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Introducing New Clinical Recommendations for Concussion Recovery

Doctor uses a stethoscope to examine patient
U.S. Army photo by Robert Shields

Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) provides health care professionals with evidence-based psychological health and traumatic brain injury resources. We want to make sure you have the tools to effectively care for service members, families and veterans.

The Defense and Veterans Brain Injury Center (DVBIC), a DCoE center, recently released new clinical recommendations to help service members who have sustained a concussion, also known as mild traumatic brain injury (mild TBI), gradually return to activity. The first-of-its-kind tools provide a stepped-process that uses patient feedback with provider assessment.

The “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” resource suite includes four separate clinical support tools for primary care managers and rehabilitation providers.

The primary care manager suite of tools includes:

Clinical recommendation — a standardized approach that includes six stages to help concussed patients gradually return to normal activity as soon as safely possible. The stages include:

  • rest
  • light routine activity
  • light occupation-oriented activity
  • moderate activity
  • intensive activity
  • unrestricted activity

Outlined in the recommendation are goals for each stage and criteria to refer patients to a rehabilitation provider.

Clinical support tool — pocket-sized reference cards make it easy to access complete guidance as you monitor patients in recovery.

Educational brochure — a self-guide for patients on activities they can safely perform at each stage, standards for moving on to a new stage, and when they should contact their provider. It includes a chart for them to rate how they feel each day.

Provider training slides — a summary of the progressive return to activity process; includes a knowledge test and case studies.

When recovery doesn’t progress as expected, symptoms are worse or the service member is symptomatic after testing following the intensive activity stage, referral to the rehabilitation provider is recommended.

In the rehabilitation provider suite of tools you can expect:

Clinical recommendation — guidelines from rest through return to pre-injury activity for service members who continue to have symptoms of mild TBI after initial treatment.

Clinical support tool — outlines the six rehabilitation stages and includes a neurobehavioral symptom inventory for evaluating symptoms.

Patient education products — five “Patient Activity Guidance After Concussion” sheets that match the stages in the progressive return to activity process to share with patients.

Provider training slides — presentation on rehabilitation management tools; with a knowledge test and case studies.

We’ll take a closer look at some of these tools later in the DCoE Blog. You can download or order the progressive return to activity suite of tools via the DVBIC website.

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