Clinical Tools for Providers on Mild TBI

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).

Department of Defense Instruction (DoDI) 6490.11 Supporting Resources

  • Military Acute Concussion Evaluation 2 (MACE 2) Card. The 2018 Military Acute Concussion Evaluation 2 (MACE 2) is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The MACE 2 incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening.
  • Concussion Management Tool. The CMT revises and replaces the 2012 Concussion Management Algorithm and the 2014 Army Concussion Management in the Garrison Setting Algorithm. The CMT replaces the prior CMA to better align with the current MACE 2, Progressive Return to Activity, and DVBIC clinical recommendations.
  • 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.
  • Recurrent Concussion Evaluation CardThe Recurrent Evaluation Concussion Card is designed to guide providers in the management of patients with a history of three or more documented concussions within a 12-month span.

Clinical Suites

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:

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.

Additional Resources

Please note that some files may not be compliant with Section 508 of the Rehabilitation Act. If you need an accessible version of a particular file, please contact us and we will provide one for you.