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• Mild TBI (mTBI), commonly known as a concussion, may affect from 10 to 20 percent of service members returning from combat deployment in Iraq and Afghanistan. Concussion is an injury from a hit, blow, or jolt to the head that briefly knocks you out (loss of consciousness) or makes you confused or "see stars" (change in consciousness). A screening tool for mTBI, the Military Acute Concussion Evaluation, or MACE, is available to assist in diagnosing mTBI. More than 90 percent of service members with TBI have concussions and recover quickly. Concussions cause acute symptoms like disorientation, headaches, dizziness, balance difficulties, ringing in the ears, blurred vision, nausea, vomiting, irritability, temporary gaps in memory, sleep problems, or attention and concentration problems. Many service members experiencing these temporary symptoms may not know why they have them. Often after a concussion the service member might think they're okay, yet they've actually had an injury that needs attention. Medical attention involves evaluation and education for service members and their Family members as well as early and appropriate treatment for the symptoms. The most important thing to do is to allow time to heal. Recovery is usually quick, but the time greatly depends on the individual and nature of the injury. It's very important to let one's provider decide when it's time to return to duty.



• At Fort Carson, Colo., for example, all redeploying service members are surveyed by healthcare providers for indicators of possible concussion. Fort Carson providers noted that survey responses indicated approximately 17 percent of redeploying service members could have concussion. Their careful identification methods are a "best practice" of early and appropriate treatment. This model has been expanded to other large Army posts. Leaders at Fort Carson, beginning with the Commanding General, have encouraged service members to seek any help needed without delay.



• The Defense and Veteran's Brain Injury Center (DVBIC) established after the first Gulf War, is the Defense Department's point on evaluation, treatment standards, education, and clinical research on traumatic brain injury. It has a participating network of military, VA and civilian sites which work together for a unified and seamless approach to TBI care. DVBIC also has worldwide contacts with TBI experts who participate in expert panels and research. More information is available at www.dvbic.org.. Army medical professionals collaborate and partner with DVBIC on TBI issues.



• In August 2006, the MACE tool was released. This clinical tool, recently supported by a report from the Institutes of Medicine (IOM), was used to evaluate suspected concussion in deployed service members. In December 2006, the first clinical practice guidelines for the assessment and treatment of mild TBI in a combat operational setting was released that offered guidance to the field on the evaluation and management of concussion occurring in theater.



• ANAM or the Automated Neuropsychological Assessment Metric is a tool that takes about 15-20 minutes to administer and provides a cognitive baseline of service members prior to deployment. The application of this instrument in theater will give front-line providers another critical piece of information for the evaluation and management of injured service members. The ANAM does not diagnose TBI but provides a standard, objective measurement for each service member's reaction time, their short-term memory, and other cognitive skills.



• There are four Department of Veteran's Affairs (VA) Polytrauma Rehabilitation Centers (PRC) designed to meet the needs of service members and veterans who experienced severe injuries including TBI.