Ms. Katherine M. Helmick, MS, RN, CNRN, CRNP Deputy Director - Traumatic Brain Injury Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
By Kathy Helmick
Deputy director for TBI at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
Brain Injury Awareness Month gives us an opportunity to raise awareness and support for service members, veterans and families whose lives are affected by traumatic brain injury (TBI). As DCoE’s deputy director for TBI, I work with many others including the Defense and Veterans Brain Injury Center to improve TBI care delivered to service members in deployed and non-deployed environments. The Defense Department made significant advancements in TBI management during the past several years and we’re continuing to learn as we treat. Navigating the clinical challenges that providers face in the field is critical to ensure we’re employing state-of-the-art care for all levels of TBI severity, from concussion to severe and penetrating brain injuries.
The department is aggressively working to improve the diagnosis and treatment of TBI in-theater. By issuing the Directive Type Memorandum (DTM) “Policy Guidance for Management of Concussion/Mild TBI in the Deployed Setting,” commanders or their representatives are required to assess all service members involved in potentially concussive events, to include those without apparent injuries, using the Injury/Evaluation/Distance from Blast (I.E.D.) checklist. Highlights from the directive include:
- Mandatory event-driven protocols for exposure to potentially concussive events
- Required medical evaluation and rest
- All sports and activities with risk of concussion are prohibited until medically cleared
- Service members diagnosed with mild TBI will receive a standardized educational sheet
- New protocols for anyone who sustains three or more mild TBIs within a 12-month period
We’ve learned that early diagnosis and treatment help to maximize the possibility that service members will fully recover from a TBI and return to duty. This applies to injuries sustained during deployment and at home station.
Following a traumatic brain injury, an individual may experience persistent symptoms and functional limitations, so we’re studying the cognitive rehabilitation effects for mild TBI. Cognitive rehabilitation therapy is now performed at 13 military treatment facilities. Cognitive domains, the areas involving conscious intellectual activity, affected after a TBI include:
- Attention issues
- Memory problems
- Social and emotional functioning
- Executive functioning including planning and judgment
One of the challenges with treating patients with mild TBI is the existence of co-occurring conditions. DCoE recently released the “Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health,” a comprehensive clinical guidance tool to assist primary care providers with assessing and managing patients with co-occurring traumatic brain injury and psychological health conditions. The Co-occurring Conditions Toolkit addresses the following:
- Concussion
- Post-traumatic stress
- Depression
- Chronic pain
- Headache
- Substance use disorder
The department is committed to fast-tracking, promising TBI research to improve the diagnosis and treatment of traumatic brain injury to benefit our service members, veterans and their families. I invite you to visit DCoE’s Brain Injury Awareness Month page for brain injury resources for warriors, families and health professionals. We’re making great strides in the field of TBI that benefit more than just the Defense Department—they help our civilian and global partners too.
We’d like to hear from you, so join conversations taking place throughout the month on DCoE’s blog, Facebook and Twitter.
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