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TBI Resources

The documents below are select tools and resources from the Traumatic Brain Injury (TBI) portfolio of resources in the DOD. The documents listed here are DOD policies on TBI and resources that support those policies. If you are looking for additional information on TBI, please visit the Traumatic Brain Injury Center of Excellence webpages. TBICoE is the TBI Pathway of Care manager within the MHS and promotes state-of-the-science care from point-of-injury to reintegration for service members, veterans, and their families to prevent and mitigate consequences of mild to severe TBI.

File Description
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.
Military Acute Concussion Evaluation 2 (MACE 2) The 2018 Military Acute Concussion Evaluation 2 (MACE 2) is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The MACE 2 incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening. The MACE 2 is an update to and replaces the original MACE.
Progressive Return to Activity Following Acute Concussion/Mild TBI The 2021 Progressive Return to Activity (PRA) Following Acute Concussion/Mild Traumatic Brain Injury 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.
DoD Instruction Number 6490.11: DoD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting This instruction establishes policy, assigns responsibilities, and provides procedures on the management of mild traumatic brain injury (mTBI), also known as concussion, in the deployed setting.
DoD Instruction 6490.13: Comprehensive Policy on Traumatic Brain Injury-Related Neurocognitive Assessments by the Military Services This instruction establishes policy, assigns responsibilities, and prescribes standard elements, pursuant to section 722 of Public Law 111-383, requiring the implementation of a comprehensive neurocognitive assessment policy in the Military Services.
Recurrent Concussion Evaluation The TBICoE Recurrent Concussion Evaluation card is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.
Indications and Conditions for In-Theater Post-Injury Neurocognitive Assessment Tool (NCAT) Testing This clinical recommendation provides background of pre-deployment neurocognitive testing and the use of automated neuropsychological assessment metrics.
Neuroimaging Following Mild TBI in the Non-Deployed Setting Clinical Recommendation The Neuroimaging Following Mild TBI in the Non-Deployed Setting clinical recommendation offers guidance for a standard approach for imaging from the acute through chronic stages following mild TBI in the non-deployed setting.
Neurobehavioral Symptom Inventory Form Form used by providers to question patients about their symptoms
Patient Global Impression Change Scale Form filled out by patients to rate their changes in activity, symptoms, emotions and quality of life.
Traumatic Brain Injury: Updated Definition and Reporting This memorandum updates the DoD definition of TBI, severity of brain injury stratification, and method of data collection.

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