Back to Top Skip to main content Skip to sub-navigation

Updated tools and training improve TBI and concussion recovery

A group of military personnel wearing face mask working on laptop computers Air National Guard service members from the 119th Civil Engineer Squadron take a baseline neuro-cognitive assessment known as an Automated Neuropsychological Assessment Metric as part of their pre-deployment training at the North Dakota Air National Guard Base, Fargo North Dakota, Feb. 6, 2021. This assessment can be repeated and used by medical professionals in the event of a suspected traumatic brain injury or concussion (Photo by: Air National Guard Tech. Sgt. Nathanael Baardson).

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Up-to-date clinical tools help military health care providers diagnose and manage traumatic brain injury (TBI) on and off the battlefield. And an increased focus on training providers to use these tools is improving patient outcomes and mission readiness, according to research by the Traumatic Brain Injury Center of Excellence.

TBICoE recently conducted research on the Department of Defense Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury clinical recommendations for managing headaches, as well as the Military Acute Concussion Evaluation 2, known as MACE 2.

TBICoE assessed the effectiveness of the return-to-activity guidelines after offering on-site training to providers. Using a similar study design, TBICoE also reported on the effectiveness of a post-traumatic headache management clinical recommendation. At the end of 2020, TBICoE published results of a study on the usability and utility of its MACE 2 screening tool when used in the field.

"We are applying what began with the (return to activity guidelines) a few years back to other TBICoE products," said TBICoE Division Chief, Navy Capt. (Dr.) Scott Pyne. "By training providers in how to use our state-of-the science tools and rehabilitation strategies, patients get better faster, and this contributes to our mission goals of better health and readiness."

TBICoE is a division of the Defense Health Agency Research and Development Directorate.

Based on a study at Army, Navy, and Marine installations, TBICoE researchers found training providers on the return-to-activity guidelines expanded their knowledge, leading to changes in concussion management, and in turn, a positive impact on patient outcomes. The researchers gave providers standardized training on the content and how to clinically apply return-to-activity guidelines for service members with acute concussion. The clinical recommendation describes how to gradually increase patient activity through six stages. The study assessed providers' approach to patient progression through the stages before and after the training.

“Providers who are directly trained in return-to-activity guidelines are more likely to provide effective patient education, ultimately helping their patients to recover more rapidly,” wrote Mark Ettenhofer, a TBICoE research neuropsychologist at Naval Medical Center San Diego, in an article authored with TBICoE colleagues at Fort Bragg, North Carolina; Camp Pendleton, California; and TBICoE headquarters in Silver Spring, Maryland. Recently, TBICoE revised the return-to-activity recommendations to align with the latest scientific literature findings.

TBICoE also assessed the effectiveness of its headache management clinical recommendation, and found instructing providers in its use also improved outcomes. Like the return-to-activity study, providers learned about the headache management clinical recommendation, which provides tools for assessing post-traumatic headaches and contains both drug and non-drug interventions for decreasing their frequency, severity, and duration. The researchers assessed the providers’ treatment approaches before and after instruction, and found, after training, providers scheduled follow-up visits more frequently, which led to better patient monitoring.

"The results presented in this study demonstrate the potential of the Management of Headache Following Concussion (Clinical Recommendation) to promote provider knowledge and confidence in treating (post-traumatic headaches) in a military setting. This in turn may translate to timely return to duty," wrote Camp Pendleton Research Scientist Rosemay Remigio-Baker and colleagues.

In another study published in 2020, TBICoE researchers showed primary care managers and medics could use the MACE 2 screening tool effectively. Designed by TBICoE in conjunction with the TBI Advisory Committee and the military services, the MACE 2 enables users in the field to screen for common symptoms, cognitive deficits, and neurological signs following concussion. Revised in 2018 to improve accuracy, the newer tool now assesses balance and eye motion, increasing screening time.

Bilal Khokhar, an epidemiologist at TBICoE, and his colleagues surveyed 28 active duty primary care managers and 22 Army combat medics. They were asked to rate, on a scale from strongly disagree to strongly agree, whether they could use the tool, whether various tests were helpful, and whether they were confident about those tests.  When the individual responses were averaged by category of question, the response was positive, and no overall average score fell below the neutral rating.

"Despite the increased complexity and duration of the MACE 2 compared with the previous version of this tool, military providers and Army medics found the new MACE 2 very useable and had a high degree of confidence in its performance," wrote Khokhar and colleagues. However, the researchers cautioned that future studies may result in additional revisions.

"Work must be performed in perpetuity to deliver a product usable by clinicians that offers the greatest validity," said Seth Kiser, the study's senior author and a research scientist at TBICoE.

All these studies demonstrate how TBICoE draws on its expertise in research, clinical affairs, and education to continually update its products and facilitate training, so providers will always "Be TBI ready," based on the latest science. Providers can get the most current information on these tools from TBICoE’s publications, and obtain training on their use from regional education coordinators.

To learn more about Brain Injury Awareness Month, check out the BIAM page on Health.mil.

You also may be interested in...

USU Co-leads Largest NCAA-DOD Concussion Study in History

Article
10/8/2021
A doctor looks at a patient's prosthetic arm.

The Uniformed Service University will co-lead the next phase of the largest concussion and repetitive head impact study.

Recommended Content:

Traumatic Brain Injury

Back from the Brink: One Marine's Recovery from Suicidal Thoughts

Article
9/29/2021
Portrait photo of John Peck

After suffering a TBI in Iraq and losing all four limbs in Afghanistan, Marine Sgt. John Peck talks about his own experience and the differences in the ways in which individuals deal with traumatic life events.

Recommended Content:

Traumatic Brain Injury | Suicide Prevention | Talking About Afghanistan

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

Article
9/28/2021
Picture of blast waves during an explosion

A clear link between blast-related concussions and mental health symptoms like depression, anxiety, and PTSD, is shown in a series of recent studies.

Recommended Content:

Traumatic Brain Injury

NICoE, NHRC Team Up To Make CAREN Technology Portable

Article
8/12/2021
A person walks in front of a large virtual reality screen.

Head-mounted display technology has become more affordable and accessible

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

Caregiver Guide supports service members and veterans with TBI

Article
7/22/2021
Military family posing for a picture

Traumatic Brain Injury Center of Excellence’s 2021 Caregiver Guide provides specific tools to help caregivers manage TBI patient recovery.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury | TBI Education and Training Events

Aphasia, Caused by Stroke or TBI, is Frustrating and Little Known

Article
6/29/2021
A doctor looking at brain scans

Aphasia is an incurable disease usually caused by stroke that affects all forms of communication.

Recommended Content:

Total Force Fitness | Heart Health | Centers of Excellence | Traumatic Brain Injury

Signs and symptoms of a stroke, and what to do about them

Article
5/18/2021
Infographic about the sign of a stroke

For Stroke Awareness Month, we highlight some of the most important facts about strokes in men and women.

Recommended Content:

Health Readiness | Traumatic Brain Injury

TRIP initiative bridges the gap between TBI research, clinical care

Article
5/13/2021
a statue of a broken circle

The Defense Intrepid Network launches the TRIP initiative to translate research findings into clinical practice.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Centers of Excellence

NICoE at forefront of traumatic brain injury research and treatment

Article
5/3/2021
Picture of a mask with the American flag on one side and camo on the other side

The National Intrepid Center of Excellence is dedicated to treating and researching TBI injuries with the aim of getting patients back to maximum function.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Centers of Excellence

METC NDT trainees learn about brain disorders & care

Article
4/23/2021
Military health personnel wearing face mask practicing using an EEG

NDTs help diagnose problems with the brain and nervous system, as well as sleep disorders, by use of state-of-the-art digital equipment to record electrical patterns which result in valuable data that the doctor needs to diagnose and treat their patients.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month

DOD warfighter brain health draft plan has six priorities

Article
3/31/2021
Military medical personnel looking at a patient's brain scan

Cognitive testing documentation throughout a service member’s career and beyond is one of six major operational concerns and priorities of service members.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

DHA Centers of Excellence collaborate to improve TBI care

Article
3/31/2021
Medical personnel holding a model of the inner ear

The centers of excellence are divisions of the Defense Health Agency Research and Development Directorate.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Intrepid Spirit Centers promote healing from traumatic brain injury

Article
3/30/2021
Military health personnel in physical therapy

Intrepid Spirit Centers help heal TBI service members’ brains with interdisciplinary program and model of care.

Recommended Content:

Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Traumatic Brain Injury Center of Excellence | A Head for the Future | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Women leaders say military health care offers limitless opportunities

Article
3/30/2021
Military personnel speaking through a microphone

Women military health leaders speak on way toward equity and limitless opportunities.

Recommended Content:

Women's Health | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Five ways to keep your brain healthy

Article
3/30/2021
Infographic with five ways to keep your brain healthy

Five ways to keep your brain healthy

Recommended Content:

Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Traumatic Brain Injury Center of Excellence | A Head for the Future | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit
<< < 1 2 3 4 > >> 
Showing results 1 - 15 Page 1 of 4

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.