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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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Fact Sheet
Mar 7, 2024

Medical Devices for Assessment of TBI Fact Sheet

.PDF | 698.53 KB

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 shares some considerations for clinicians and researchers before using a device.

Fact Sheet
Mar 6, 2024

Managing Headaches Following Concussion Fact Sheet

.PDF | 592.42 KB

This patient fact sheet on managing headache following concussion will help patients understand post-traumatic headache basics, triggers, and non-drug remedies. Post-traumatic headache is one of the most common and persistent symptoms of mild traumatic brain injury.

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
Jun 14, 2023

Leader Policy Guidance for Mild TBI/Concussion in the Deployed Setting Fact Sheet

.PDF | 723.27 KB

This document describes the line leader responsibilities for the Department of Defense mandated policy, DOD Instruction 6490.11, “DOD Policy Guidance for the Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting,” that applies to all service members involved in potentially concussive events in deployed settings.

Fact Sheet
Nov 16, 2022

Healthy Sleep Following Concussion/mTBI Fact Sheet

.PDF | 108.25 KB

Getting restful sleep is one of the most important things you can do for your health, and it often takes thoughtful preparation during the day. This fact sheet offers service members and veterans who experience sleep disturbances after a concussion with healthy sleep tips that can likely improve sleep.

Fact Sheet
Sep 14, 2022

Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet

.PDF | 168.72 KB

The Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet, developed by TBICoE, is a one page document that gives primary care managers (PCMs) an overview of neuroendocrine dysfunction (NED) that can occur after concussion, or mild TBI. It highlights conditions with overlapping symptoms, screening and treatment considerations, ...

Fact Sheet
Apr 28, 2021

Help With Ongoing Symptoms Following Concussion/Mild TBI Fact Sheet

.PDF | 144.49 KB

Although the majority of service members recover from concussion with little to no intervention, some experience symptoms beyond the first three months after their initial injury. This fact sheet addresses why symptoms continue to persist in some patients and how they can cope or seek additional help.

Fact Sheet
Jul 30, 2020

Neck Pain Following Concussion/mTBI Fact Sheet

.PDF | 205.90 KB

Neck pain can occur together with headaches following a concussion. This TBICoE fact sheet provides information to help patients manage neck pain. Various techniques are explained, including the use of heat or cold therapy, neck stretches, proper sleep positions and common activities that may contribute to neck strain.

Fact Sheet
Jul 30, 2020

Ways to Improve Your Memory Following Concussion/mTBI Fact Sheet

.PDF | 158.74 KB

This TBICoE fact sheet can be used by health care providers to educate patients with concussion, or mild traumatic brain injury, on how to manage memory problems related to their injury.

Fact Sheet
Jul 30, 2020

Concussion/Mild TBI Signs and Symptoms Spanish Version Fact Sheet

.PDF | 455.08 KB

This fact sheet — in Spanish — identifies major physical, cognitive and emotional symptoms of concussion/mild TBI, and provides coping and recovery tips.

Last Updated: May 20, 2024
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