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Five Clinical Tools To Help Assess and Treat TBI

Image of An Army 'gun team' brace for the concussion of a 105mm howitzer during operations in Iraq in 2008. (Photo: Master Sgt. Kevin Doheny). An Army 'gun team' brace for the concussion of a 105mm howitzer during operations in Iraq in 2008. (Photo: Army Master Sgt. Kevin Doheny)

Traumatic Brain Injury, or TBI, is a major health concern for the military. Over the past two decades, nearly 450,000 service members have suffered a first-time TBI. While some occur in a deployed setting, the majority happen closer to home – during training, sports, recreation, car accidents, or slips and falls.

Left untreated, even mild TBIs can have serious long-term complications. TBIs, also known as concussions, can affect mental health, impacting mission readiness and the ability to deploy.

But there is hope. TBI is treatable. With appropriate care, service members can expect a full recovery. The Military Health System offers the following tools and clinical recommendations to help providers in the identification, treatment and management of mild TBI.

1. Dizziness and Vision following Concussion/Mild TBI Clinical Recommendation

Dizziness and visual problems are among the most common symptoms after a mild TBI. In November 2021, the Traumatic Brain Injury Center of Excellence released the Dizziness and Visual Disturbances Clinical Recommendation. It's a vital tool for primary care managers treating mild TBIs. It provides a single, comprehensive reference for the assessment and management of dizziness and visual problems following concussions.

Providers should perform a visual and dizziness assessment. Learn more here.

2. Military Acute Concussion Evaluation 2

The MHS provides tools to quickly assess and diagnose service members with a potential TBI. The Military Acute Concussion Evaluation 2, or MACE 2, is a step-by-step tool that medical personnel can use to diagnose a possible concussion at the scene of an injury.

The TBICoE helped design the MACE 2 to improve care for service members. Users in the field can screen in for common symptoms, cognitive deficits, and neurological signs of a concussion. The latest version of the MACE 2 also assesses balance and eye motion.

Learn more here.

3. Progressive Return to Activity following Acute Concussion/Mild TBI

Service members should avoid returning to duty too soon after a concussion. That can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of more concussions.

To help determine when it's time to return to duty, military health care providers can use a tool known as the Progressive Return to Activity Following Acute Concussion (PRA). It helps ensure a safe return to full duty. The TBICoE developed the tool in collaboration with military service branches, an expert working group, and an end user group.

The PRA involves a six-step return to activity protocol. It helps service members to manage their symptoms and ensure a full recovery. Returning to duty gradually helps reduce long term complications.

Learn more here.

4. Sleep Disturbances following Concussion/Mild TBI Clinical Recommendation

Sleeping problems are common with mild TBI. The most common include insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, and restless legs syndrome. Early treatment of sleeping problems can promote recovery and prevent chronic TBI symptoms.

TBICoE's Sleep Disturbances following Concussion/Mild TBI Clinical Recommendation provides step-by-step guidance to help primary care managers assess and manage sleeping problems linked to mild TBI. The recommendation includes guidelines for medical dosing, specialty referral timelines, and more detailed information for treating sleeping problems like restless legs syndrome, insufficient sleep syndrome, and parasomnias.

Learn more here.

5. Cognitive Rehabilitation following Mild to Moderate TBI

The Cognitive Rehabilitation following Mild to Moderate TBI Clinical Recommendation helps providers to treat service members and veterans with persistent cognitive challenges like memory and attention problems. Evaluating a patient with those symptoms is especially challenging because they can overlap with other problems like post-traumatic stress or depression. The clinical recommendation ensures consistency in cognitive rehabilitation practices across MHS hospitals and clinics.

Learn more here.

The MHS is committed to protecting the brain health of our service members. These are just a few clinical tools out of many that the MHS is using to better identify, care for, and treat service members and veterans who are affected by TBI.

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Dizziness and Visual Problems After Concussion

Infographic
5/22/2023
Graphic containing general information on dizziness and vision  problems after a traumatic brain injury. Visit health.mil/TBIFactSheets and download related fact sheets for information.

More than 80% of all concussions—also known as mild traumatic brain injury—in the military are considered mild. Dizziness and visual problems are among the most common symptoms after concussion and often resolve within days or weeks

Changes in Behavior, Personality or Mood Following Concussion/mTBI Fact Sheet

Fact Sheet
5/22/2023

This TBICoE fact sheet can be used by health care providers to educate patients with a concussion, or mild TBI, on how to manage changes in mood related to their injury. Patients and caregivers would also find this information useful.

Application of Acute Concussion Care Pathway: MACE 2 & PRA Training

Calendar Event
5/16/2023

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. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

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.

TBICoE Spotlight: Lisa Moy Martin

Video
5/11/2023
TBICoE Spotlight: Lisa Moy Martin

In this edition of TBICoE Connect Employee Spotlight, we dive into Lisa Moy Martin's inspiring journey in TBI research, her dedication to the mission and the unique opportunities that helped shape her decades long career.

Vestibular Assessment and Rehab Course Focuses on Dizziness from TBI

Article
5/5/2023
Vestibular Assessment and Rehab Course Focuses on Dizziness from TBI

Hearing Center of Excellence offers training for dizziness related to concussion.

Cognitive Rehabilitation Therapy

FAQs
4/19/2023

The complexity of the brain and brain injuries has led to questions about the nature of cognitive rehabilitation therapy and its availability to service members who have sustained TBIs.

Concussion Protocols Aid Diagnosis, Treatment, and Recovery

Article
4/17/2023
Concussion Protocols Aid Diagnosis, Treatment, and Recovery

Whether on the sport field or the battlefield, the Defense Health Agency is the global leader in research on the effects of concussion—known as mild traumatic brain injury—in the military. Its research has fueled the development of protocols to help providers assess and treat concussion from initial injury to acute and post-acute medical settings, rehabilitation, and, ultimately, a return to family, community, work, continued duty, or recreation.

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.

Traumatic Brain Injury Awareness

Article Around MHS
4/6/2023
A patient receives an MRI. Rachel Mote, the regional educational coordinator at the Landstuhl Regional Medical Center traumatic brain injury clinic talk about TBIs during the Kaiserslautern Military Community News Update. (Photo by U.S. Air Force Sgt. Jared Kindlespire, Regional Media Center AFN Europe)

Symptoms of traumatic brain injuries aren't always physical, or even recognizable. Listen to our audio newscast and get potentially lifesaving advice from the experts.

Highlighting the Intrepid Spirit Concussion Recovery Clinic

Article Around MHS
4/6/2023
U.S. Navy Commander Diana Fu explains the physical therapy room at Intrepid Spirit Concussion Recovery Clinic to Marine Corps Installations East Commander on Aug. 2, 2021. (Photo by Naval Medical Center Camp Lejeune)

Would you be able to recognize the symptoms of a brain injury in yourself or someone close to you? Even the slightest head injury may not just "go way", and we've got some important tips that could save your life.

Traumatic Brain Injury Center of Excellence FAQs

FAQs
3/31/2023

The Traumatic Brain Injury Center of Excellence FAQs provides answers to questions we are regularly asked about the organization and its mission.

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Last Updated: September 01, 2022
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