1. Traumatic Brain Injury (mTBI) in the Military Populace Presentation by Julie Minich-Castro MSN, RNC, ANP-C, FNP-C

2. Traumatic Brain Injury (mTBI) in the Military Populace Learning Objectives Differentiate Traumatic Brain Injury: -Symptoms -Severity levels -Types of TBI -Conditions often associated with TBI Demonstrate Understanding of the Traumatic Brain Injury evaluation: -Neuropsychological-cognitive deficits -Vestibular Neuro-optometric Identify post-concussion treatment of mild TBI

3. Traumatic Brain Injury (mTBI) in the Military Populace Outline 1. Review of TBI terms and Military acronym’s 2. Acquired brain injury VS Traumatic Brain Injury 3. Traumatic Brain Injury 4. Military specific TBI: 5. Incidence of TBI in military population-Defense and Veterans Brain Injury Center (DVBIC) 6. Manifestations of TBI 7. Post-concussion: 8. Evaluation-Military Acute Concussion Evaluation (MACE), physical assessment, imaging, neuropsychological testing, vestibular, optometric 9. Differential diagnosis –Military Malingering, Addiction, Depression, Stress Disorder, Somatization 10. DVBIC Tools and Recommendations 11. Long term care VS return to duty 12. Overlap of symptoms with PTSD

4. Traumatic Brain Injury (mTBI) in the Military Populace 1. Review of TBI terms and Military acronym’s

5. Traumatic Brain Injury (mTBI) in the Military Populace 2. Acquired brain injury VS Traumatic Brain Injury

6. Traumatic Brain Injury (mTBI) in the Military Populace 3. Traumatic Brain Injury Explanation Severity Classification Mechanisms of injury Epidemiology Causes Penetrating injury VS closed head trauma

7. Traumatic Brain Injury (mTBI) in the Military Populace 4. Military specific TBI: Blast-Combat Jump (Parachute) Combatives (Training)

8. Traumatic Brain Injury (mTBI) in the Military Populace 5. Incidence of TBI in military population-Defense and Veterans Brain Injury Center (DVBIC)

9. Traumatic Brain Injury (mTBI) in the Military Populace 6. Manifestations of TBI

10. Traumatic Brain Injury (mTBI) in the Military Populace 7. Post-concussion:  Symptoms- cognitive, physical impairment, psychologic  Syndrome- gender, substance abuse, age, previous TBI, concurrent illness, psychiatric history

11. Traumatic Brain Injury (mTBI) in the Military Populace 8. Evaluation-  Military Acute Concussion Evaluation (MACE)  Physical assessment  Imaging  Neuropsychological testing  Vestibular  Optometric

12. Traumatic Brain Injury (mTBI) in the Military Populace 9.Differential diagnosis – ◦ Military Malingering ◦ Addiction, Depression ◦ Stress Disorder ◦ Somatization

13. Traumatic Brain Injury (mTBI) in the Military Populace 10. DVBIC Tools and Recommendations Treatment/Rehabilitation-mTBI Patient education Management of symptoms

14. Traumatic Brain Injury (mTBI) in the Military Populace 11. Long term care VS return to duty

15. Traumatic Brain Injury (mTBI) in the Military Populace 12. Overlap of symptoms with PTSD

16. Traumatic Brain Injury (mTBI) in the Military Populace References Bailie, J. M., Kennedy, J. E., French, L. M., Marshall, K., Prokhorenko, O., Asmussen, S.,... Lange, R. T. (2016). Profile Analysis of the Neurobehavioral and Psychiatric Symptoms Following Combat-Related Mild Traumatic Brain Injury: Identification of Subtypes. J Head Trauma Rehabil, 31(1), 2-12. doi: 10.1097/htr.0000000000000142 Belanger, H. G., Silva, M. A., Donnell, A. J., McKenzie-Hartman, T., Lamberty, G. J., & Vanderploeg, R. D. (2015). Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study. J Head Trauma Rehabil. doi: 10.1097/htr.0000000000000208 Farrell-Carnahan, L., Barnett, S., Lamberty, G., Hammond, F. M., Kretzmer, T. S., Franke, L. M.,... Nakase-Richardson, R. (2015). Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injury. Brain Inj, 29(12), 1400-1408. doi: 10.3109/02699052.2015.1063161 Finkel, A. G., Yerry, J., Scher, A., & Choi, Y. S. (2012). Headaches in soldiers with mild traumatic brain injury: findings and phenomenologic descriptions. Headache, 52(6), 957-965. doi: 10.1111/j.1526-4610.2012.02167.x Helmick, K. M., Spells, C. A., Malik, S. Z., Davies, C. A., Marion, D. W., & Hinds, S. R. (2015). Traumatic brain injury in the US military: epidemiology and key clinical and research programs. Brain Imaging Behav, 9(3), 358-366. doi: 10.1007/s11682-015-9399-z Holcomb, E. M., Towns, S., Kamper, J. E., Barnett, S. D., Sherer, M., Evans, C., & Nakase-Richardson, R. (2015). The Relationship Between Sleep-Wake Cycle Disturbance and Trajectory of Cognitive Recovery During Acute Traumatic Brain Injury. J Head Trauma Rehabil. doi: 10.1097/htr.0000000000000206 Lange, R. T., Brickell, T. A., Bailie, J. M., Tulsky, D. S., & French, L. M. (2016). Clinical Utility and Psychometric Properties of the Traumatic Brain Injury Quality of Life Scale (TBI-QOL) in US Military Service Members. J Head Trauma Rehabil, 31(1), 62-78. doi: 10.1097/htr.0000000000000149 Marion, D., Lattimore, T. B., & Helmick, K. M. (2015). The Military Acute Concussion Evaluation (MACE) is time sensitive. J Trauma Acute Care Surg. doi: 10.1097/ta.0000000000000906 McCutchan, P. K., Liu, X., LeardMann, C. A., Smith, T. C., Boyko, E. J., Gore, K. L.,... Engel, C. C. (2015). Deployment, combat, and risk of multiple physical symptoms in the US military: A prospective cohort study. Ann Epidemiol. doi: 10.1016/j.annepidem.2015.12.001 Towns, S. J., Silva, M. A., & Belanger, H. G. (2015). Subjective sleep quality and postconcussion symptoms following mild traumatic brain injury. Brain Inj, 29(11), 1337-1341. doi: 10.3109/02699052.2015.1045030 Yerry, J. A., Kuehn, D., & Finkel, A. G. (2015). Onabotulinum toxin a for the treatment of headache in service members with a history of mild traumatic brain injury: a cohort study. Headache, 55(3), 395-406. doi: 10.1111/head.12495