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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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TBI Caregiver Support Forms

Form/Template
6/29/2021

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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Patient Global Impression Change Scale

Form/Template
5/1/2015

Form filled out by patients to rate their changes in activity, symptoms, emotions and quality of life.

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Conditions and Treatments | Health Readiness & Combat Support | Disability Evaluation | Traumatic Brain Injury

Neurobehavioral Symptom Inventory Form

Form/Template
4/30/2015

Form used by providers to question patients about their symptoms

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Conditions and Treatments | Disability Evaluation | Traumatic Brain Injury | Health Readiness & Combat Support

Military Acute Concussion Evaluation 2012

Form/Template
4/30/2015

Use this form to screen for concussions

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Neuroimaging following TBI in non deployed setting

Form/Template
7/8/2013

The guidance contained in this CR represents a review of currently published literature and expert contributions obtained by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in collaboration with clinical subject matter experts representing the Services, Department of Veterans Affairs (VA), academic, research and civilian sectors.

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Health Readiness & Combat Support | Conditions and Treatments | Disability Evaluation | Traumatic Brain Injury

DCoE Concussion Management Algorithm Cards

Form/Template
10/8/2012

Combat Medic/Corpsman Algorithm Card to diagnose a concussion in a deployed setting

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Last Updated: March 21, 2022

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