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TBI Provider Resources

TBICoE develops practical, easy-to-use clinical recommendations and tools to support military and civilian health care providers in assessing and treating service members and veterans who have sustained a TBI. Providers can access clinically relevant information and resources that address common symptoms associated with mild TBI, such as headache, sleep disturbances, and vision problems. We also offer Provider Education materials for our clinical recommendations and tools.

Most clinical recommendations have related patient resources to help providers educate patients through recovery. Check out the Patient and Family Resources section to locate fact sheets, patient resources, and family and caregiver support tools.

TBI educators, known as regional education coordinators, are available to provide training on our clinical recommendations and tools.

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 version 2—and to ensure timely access to repeat evaluations with personalized treatment protocols in alignment with a progressive return to activity process. By establishing a standard pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated system of readiness and health.

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 DHA's 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 infographic 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. 

What is the Acute Concussion Care Pathway? The Acute Concussion Care Pathway is one of the DHA Director’s Quadruple Aim Performance Plan projects. The intent is to equip providers with state-of-the-science tools to standardize concussion assessment and care across the MHS. It is supported by the DHA Procedural Instruction 6490.04 which establishes the infrastructure to ensure patients achieve optimal concussion clinical outcomes.  What is the Acute Concussion Care Pathway?

Download the ACC Pathway Infographic

TBICoE also offers a quarterly "Application of 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, also known as concussion, 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 and are available for download below.

 

MACE 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

Download the Recurrent Concussion Evaluation

 

ICD-10 Coding Guidance for TBI

Download the ICD-10 Coding Guidance for TBI

Clinical Recommendations and Support Tools for Mild TBI

TBICoE optimizes clinical care by combining evidence from medical literature, health care research and expert opinion to develop and provide clinical suites 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.
 

*NEW* Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet

Learn more and download this new provider tool here!

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

 

Headache Following Concussion/Mild TBI

 

Cognitive Rehabilitation Following Mild to Moderate TBI

 

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

 

Additional Clinical Support Tools

TBICoE also offers the following tools to assist in the identification, treatment and management of patients with mild TBI in deployed and non-deployed settings.

Find and download the additional tools here.

You also may be interested in...

Publication
Mar 24, 2021

TBI Hot Topics Bulletin March 2021

.PDF | 133.46 KB

Are you a busy health care provider? Not enough time to keep up with the latest TBI research trends and news? Stay informed with the TBI Hot Topics Bulletin. TBICoE tracks the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the fourth quarter of calendar year 2020.

Video
Feb 25, 2021

Progressive Return to Activity After Concussion Video

Progressive Return to Activity Provider Video

The PRA is an evidence-based, easy-to-use approach to help providers return service members with mild TBIs back to duty safely. TBICoE researchers have found that, if medical providers completed a two-hour, in-person training on the use of the PRA, their patients saw an overall reduction in symptoms after one week, one month, and three months, when ...

Infographic
Feb 24, 2021

Returning to Duty After Concussion

What's the best way to recover from a concussion? Returning to duty too soon after a concussion can lead to prolonged symptoms, decreased readiness, poor marksmanship, accidents and falls, and increased risk of more concussions. Progressively increasing activity in a step-wise manner can help you resolve your symptoms and return to duty safely. Ask your primary health care provider about TBICoE's Progressive Return to Activity to help you return to duty as quickly and safely as possible. Visit health.mil/TBICoE.

This TBICoE infographic gives an overview of the risks of returning to duty too soon after a concussion and explains how a progressive increase in activity can help get you back to duty safely. Returning to duty too soon after concussion can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of ...

Publication
Feb 23, 2021

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

.PPTX | 7.22 MB

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.

Publication
Aug 10, 2020

2018 DoD Worldwide Numbers for TBI

.PDF | 1.09 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.

Publication
Aug 10, 2020

2017 DoD Worldwide Numbers for TBI

.PDF | 3.24 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.

Publication
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.

Publication
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.

Last Updated: July 21, 2023
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