DVBIC offers providers a variety of tools to help ensure the delivery of quality care in the treatment and rehabilitation of traumatic brain injury (TBI).
DVBIC optimizes clinical care by combining evidence from medical literature, health care research and expert opinion to develop and provide clinical suites to help providers deliver evidence-based treatment and address the challenges associated with mild TBI. Clinical suites can be made up of one or more of the following:
- Clinical recommendations, which provide guidance on assessing and managing mild TBI symptoms
- Clinical support tools that offer an algorithmic approach to evaluating, managing and referring mild TBI patients for specialty care
- Training slides that show providers how to identify and treat patients with mild TBI-related symptoms
- Fact sheets or brochures, which provide tips and tools to help service members and veterans cope with a mild TBI
Below are the topics of our clinical suites:
- Management of Headache Following Concussion/Mild TBI: Guidance for Primary Care Management in Deployed and Non-Deployed Settings (February 2016)
Includes state-of-the-science products that can support the diagnosis, evaluation and treatment of post-traumatic headache. You can access recommendations to guide treatment in deployed and non-deployed settings. Clinical suite includes a clinical recommendation, clinical support tool/reference card, training slides, patient education fact sheet and interactive clinical support tool.
- Management of Sleep Disturbances Following Concussion/Mild TBI: Guidance for Primary Care Management in Deployed and Non-Deployed Settings (June 2014)
Provides guidance to help primary care managers assess and manage sleep disturbances associated with mild TBI. Includes specific recommendations for managing symptoms of insomnia, circadian rhythm sleep-wake disorder and obstructive sleep apnea. Clinical suite includes a clinical recommendation, clinical provider training, clinical support tool, training slides and healthy sleep fact sheet.
- Progressive Return to Activity Following Acute Concussion/Mild TBI (January 2014)
- Guidance for the Primary Care Manager in Deployed and Non-Deployed Settings
Provides an initial framework for gradually increasing service member activity following mild TBI. Clinical suite includes a clinical recommendation, clinical support tool, training slides and educational brochure.
- Guidance for the Rehabilitation Provider in Deployed and Non-Deployed Settings
Provides details for rehabilitation providers in the management of service members who have sustained mild TBI and includes guidance for six rehabilitation stages of the evaluation and monitoring process. Clinical suite includes a clinical recommendation, clinical support tool, training slides and patient education tool.
- Guidance for the Primary Care Manager in Deployed and Non-Deployed Settings
- Neuroimaging Following Mild TBI in the Non-Deployed Setting (July 2013)
Offers guidance for a standard approach for imaging from the acute through chronic stages following mild TBI in the non-deployed setting. Clinical suite includes a clinical recommendation, clinical support tool and training slides.
- Assessment and Management of Visual Dysfunction Associated with Mild TBI (January 2013)
Provides an approach to evaluating visual dysfunction following mild TBI and offers guidance regarding referral for further eye or visual evaluation and care. Clinical suite includes a clinical recommendation, clinical support tool and training slides. Also available separately is the Vision Problems After Concussion brochure.
- Assessment and Management of Dizziness Associated with Mild TBI (September 2012)
Provides an approach to evaluate dizziness following mild TBI and guidance regarding referral for further vestibular evaluation and care. Clinical suite includes a clinical recommendation, clinical support tool, training slides and patient education fact sheet.
- Neuroendocrine Dysfunction Screening Post Mild TBI Recommendation (March 2012)
Provides an approach to identifying patients with mild TBI who may benefit from further endocrine evaluation and care. Clinical suite includes a clinical recommendation, clinical support tool and training slides.
More Clinical Tools
DVBIC also offers the following tools to assist in the identification, treatment and management of patients with mild TBI in deployed and non-deployed settings.
- Dizziness Handicap Inventory (DHI), PDF [80 KB]
The 25-item self-assessment evaluates the impact of dizziness on daily life imposed by vestibular system disease.
- Epworth Sleepiness Scale (ESS), PDF [14 KB]
The ESS is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness. The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0 - no chance of dozing, to 3 - high chance of dozing.
- Glasgow Coma Scale (GCS), PDF [28 KB]
The GCS is used to assess the consciousness and neurological functioning of a person who has just received a TBI. The total score is the sum of the scores in three categories: eye-opening response, verbal response and motor response. (Source: DVBIC)
- Neurobehavioral Symptom Inventory (NSI), PDF [17 KB]
The NSI is used as a subjective measure for symptom reporting. The NSI is a 22-item symptom inventory of non-specific but common mild TBI symptoms.
- Patient Health Questionnaire (PHQ-9), PDF [86 KB]
The PHQ-9 is a nine-item tool commonly used in the primary care setting to assess the presence and severity of depression symptoms.
- Posttraumatic Stress Disorder Checklist -5 (PCL-5), PDF [103 KB]
The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including: monitoring symptom change during and after treatment, screening individuals for PTSD and making a provisional PTSD diagnosis.
- Headache Impact Test (HIT-6), PDF [64 KB]
The six-item HIT-6 provides a global measure of adverse headache impact and is used to screen and monitor patients with headaches in both clinical practice and clinical research. The HIT-6 items measure the severity of headache pain and the adverse impact of headache on social functioning, role functioning, vitality, cognitive functioning and psychological distress. (Source: NIH)
- Patient Global Impression of Change (PGIC), PDF [65 KB]
The PGIC captures clinically meaningful change that makes a difference to the patient. Consisting of one question rated on a seven-point Likert scale, the PGIC offers a quick and simple method of quantifying clinical progress. The patient is asked to describe the change in activity limitations, symptoms, emotions and overall quality of life related to the concussion.
- Insomnia Severity Index (ISI), PDF [65 KB]
The ISI is a brief, validated, seven-item self-report questionnaire useful for the initial assessment of insomnia symptom severity and ongoing monitoring of treatment response.
- ICD-10 Diagnostic Coding Guidance for Traumatic Brain Injury Training Slides
The training slides provide guidance to help facilitate consistent and accurate coding for TBI diagnoses and related symptoms and conditions.
- Mild Traumatic Brain Injury Pocket Guide (CONUS)
A concussion screening tool that includes an all-encompassing, quick reference on the assessment, treatment and management of patients with mild TBI and related symptoms. The pocket guide is also available as a mobile app.
- MACE: Military Acute Concussion Evaluation Pocket and Wallet Cards
- Concussion Management Algorithm Pocket and Wallet Cards
The Concussion Management Algorithm, available as a Pocket Card and Wallet Card, is a tool for all levels of providers on the assessment, evaluation and treatment of concussion in the deployed setting.
- Indications and Conditions for In-Theater Post-Injury Neurocognitive Assessment Tool (NCAT) Testing Clinical Recommendation
This clinical recommendation provides background on pre-deployment neurocognitive testing and the use of automated neuropsychological assessment metrics following a concussion in the deployed setting.
- Departments of Veterans Affairs and Defense (VA/DoD) Clinical Practice Guideline - Management of Concussion/Mild Traumatic Brain Injury (2016)
This guideline describes the critical decision points in the management of concussion/mild TBI and provides clear and comprehensive evidence-based recommendations to improve patient outcomes and local management of patients with concussion/mild TBI. Information about the Management of Concussion/Mild Traumatic Brain Injury (2016) clinical practice guideline and links are available on the VA website.