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TBI Provider Resources

TBICoE develops practical, easy-to-use clinical 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 their patients through recovery. Check out the Patient and Family Resources section to locate fact sheets, family and caregiver support tools.

TBI educators, known as regional education coordinators, may also be available in your location to provide training on our clinical tools. Email TBICoE's dissemination team to be connected with an REC nearest you.

Supporting TBI Resources for DODI 6490.11 and DHA-PI 6490.04

The DODI 6490.11, DOD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting establishes policy, assigns responsibilities, and provides procedures on the management of mild traumatic brain injury (mTBI), also known as concussion, in the deployed setting. The DHA-PI 6490.04 Required Clinical Tools and Procedures for Assessment and Clinical Management of Mild Brain Injury (mTBI)/Concussion in Non-Deployed Setting establishes the Defense Health Agency's required clinical tools and procedures for management of mTBI/concussion, specifically, the use of the Military Acute Concussion Evaluation, Version 2 (MACE 2) and a progressive return to activity (PRA) framework for the assessment, management, and rehabilitation of all patients with mTBI/concussion.

The following resources specifically support these policies.

Military Acute Concussion Evaluation 2 (MACE 2)

Progressive Return to Activity: Primary Care for Acute Concussion Management

Recurrent Concussion Evaluation Card

ICD-10 Coding Guidance for TBI

Clinical Recommendations 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.

Learn more about clinical recommendations and supporting resources.

*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...

Acute Concussion Care Pathway: MACE 2 and PRA Training

Publication
5/12/2023

The Traumatic Brain Injury Center of Excellence is hosting a combined Military Acute Concussion Evaluation 2 and Progressive Return to Activity clinical recommendation virtual training.

Anomalous Health Incident Acute Assessment Training

Publication
4/17/2023

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce MHS health care providers to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident (AHI) Acute Assessment (DHA Form 244), will be provided.

2023 TBICoE Quarterly Education Series Schedule

Publication
4/14/2023

The Traumatic Brain Injury Center of Excellence's Quarterly Education Series is an enterprise-wide learning opportunity for Military Health System stakeholders. Since inception, the QES provides trainings and events that are relevant to the MHS, discussing specialty topics and current research related to TBI.

2022 TBICoE Publication Catalog

Publication
4/7/2023

TBICoE publication citations and summaries are organized by category, or overarching research topic. The purpose of this document is to (1) summarize key findings and potential clinical implications of calendar year 2022 TBICoE publications, (2) increase awareness, and (3) assist in planning of future efforts.

TBI—The Female Experience

Publication
4/6/2023

Join the Traumatic Brain Injury Center of Excellence for an exploration of the unique ways in which brain injury manifests in the female population at the next Quarterly Education Series virtual event. Etiology, symptomatology, and diagnosis can be nuanced and have long gone unstudied in women. Experts will discuss a new wave of research, clinical support, and barriers for females with TBI. TBICoE's QES is an enterprise-wide learning opportunity for Military Health System stakeholders.

TBICoE Research Review: Chronic Traumatic Encephalopathy

Publication
3/17/2023

The purpose of this Research Review is to summarize current peer-reviewed scientific literature and expert assessment regarding the pathology, genetic pre-disposition, causes, clinical manifestations, and neuroimaging of chronic traumatic encephalopathy.

Back to School: A Guide to Academic Success After Traumatic Brain Injury

Publication
3/16/2023

Back to School: A Guide to Academic Success After Traumatic Brain Injury is a free resource, developed by the Traumatic Brain Injury Center of Excellence that is tailored to help service members and veterans who have sustained a TBI and are pursuing higher education. Those who have sustained a TBI may face unique challenges, and this guide provides information and resources on how to navigate higher education while still prioritizing brain health care.

INFORMATION PAPER: The Impact of Mild Traumatic Brain Injury on the Autonomic Nervous System

Publication
3/15/2023

The purpose of this information paper by TBICoE is to provide a general overview of the current evidence related to the impact of concussion/mild traumatic brain injury (mTBI) on the autonomic nervous system (ANS). This paper will focus on heart rate variability (HRV), pupillary light reflex (PLR), and hyperhidrosis within the military and civilian populations.

FEB 2023 TBICoE Quarterly Education Series Flyer

Publication
2/8/2023

TBICoE Quarterly Education Series: TBI Across the Lifespan. Join TBICoE at this virtual event to explore clinical best practices for prevention, assessment, and treatment of mild TBI, also known as concussion, for military dependents. Download the flyer for details.

Progressive Return to Activity: Primary Care for Acute Concussion Management

Publication
1/23/2023

The Progressive Return to Activity (PRA): Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Neuroimaging Following Mild TBI Clinical Recommendation

Publication
5/16/2022

This TBICoE clinical recommendation allows primary care managers to make an informed, evidenced-based decision regarding whether or not imaging is indicated following a concussion/mild TBI.

2021 Traumatic Brain Injury Center of Excellence Annual Report

Publication
4/26/2022

The 2021 Traumatic Brain Injury Center of Excellence (TBICoE) Annual Report provides a look at accomplishments and activities from calendar year 2021.

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

Publication
10/22/2021

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.

Improving Relationships after TBI

Publication
10/21/2021

Flier for the Interactive Relationship Building Workshop for Active-Duty Military and Veteran TBI Caregivers and Families: This flier provides information on TBICoE's educational session for caregivers of active-duty service members and veterans who have sustained a TBI. In addition to sharing caregiver resources and current research initiatives, webinar topics will also include relationship building strategies, improving communication and addressing intimacy after TBI.

PRA Case Study Workbook

Publication
7/23/2021

This workbook, paired with corresponding PRA Training Video 8, is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity. We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion.

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Last Updated: February 17, 2023
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