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Military Health System

Traumatic Brain Injury Center of Excellence

Download Now! TBI Caregiver Fact Sheets are now available! Download now from health.mil/TBICaregivers.

 

 

Welcome to the Traumatic Brain Injury Center of Excellence. Here, you'll find TBI clinical tools, educational resources, and research information.

Vision

Principal organization to lead, translate, and advance brain health 

Mission

TBICoE unifies a system of TBI health care, reliably advancing the science for the warfighter and ready to meet future brain health challenges

More About Our Mission

To accomplish the mission, TBICoE supports, trains and monitors service members, veterans, family members and providers who have been, or care for those who are affected by traumatic brain injury.

TBICoE works at the macro-level, screening and briefing service members heading into theater, performing pre-deployment provider training at military hospitals and clinics, gathering data mandated by Congress and DOD, and overseeing research programs. TBICoE develops educational materials for military and civilian providers, and for service members, veterans, and their families.

The DOD has further solidified TBICoE's role by naming it the Office of Responsibility for these tasks:

  • Creation and maintenance of a TBI surveillance database
  • Creation and distribution of the Family Caregiver Guide
  • Design and execution of a 15-year longitudinal study of the effects of TBI in Operations Enduring and Iraqi Freedom service members and their families

TBICoE Annual Report

The TBICoE Annual Report provides an overview of accomplishments and activities in calendar year 2021—download the report to learn more about us!

Thumbnail image of the 2021 TBICoE Annual Report

TBI and the Military

Traumatic brain injury is a significant health issue which affects service members and veterans during times of both peace and war. The high rate of TBI and blast-related concussion events resulting from current combat operations directly impacts the health and safety of individual service members and subsequently the level of unit readiness and troop retention. The impacts of TBI are felt within each branch of the service.

TBI, Service Members, and Medical Providers

Frequently Asked Questions

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

Q1:

What is the Traumatic Brain Injury Center of Excellence?

A:

TBICoE is a congressionally mandated collaboration of the Departments of Defense and Veterans Affairs to promote 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 traumatic brain injury.

Q2:

Why does DVBIC now prefer TBICoE?

A:

The preferred name Traumatic Brain Injury Center of Excellence (TBICoE) aligns with the other centers of excellence within the Defense Health Agency’s Research and Development Directorate, under which the TBICoE operates. This name reflects the mission of the TBICoE, and will make for easy identification with internal and external stakeholders in identifying the organization and its mission.

Q3:

Will this name change adjust the mission or functions of TBICoE?

A:

No. TBICoE will continue to oversee and conduct TBI clinically relevant research addressing gaps in TBI knowledge for our service members and veterans who have sustained a TBI. Additionally, TBICoE continues to provide training and materials to military medical personnel for diagnosis, prevention and treatment of TBIs. TBICoE develops, provides and distributes educational materials for both military and civilian providers, families, service members and veterans. Gathering and analyzing data mandated by Congress and the Department of Defense for reports will also continue.

Q4:

Where is TBICoE located?

A:

Our headquarters is located in the Washington, D.C. metro area. TBICoE supports a multi-center network of military treatment facilities and Department of Veterans Affairs medical centers nationwide and in Germany. At these facilities, regional education coordinators have resources and conduct education for medical providers, service members, veterans and their families. TBICoE conducts and supports traumatic brain injury clinical investigations at these collaborator facilities as part of the TBICoE research program.

Q5:

How do I find TBICoE resources?

A:

For providers, visit the Provider Resources section of the TBICoE webpages. There, medical personnel can find TBI clinical recommendations, support tools and education materials. Visit the TBICoE Research page and download the latest TBI Hot Topics Bulletin for the latest trends in TBI research.

The Patient and Family Resources section of TBICoE has fact sheets, patient guides for recovery, and family and caregiver guides.

TBICoE materials are available by download only. We will continue to develop and update TBI clinical and educational products, so bookmark the pages and check back often or sign up for the TBI Providers Brief or TBI Resources Updates email news to stay informed.

Q6:

Will TBICoE continue to collaborate with the VA on TBI issues?

A:

Yes, TBICoE will continue its 28-year historical relationship with the VA. In fact, TBICoE has ongoing clinical research or educational activities that are coordinated through the VA and TBICoE.

Q7:

Does TBICoE or its network personnel provide medical care?

A:

No, TBICoE does not provide medical care or referrals, but we do offer resources to help patients, their families and caregivers learn more about TBI together with their medical provider. Visit the Patient and Family Resources page to find fact sheets and other TBI patient and caregiver guides. TBICoE's outreach initiative, A Head for the Future is a resource to learn how to prevent, recognize and recover from a brain injury, and hear stories from TBI Champions.

Q8:

How do I contact TBICoE?

A:

If you have a question or concern about TBICoE or any of the products, please email us!

Q9:

What if I need immediate TBI medical help, advice, or information?

A:

You can find support 24/7 through the websites and numbers listed below.

National Resource Directory

The national resource directory connects wounded warriors, service members, veterans and their families with services and resources at the national, state and local levels to support recovery, rehabilitation and community reintegration.

Military/Veterans Crisis Line

Dial 988, and press 1 or Text 838255

Crisis Line, text-messaging service, and online chat provide free, confidential support for all service members, including members of the National Guard and Reserve, and all veterans, even if they are not registered with VA or enrolled in VA health care.

Military OneSource

800-342-9647

Help for active duty military and their dependents, including 12 free non-medical counseling appointments.

VA's Polytrauma/TBI System of Care

VA's Polytrauma System of Care provides a full range of medical and rehabilitation services for all enrolled veterans and for service members covered by TRICARE authorization, who have sustained polytrauma, TBI or other acquired brain injury. Click on this link for admissions and referrals.

Department of Veterans Affairs Customer Service Hotlines

Health Care: 877-222-8387

Benefits: 800-827-1000

White House VA Hotline

Open 24-hours a day, 365 days a year

855-948-2311

VA's first non-clinical, non-emergency, around-the-clock call center. It provides Veterans a supplemental option to report issues if they are not being addressed through VA's normal customer service channels. Hotline agents answer inquiries, provide directory assistance, document concerns about VA care, benefits and services, and expedite the referral and resolution of those concerns.

Vet Centers

Vet Centers are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible veterans, active duty service members, including National Guard and Reserve components, and their families. Readjustment counseling is free of charge and anonymous, and is offered to help make a successful transition from military to civilian life or after a traumatic event experienced in the military, including TBI. Does not require enrollment in VA health care.

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.

View questions and answers about cognitive rehabilitation therapy.

Q1:

Does DOD/TRICARE cover CRT?

A:

On April 14, 2010, the Assistant Secretary of Defense (Health Affairs) directed the implementation of a broad-based DOD pilot program intended to conform to the proceedings, and resulting guidance document, of the Consensus Conference on Cognitive Rehabilitation for Mild Traumatic Brain Injury held in April 2009. This guidance document outlined a standardized and measurable process for the provision of CRT services. This policy mandated the implementation of the guidance at 13 military treatment facilities (MTF’s).

In 2010, DOD provided over 45,000 hours of care involving CRT to service members and over 32,000 hours to family members of active duty members and retirees. These treatments were delivered by a wide array of health professionals, including psychologists; occupational, speech and physical therapists; and physicians.

Q2:

Who may benefit most from CRT?

A:

Patients who have experienced moderate to severe TBI and who suffer from recurring symptoms such as attention and memory deficits, problems with executive functioning and social pragmatics deficits are most likely to benefit from CRT. In cases of mild TBI, nearly 90 percent recover with no residual problems and only those with persistent symptoms need to be evaluated and treated.

Q3:

What is CBT?

A:

Cognitive behavioral therapy is a common type of mental health counseling consisting of a range of therapies designed to treat conditions like anxiety or depression. CBT is meant to help patients become aware of inaccurate or negative thinking and to view challenging situations more clearly and respond to them in a more effective way. CBT can be an effective tool to help anyone learn how to better manage stressful situation.

Q4:

What is the difference between CRT and CBT?

A:

Cognitive Rehabilitation Therapy is a collection of treatment strategies designed to address problems with memory, attention, perception, learning, planning and judgment brought about by brain injury, neurological disorders and other illnesses. Cognitive Behavioral Therapy is a common type of mental health counseling to help a patient become aware of inaccurate or negative thinking.

Q5:

Why is it difficult to determine how effective CRTs can be; there seems to be great disparity of opinion on the subject?

A:

Limited data on the effectiveness of cognitive rehabilitation programs are available, and this is in part due to the heterogeneity of the subjects, interventions and outcomes studied. Lack of rigorous methodology (i.e., randomized controlled trials) in efficacy studies has also contributed to the disparity in opinion on the effectiveness of CRT.

Q6:

Are CRTs effective or ever used for injuries that did not involve head injuries? For example, is CRT effective for psychological disorders?

A:

The benefit of CRT is not limited to patients with head injuries. Patients with psychological disorders that have impairments in attention, memory, socialization, and reasoning and processing skills can also benefit from CRT.

Q7:

Are there "specialists" in CRTs, or do most doctors understand their uses?

A:

Neuropsychologists specialize in neuropsychological cognitive testing that is used to determine if a patient will benefit from cognitive rehabilitation. They are also the primary providers who develop the individualized cognitive rehabilitation plan for patients. However, cognitive rehabilitation may be performed by an occupational therapist, physical therapist, speech/language pathologist, neuropsychologist, or a physician.

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In this lesson we explain the differences between complete rest and relative rest in a staged concussion recovery process, and provide examples of activities that promote relative rest. The revised Progressive Return to Activity (PRA) Clinical Recommendation uses the term 'relative rest' to emphasize the importance of early introduction of physical and cognitive activities that do not provoke symptoms following TBI. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 8: Clinical Case Scenario

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This is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity (PRA). We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 7: Symptom-Guided Management and Specialty Referral Guidance Tables

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This lesson covers how to use the Progressive Return to Activity, or PRA's Symptom-Guided Management and Specialty Referral Guidance tables. This lesson also details primary care management strategies for service members who are not progressing as expected in the PRA. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 1: PRA Overview

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In the first of TBICoE's Progressive Return to Activity (PRA) video training series, you will learn about the reasons for using a progressive return to activity process and receive an overview of the 2021 PRA algorithm and its associated tools. By the end of lesson one, providers will better understand the PRA process, and explain that process to service members diagnosed with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 2: Six Major Changes

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In this lesson we review the six major changes in the TBICoE's revised 2021 Progressive Return to Activity (PRA) Clinical Recommendation that differ from the original recommendation. The changes reflect the latest TBI research, and will make it easier for providers to manage the recovery process and return service members with concussion to full duty as quickly and safely as possible. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 5: The Six Stages of the PRA

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In this lesson, we cover the key activity objectives for each of the six stages of the Progressive Return to Activity (PRA) Clinical Recommendation and provide activity examples for each stage. Each stage is designed to gradually increase the intensity and duration of a service member's physical and cognitive activity as they advance in the PRA process. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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PRA Training Video 4: PRA Progression Criteria

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In this lesson, we review the criteria for advancing through the stages of the Progressive Return to Activity (PRA) Clinical Recommendation. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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Caregiver Guide supports service members and veterans with TBI

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

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2020 TBICoE Annual Report

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Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans

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The 2021 "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans" is a recovery support tool to assist caregivers of service members and veterans who have sustained a traumatic brain injury at any severity level.

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TBI Caregiver Support Forms

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This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

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

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TBICoE Virtual Quarterly Education Series: July 2021

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Last Updated: September 23, 2022
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