of our scientific knowledge and evidence-based practices for diagnosis and treatment of diseases and conditions that impact our military personnel and their families.

Infographic
Feb 8, 2024

Brain Injury Awareness Month: Infographic

Brain Injury Awareness Month infographic, visit health.mil/BIAMonth.

Even a mild traumatic brain injury can impact mission readiness and the ability to deploy. #BeABrainWarrior by understanding the signs and symptoms of TBI and knowing when to seek care. TBI is treatable and recovery is possible. https://health.mil/BIAMonth #BIAMonth

Topic
Feb 6, 2024

Brain Injury Awareness Month

The Department of Defense commits to the protection, and the health and well-being of our people to maximize our ability to defend the nation. Brain health is critical to overall mission readiness. Service members should learn the causes and symptoms of traumatic brain injury, or commonly known as TBI. Knowing when to seek care contributes to overall ...

Article Around MHS
Feb 5, 2024

U.S. Army Medical Research & Development Command Supports Development of Blast Injury Prevention Standard

 Researchers from the Walter Reed Army Institute of Research used data collected during live fire training exercises to create accurate 3D simulations of blast overpressure exposures on virtual weapons crews to help training range managers, range safety officers and instructors position personnel to minimize their exposure to shock waves created by the firing of heavy weapons. The color coding indicates the blast pressure intensity as the wave expands and dissipates.

A new tool being developed by the U.S. Army Medical Research and Development Command’s DOD Blast Injury Research Coordinating Office will help Service Members protect themselves from the effects of high-pressure shock waves created by heavy weapons when they are fired during training.

Video
Jan 31, 2024

Be a Brain Warrior: Protect. Treat. Optimize.

Be a Brain Warrior: Protect. Treat. Optimize.

The Traumatic Brain Injury Center of Excellence is championing the theme 'Be a Brain Warrior: Protect, Treat, Optimize' during Brain Injury Awareness Month. The theme showcases the idea that service members, veterans, healthcare providers, caregivers, family members, and advocates can be warriors for brain health. Visit health.mil/BIAMonth to learn more.

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