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...

Find Your Story: TBI Champions

Video
11/16/2020
Find Your Story: TBI Champions

In this video, A Head for the Future’s TBI Champions share their experiences with traumatic brain injury and resources that helped them through recovery. They can help you too.

Recommended Content:

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

TBI Champion Derek Poor

Video
11/16/2020
TBI Champion Derek Poor

While instructing hand-to-hand combat training, U.S. Army Special Forces veteran Derek Poor slammed his head against a wall and sustained a traumatic brain injury (TBI). Seeing stars and unable to shake his persistent, daily headaches, Poor sought help.

Recommended Content:

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

Talking TBI: Talking to Kids

Video
11/16/2020
Talking TBI: Talking to Kids

While on patrol in Iraq, former U.S. Marine Corps Sgt. Maj. Gary Moran was knocked unconscious by an improvised explosive device, resulting in a traumatic brain injury (TBI). Gary and his son discuss how TBI affected their relationship early on and ultimately brought them closer together.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | A Head for the Future

Talking TBI: Going Back to School

Video
11/16/2020
Talking TBI: Going Back to School

Marine Corps veteran Chris shares his experience going back to school following his TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

TBI Champion Dalton Mask

Video
11/16/2020
TBI Champion Dalton Mask

Facing a long road to recovery following his TBI, Dalton remained positive and participated in the 2019 Warrior Games.

Recommended Content:

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

TBI Champion Beth King

Video
11/16/2020
TBI Champion Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way — recumbent biking.

Recommended Content:

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

Talking TBI: Connect with Others

Video
11/16/2020
Talking TBI: Connect with Others

Navy veteran Amanda Burrill and Army veteran Elana Duffy had a few things in common: They both lived in New York City, experienced traumatic brain injuries (TBI) while in service and were coping with the injuries alone. Until they met each other.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

MACE 2 Provider Training Video

Video
9/29/2020
MACE 2 Provider Training Video

This video illustrates how to conduct a MACE 2 training event. This video supports the MACE 2 and its training materials created by the Traumatic Brain Injury Center of Excellence.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Provider Resources

Defense and Veterans Brain Injury Center Celebrates 25 Years

Video
3/12/2018
Defense and Veterans Brain Injury Center Celebrates 25 Years

Katherine Helmick, DVBIC acting national director, discusses DVBIC achievements and goals to advance service members' health care. DVBIC honors 25 years of military health care by continued dedication to research and treatment of traumatic brain injury.

Recommended Content:

Traumatic Brain Injury

Technician Discusses TBI Research

Video
5/20/2016
Photo of an Edgerton Shadowgraph, a technique which allows researchers to visualize shockwaves in a transparent medium so they can see the shockwaves in the air. Upon visualizing the shockwaves, researchers can measure their locations and use the timing from high-speed video cameras to determine a velocity, which is critical in indicating the shockwave’s pressure. Once researchers have all this information, they can tell the pressure impacted on the test subject. (DoD photo)

Richard Benjamin, lead physical science technician at the Army Research Laboratory at Aberdeen Proving Ground, Md., discusses using technology to better understand traumatic brain injuries.

Recommended Content:

Traumatic Brain Injury

A Head for the Future: Randy Gross

Video
3/25/2016
Randy Gross

When he was 23, Randy Gross was riding in a car with his seat belt off. The former Army staff sergeant sustained a TBI when the vehicle crashed. He sought help immediately, making a full recovery from his TBI and continuing to serve in the Army until 2006. Now, Gross helps those in the military with TBI as a regional education coordinator for DVBIC.

Recommended Content:

Traumatic Brain Injury

Head for the future

Video
3/14/2016
Woman putting on bike helmet

In 2005, a car struck Marine reservist Maj. Eve Baker head-on while she was biking to work in Honolulu. She flew face-first into the windshield, shattering her helmet — which likely saved her life.

Recommended Content:

Traumatic Brain Injury

TBI Awareness: Memorial Box

Video
3/27/2015
Image of a memorial box.

US Army Sgt Fox explains how his memorial box has helped him heal and remember meaningful events and people in his life.

Recommended Content:

Traumatic Brain Injury

Dr. Heechin Chae on The Mystery of the Brain

Video
3/23/2015
Dr. Heechin Chae on The Mystery of the Brain

Traumatic brain injury expert, Dr. Heechin Chae speaks on the mystery of the brain.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury

Army Sgt. R. Fox

Video
3/19/2015
Image of Army Sgt. Robert Fox

Army Sgt. Robert Fox describes his challenges with PTSD and how art therapy has helped him.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 3 > >> 
Showing results 16 - 30 Page 2 of 3

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.