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

Updated tools and training improve TBI and concussion recovery

Image of A group of military personnel wearing face mask working on laptop computers. Click to open a larger version of the image. 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 To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness Month | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness

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...

Army Announces FDA Clearance of Field Deployable TBI Blood Test

Article
3/12/2021
Military personnel standing in the snow preparing to fire a missile

The US Army announced Food & Drug Administration clearance of a field-deployable traumatic brain injury blood test.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury | Brain Injury Awareness To Improve Readiness | Health Innovation Toolkit

Distinguishing between TBIs, psychological conditions key to treatment

Article
3/10/2021
Military personnel holding a gun

Expert says long-lasting symptoms may be a sign of another issue.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | TBI and Total Force Fitness

New NICoE director sets an ambitious agenda for the future

Article
3/8/2021
Military personnel wearing face mask while talking to each other

The accomplished new leader of the NICoE and Intrepid Spirit Center network has plans for increased services and a higher profile for the unique care center.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | TBI Education and Training Events | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Centers of Excellence | The National Intrepid Center of Excellence

Proper nutrition impacts overall health & readiness

Article
3/4/2021
Man wearing a face mask restocking fruit at a store

Nutritional fitness implications for Total Force Fitness are far reaching.

Recommended Content:

Total Force Fitness | Nutritional Fitness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness

March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Article
3/2/2021
Military health personnel performing a balance test on a patient

Staying a-head of TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence | Brain Injury Awareness To Improve Readiness | A Head for the Future | Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Centers of Excellence

DHA’s TBI-focused Caregiver & Family Member Study continues at TBICoE

Article
2/19/2021
A husband, wife, and two children sitting at the Warrior and Family Support Center

TBICoE and NICoE continue with the Caregiver and Family Member Study.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Patient and Family Resources | TBICoE Research | TBICoE Podcasts | A Head for the Future

Caregivers share their stories of support for TBI recovery

Article
11/23/2020
Group of people walking and on wheelchairs through the forest

"Recovery is possible to help lead a normal life."

Recommended Content:

Warrior Care | Warrior Care | Warrior Care | Traumatic Brain Injury | Warrior Care

NICoE & ISC Network maintain TBI care during COVID-19

Article
11/19/2020
Image of United States map with locations noted

The Network leveraged their geographic distribution to help each other quickly adapt to changing times.

Recommended Content:

Coronavirus | Traumatic Brain Injury | Coronavirus and the COVID-19 Vaccine | Centers of Excellence

How to develop a new relationship path after a TBI

Article
11/12/2020
A pair of hands clasped together

TBI can change the dynamics of a romantic relationship.

Recommended Content:

Traumatic Brain Injury

NICoE’s 3rd Annual Research Fair Focuses on the Future of TBI care

Article
10/28/2020
Man standing at podium next to American flag

[T]he event was intended to educate all attendees, no matter their scientific background.

Recommended Content:

Traumatic Brain Injury | Centers of Excellence

DVBIC blood plasma study assists in TBI and PTSD diagnosis

Article
10/8/2020
Air Force Senior Airman Kristen N. Kelsey, a medical laboratory technician with the 514th Aeromedical Evacuation Squadron, Air Force Reserve Command, labels blood samples at Joint Base McGuire-Dix-Lakehurst, New Jersey. (U.S. Air Force photo by Master Sgt. Mark Olsen)

Since 2000, more than 400,000 active-duty service members have been diagnosed with TBI

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence

DVBIC study focuses on concussion-related headaches

Article
9/17/2020
Soldier (center) standing at attention receives an award pinned to their uniform, from a soldier standing directly before her, with a soldier standing at attention to one side. A long building is seen in the background with two flagpoles, one flying the US flag.

Service members with concussion-related headaches experience more frequent and severe pain compared to those with headaches unrelated to this condition.

Recommended Content:

Traumatic Brain Injury

Air Force opens Intrepid Spirit Center at Eglin AFB

Article
9/15/2020
Soldiers holding a long ribbon and cutting it

The EISC...recognizes the need for a medical facility dedicated to invisible wounds.

Recommended Content:

Posttraumatic Stress Disorder | Traumatic Brain Injury

DVBIC eye-tracking tech may help service members with concussions

Article
7/28/2020
Soldier sitting in front of a laptop with headphones on

The Fusion technology is more objective, by assessing eye reaction time.

Recommended Content:

Traumatic Brain Injury | Health Innovation Toolkit

TBI researchers increased access to data expands ability to care

Article
7/24/2020
Image of woman speaking at a podium

The study's impact will expand with its inclusion in FITBIR.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 3 4 > >> 
Showing results 31 - 45 Page 3 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.