Military leaders set the stage for three days of education and training on traumatic brain injury (TBI) at Defense Health Headquarters, Falls Church, Virginia, Monday. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) sponsored “TBI Global Synapse: A Summit Without Borders,” to help military health care providers sharpen and deepen their knowledge and practice of treating traumatic brain injury.
Before a room set for 200 with nearly 1,000 attending virtually, Navy Capt. Richard F. Stoltz, DCoE director, established the tone and direction for the event. Reflecting the intense focus Congress, the White House, Defense Department (DoD) and Department of Veterans Affairs (VA) have on improving the health and well-being of service members, veterans and families, he confirmed DCoE as integral to that progress, and emphasized collaboration and integrated care as central to success.
“It’s important we don’t talk about traumatic brain injury in isolation,” said Stoltz. He supported his claim with medical records from the VA showing a small minority of patients diagnosed with TBI, posttraumatic stress disorder (PTSD) or chronic pain only. The vast majority receive multiple diagnoses with overlapping symptoms, reaffirming the need to integrate and coordinate care.
“The reason people don’t get better faster, as many of us would like them to, is because they have pretty complex issues,” said Stoltz.
Several facts stood out and were reinforced throughout the conference:
- Greater than 80 percent of traumatic brain injuries occur outside of deployment
- Service members have higher rates of TBI than the general population
- Most traumatic brain injuries are mild, also known as concussion. But, if not appropriately handled or multiple concussions are incurred, there can be significant issues requiring coordinated care and treatment.
Stoltz bridged the facts with an emphasis on the flow of care from education and prevention through rehabilitation, reintegration and resilience. “Continue to be involved in that continuum of care to improve the quality of what we do,” he said.
Air Force Lt. Gen. Douglas Robb, Defense Health Agency director, followed Stoltz with an examination on why the agency was stood up, the premise and expectations.
“With a unified medical command, we’re looking at a more globally integrated health system, standardized clinical and business processes, and a better, stronger, more relevant medical force,” he told the audience.
He put it in terms of the “big, small side picture,” a reference to the critical need to tie all efforts to boots on the ground in areas of deployment. “Our job is to lighten the load for those we ask to go into harm’s way. Are we adding to his load, or removing some piece of physical, psychological or spiritual load from it?” asked Robb.
Robb also echoed the military health system’s commitment to the health and well-being of the military community.
“[It’s] up to men and women in this room and virtually to make sure we increase quality of life (for service members) so we decrease the burden on the families,” said Robb. “Keep pushing the envelope.”
Kathy Helmick, Defense Veterans and Brain Injury Center (DVBIC) deputy director, rounded out the opening sessions with a review of traumatic brain injury advancements and challenges since the 2013 TBI Global Synapse. She drew attention to two clinical recommendations DVBIC released this year:
- Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager and the Rehabilitation Provider in the Deployed and Non-deployed Setting – a first-of-its-kind tool to provide a stepped-process to return to pre-injury activity that relies on patient feedback with provider assessment
- Management of Sleep Disturbances Following Acute Concussion/Mild TBI Clinical Recommendations – support tools to help identify and treat sleep disturbance in patients after a concussion
Helmick ran through a list of DoD and VA TBI research currently underway, including a DoD 15-year longitudinal study that in part will identify factors that can improve quality of life for TBI caregivers. She also referenced major research and education efforts by professional and collegiate sports organizations on injury and sideline evaluation.
Helmick pointed out two patient-centered guides DVBIC developed in the interim: a guide for service members and veterans who want to continue their academic journey after a TBI and a parent’s guide to when a child is ready to return to school after a TBI.
Looking ahead, she identified two significant studies on TBI treatment expected to come to fruition this fall and report results. One is the “Study of Cognitive Rehabilitation Effectiveness” (SCORE). The other is “Head to Head,” which compares four computer-based cognitive tests to identify service members who are at risk for brain injury-related problems.
While advancements in TBI treatment have been strong, there’s more work to do according to Helmick. DVBIC was recently named the DoD lead on clinical, research, education and training TBI pathways of care and will be a hub for the surge ahead.
“The message is one of hope and excitement as we forge our way ahead together,” said Helmick.