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Traumatic Brain Injury (TBI)

What is it?
Traumatic Brain Injury is a disruption of function in the brain resulting from a blow or jolt to the head or penetrating head injury. Causes of TBI include: falls, motor vehicle crashes, assaults, and combat events such as explosions. At the time of injury, the severity of TBI is classified as mild, moderate, severe, or penetrating. Nearly all TBIs are mild TBIs, also known as "concussions". We prefer to use the term concussion to reduce the stigma and negative impact of the brain injury label and to clearly distinguish this from moderate and severe TBI. Often after a concussion, Soldiers think they are OK, yet actually have an injury that needs attention. Most Soldiers with concussions recover within a few hours to days; a small percentage may have persistent post-concussive symptoms. Moderate and severe TBIs are less common, easier to recognize at the time of injury, and typically require prolonged recovery.

What has the Army done?
In January 2007, the Army Surgeon General chartered a TBI Task Force to gain a clearer picture of the processes and research involved with the prevention, identification, assessment, treatment, rehabilitation, family support, and transition to civilian life of Service members with TBI. After careful review, the TBI Task Force made 47 recommendations. In May 2007, the Office of The Surgeon General (OTSG) stood up the Proponency Office for Rehabilitation and Reintegration and assigned it the responsibility to develop and implement the TBI Action Plan based on the 47 Task Force recommendations.

In FY08, the Army executed $122 Million of supplemental funds to improve access to care, quality of care, and screening and surveillance of Service members with TBI. In addition, the Army executed $150 Million in supplemental funds to support TBI research. To date, 21 of the 47 Task Force recommendations are complete or appropriately tasked to another organization, 25 are in progress, and one is planned. The following are accomplishment highlights:

  • The Assistant Secretary of Defense for Health Affairs released a memorandum providing a standard definition of TBI, severity of brain injury stratification, and a uniform process for reporting (October 2007).
  • The Department of Defense (DoD), in collaboration with the Veterans Administration, developed a non-deployed Clinical Practice Guideline for Mild TBI (October 2008) and the DoD, in collaboration with the Defense and Veterans Brain Injury Center (DVBIC), developed an in-theater Mild TBI Clinical Practice Guideline (October 2008).
  • The OTSG released Army TBI Program Validation guidelines to establish and standardize screening, treatment, and rehabilitation based on the needs of the population served (October 2007).
  • The DoD revised Post Deployment Health Assessment (PDHA) and Post Deployment Health Reassessment (PDHRA) to include TBI screening questions (April 2008).

Each medical treatment facility (MTF) has a TBI Program Manager to establish a comprehensive program that provides a continuum of integrated care and services for Soldiers and patients with TBI, from point-of-injury to the highest functional level, whether that is return to duty or transition from active duty to civilian life. The emphasis is on primary care and case management and utilizes a family-centered approach. Specialty services are also available, as needed.

We are currently implementing pre-deployment neurocognitive testing using Automated Neuropsychological Assessment Metrics; developing TBI education modules for Soldiers, leaders, and providers; implementing a comprehensive marketing and risk communication strategy; and standardizing and optimizing clinical care documentation using PureEdge forms technology.

What continued efforts does the Army have planned for the future?
The Army plans to increase TBI research, validate every medical facility that provides TBI care, train every provider working with TBI patients, and, when necessary, work with the Department of Veterans Affairs as well as our TRICARE partners to deliver the best TBI care possible. The Army will sustain funding for TBI operations by continuously identifying and updating all requirements in the Planning, Programming, Budgeting, and Execution System. The desired end state is that the Army Medical Command provides state-of-the-art and continuously improving care for Soldiers and beneficiaries with TBI and their Families within Army MTFs, according to their TBI program capability level, in order to optimize functional outcomes and return to duty.

Why is this important to the Army?
On post-deployment surveys, 10-20 percent of service members report they had a head injury at some point during their combat tour. In 2007, over 10,000 beneficiaries coded with TBI diagnoses were treated in Army MTF's or in TRICARE network facilities. Current weaponry, such as improvised explosive devices (IEDs) and rocket-propelled grenades result in a greater chance of TBI, especially concussion, compared to small arms or other ballistic weapons. The use of body armor, the rapid transport to life-saving personnel, and the presence of state-of-the-art care have led to unprecedented survival rates for patients with a variety of injuries, including TBI. The Army is committed to properly caring for its wounded Soldiers, including those with TBI.

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