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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)

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Traumatic Brain Injury

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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2021 DOD Worldwide Numbers for TBI

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TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in 2021. The data is also broken down by each branch of the armed services.

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2000-2021 DOD Worldwide Numbers for TBI

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TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the fourth quarter of 2021. The data is also broken down by each branch of the armed services.

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Neuroimaging Following Mild TBI Clinical Recommendation

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This TBICoE clinical recommendation allows primary care managers to make an informed, evidenced-based decision regarding whether or not imaging is indicated following a concussion/mild TBI.

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2021 Traumatic Brain Injury Center of Excellence Annual Report

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The 2021 Traumatic Brain Injury Center of Excellence (TBICoE) Annual Report provides a look at accomplishments and activities from calendar year 2021.

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Lt. Gen. George S. Patton and Brig. Gen. Theodore Roosevelt Jr. are pictured here in 1943 wearing the standard M1 helmet, sometimes called the "steel pot." (Photo: 1st Infantry Division Courtesy Photo)

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Concussion Care Pathway Streamlined for Better Results

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The Defense Health Agency has developed a comprehensive clinical care program (Acute Concussion Care Pathway) to manage concussions based on the military medical community’s many years of experience with injured service members.

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Brain-Boosting Meal Plans Help Service Members with TBI

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During the NICoE intensive outpatient program (IOP), staff nutritionist Ruth Clark teaches hands-on classes in the on-site patient kitchen. (Photo: Tahira Hayes (Ctr), NICoE/WRNMMC, NSA Bethesda)

Research has shown that dietary changes may help relieve symptoms that might complicate recovery from a traumatic brain injury (TBI), such as chronic pain, anxiety, depression, and sleep problems.

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Immediate Testing: How the Military Evaluates Risk For Brain Injuries

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Pfc. Thomas Icenogle, a student in the Army’s Combat Medic Specialist Training Program at the Medical Education and Training Campus on Joint Base San Antonio-Fort Sam Houston, Texas, conducts a Military Acute Concussion Evaluation 2 (MACE 2) on Pvt. Alejandro Leija, while Pvt. Dominic Dubois refers to the MACE 2 card. (Photo: Lisa Braun, Medical Education and Training Campus Public Affairs)

MACE 2 allows for a quick assessment of traumatic brain injuries in the field and is similar to sports concussion checks.

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One Airmans Recovery from TBI

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Ask the Doc: Can a Concussion Affect Hearing and Vision?

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Elizabeth Kirkpatrick, a physical therapist for the Fort Drum Traumatic Brain Injury (TBI) Clinic, New York, uses a model of the inner ear on Feb. 27, 2019, to demonstrate how a concussion can cause inner ear, or vestibular, damage which may result in dizziness, anxiety, depression, moodiness, balance problems and irritability to name a few. (Photo: Warren W. Wright Jr., Fort Drum MEDDAC)

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One Airman's Recovery from TBI

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After a motorcycle accident, Master Sergeant Stalnaker started having symptoms of traumatic brain injury, or TBI. He tells his story about his symptoms and his road to recovery from physical and emotional wounds as a result. If you’re experiencing symptoms of TBI, visit health.mil/TBI to learn about the resources available to you.

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A Retired Navy SEAL Discusses his TBI

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#DYK? Family support helps TBI recovery? Learn how to support your loved one here: https://www.health.mil/News/Articles/2021/07/22/Caregiver-Guide-supports-service-members-and-veterans-with-TBI #BeTBIReady #BIAMonth

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BIAM TBI 3

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#DYK Symptoms of TBI aren’t just physical? Severe TBIs can increase the risk for mental health conditions, such as anxiety and depression. Learn more: https://www.health.mil/Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/Patient-and-Family-Resources #BeTBIReady

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Last Updated: March 21, 2022

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