ANNUAL REPORT

Defense anD Veter ans

Br ain injury Center

2011
DVBIC MISSION 

Defense and Veterans Brain Injury Center’s 

mission is to serve active duty military, their 

beneficiaries, and veterans with traumatic 

brain injuries (TBIs) through state-of-the-art 

clinical care, innovative clinical research 

initiatives and educational programs, and 

support for force health protection services. 

DVBIC fulfills this mission through ongoing 

collaboration with the DoD, military 

services, Department of Veterans Affairs, 

civilian health partners, local communities, 

families and individuals with TBI.

Photo courtesy of DVIDS
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TABLE OF CONTENTS

2011 Annual Report

n Message from the Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

n Operational Updates........................................... 4

n Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DVBIC Research Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

High Profile Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

15-Year Longitudinal Study on TBI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Head-to-Head Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

SCORE! Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DVBIC Research Portfolio..................................... 7

TBI Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

TBI Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

TBI Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

TBI Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Studies Crossing Multiple Categories of Research. . . . . . . . . . . . . . . . . . 10

Looking Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

n Clinical Affairs............................................... 12

Office of Care Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Office of Clinical Initiatives................................... 14

Neurocognitive Assessment Test (NCAT) Program Office . . . . . . . . . . . 16

n Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

n Education................................................... 18

Multimedia Education and Materials Distribution . . . . . . . . . . . . . . . . . 18

Print Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Web-Based Resources and Support............................ 19

Annual TBI Training Summit.................................. 21

Family Caregiver Guide...................................... 22

Moving Forward: 2012 Projected Activities . . . . . . . . . . . . . . . . . . . . . . 23

Far-reaching TBI Education................................... 23

Partnerships with the Military . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Provider Education as a Force Multiplier........................ 25

Increasing the Visibility of TBI at Professional Conferences . . . . . . . . . 25

TBI Education for Service Members, Veterans and Families . . . . . . . . . 26

Outreach to National Guard and Reserve . . . . . . . . . . . . . . . . . . . . . . . 26

Brain Injury Awareness Month................................ 27

Preparing Communities to Welcome Veterans . . . . . . . . . . . . . . . . . . . 27

Next Up in 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

n Network Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

n Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2

MESSAGE FROM THE DIRECTOR

2011 Annual Report

Dear Service Members, Veterans, Families and Friends:

2011 was a year of change and growth for the Defense and Veterans Brain 

Injury Center (DVBIC). More, bigger, and new are words that characterize 

seemingly everything we did last year. A few examples:

• We moved. DVBIC’s headquarters location moved after 19 years due to the

Base Realignment and Closure merger of Walter Reed Army Medical Center 

in Washington, D.C., and National Naval Medical Center in Bethesda, 

Md.; a DVBIC network site was installed at the newly-created Walter Reed 

National Military Medical Center in Bethesda, and DVBIC’s headquarters 

staff moved into nearby Silver Spring and Rockville office space.

• We began treating service members in a new location: Fort Belvoir 

Community Hospital.

• We launched BrainLineMilitary.org in August and went live with mobile 

sites for BrainLine.org and BrainLineMilitary.org.

• We convened our largest number of military medical providers yet at our 

5th Annual Defense and Veterans TBI Summit.

• We shipped more than 960,000 educational materials — nearly triple the

number we distributed in 2008.

All of these accomplishments happened in a year in which I spent six months

in Afghanistan! This list of show-stopping achievements demonstrates 

DVBIC’s commitment to our mission of serving those who have served and 

are serving. It is the service members and veterans and their families who 

drive our motivation each day to do the best we can, plus a little bit more.

Photo courtesy of DVBIC
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MESSAGE FROM THE DIRECTOR

2011 Annual Report

My own work in Afghanistan helped me see how extensively DVBIC materials 

are used and how important those tools really are, especially the MACE, for 

deployed providers of all services in screening and making the diagnosis 

of concussion. As the Theater Neurology/TBI Consultant, standardization 

of mTBI care and reporting was one of the key missions at hand at the 

11 concussion care centers in-theater. I was inspired by the dedication 

and ingenuity of these concussion center providers in achieving this goal, 

including their outreach to commanders, providers and the very warriors 

themselves. As a result, we see 95 percent of wounded warriors with mTBI 

recovering in theater on average in five days (or less than one week). I 

returned from my deployment determined more than ever to ensure that 

DVBIC’s network and headquarters work together seamlessly and with our 

partners to fulfill our mission not only in theater but back home, across the 

continuum of care.

Coming in 2012, I can promise you that there will never be a dull moment, 

and we will work our hardest to meet the needs of our nation’s service 

members, veterans and families. As anticipated completion of contingency 

operations lead to fewer deployment injuries, we will continue to operate as 

DoD’s enduring trusted TBI resource and enhance our focus on prevention 

and treatment of injuries stateside. Next year DVBIC will mark 20 years of 

service, a period which will surely prompt reflection of how our work has 

changed over the years past, and will change in years to come. On behalf of 

all of the DVBIC network and headquarters team, thank you for being a part 

of our mission. 

Very respectfully,

COL Jamie Grimes, MD

National Director, DVBIC

Photo courtesy of DVBIC
4

OPERATIONAL UPDATES

2011 Annual Report

For DVBIC, 2011 was a year of 

change and increased capability . 

We placed the first on-location 

government site directors for the 

Charlottesville and Johnstown 

Neurorehabilitation and Community Reintegration Centers this 

year . This ensures that each of 

these centers provide the very 

best care to our service members 

with TBI injuries . 

We continued a productive relationship with a consulting company to help us conduct strategic 

planning . There was a change in 

the structure of our national meeting held in St . Petersburg, Fla ., this 

year . We increased the breakout 

sessions and altered the makeup 

of the sessions, which provided an 

excellent opportunity for the staff 

to learn from each other, work 

out common problems in group 

sessions and establish professional relationships to strengthen 

the DVBIC family . Network communication was further facilitated 

through a poster presentation that 

each site and the headquarters 

team developed and shared during an evening event . Attendees 

not only had the opportunity to 

discuss their site, they were able 

to visit the other posters to learn 

more about the DVBIC network . 

Our internal organizational growth 

coincided with major outward 

changes . Because of the closure of 

Walter Reed Army Medical Center, 

we moved our central office operations to Silver Spring, Md ., and 

opened two new network sites: 

one at Walter Reed National Military Medical Center, in Bethesda, 

DVBIC logo created to unify and present the 

DVBIC brand so those who see it instantly 

associate the logos, fonts and colors with the 

highest standards in the research, education 

and treatment of traumatic brain injury .

Md ., and one at Fort Belvoir Community Hospital in Virginia . This 

expansion to Fort Belvoir provides 

increased TBI services to Marine 

Corps Base Quantico and northern 

Virginia . 

During 2011, we hired our first 

full-time, dedicated Contracting 

Officer’s Representative, a vital 

government position to oversee 

the organizational relationship 

between the government and 

contracting company, as well as 

the contracts themselves . DVBIC 

continued the challenging process 

this year of separating our current 

contract into three more manageable and service-specific contracts . 

We successfully awarded a headquarters support contract, one of 

the three projected . The lengthy 

process continues for the other 

two contracts, and we look forward to its fruition . 

Overall, DVBIC’s internal changes 

are intended to strengthen operations at headquarters and our 

network sites; serve our health 

care partners of the military and 

VA better; and ultimately, improve 

care to the service members, veterans, families and providers who 

are affected by TBI .
5

RESEARCH

2011 Annual Report

DVBIC RESEARCH MISSION 

DVBIC’s Division of Research brings together leading experts from the DoD and VA, as well as other federal and non-federal 

partners, to study the effects of TBI on service members, veterans, and their family members and caregivers. Together, 

these experts investigate interventions that prevent or treat the effects of TBI. This work, much of which is congressionally 

mandated, is accomplished through clinical investigations across all TBI severity levels in active duty and veteran populations, in epidemiological and longitudinal studies to understand the long-term effects of TBI and assess the efficacy of TBI 

treatments and interventions.

HIGH PROFILE STUDIES

15-Year Longitudinal Study 

on TBI

Section 720, HR 5122 of the 2007 

National Defense Authorization 

Act (NDAA) requires a longitudinal 

study on TBI sustained by service 

members in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) . The study is 

to be conducted over a 15-year 

period and address: 1) the longterm physical and mental health 

effects of TBI incurred by members of the Armed Forces during 

service in OIF and OEF; 2) the care 

and rehabilitation needs of these 

members with TBI; 3) the type and 

availability of care and rehabilitation programs and services within 

and outside the DoD and the DVA 

for these service members and 

veterans with TBI; and 4) the effect 

this injury has on family members 

and caregivers .

This study will collect information 

on service members and veterans 

with deployment-related TBI for up 

to 15 years after injury . Patients 

can enroll in one of two pathways: 

a comprehensive pathway in which 

intensive clinical evaluations every 

three years will provide neuroimaging, neurocognitive, neurobehavioral, blood specimen, and 

clinical data; or a brief pathway 

in which phone/web-based abbreviated clinical evaluations are 

conducted annually for up to 15 

years . Participants will fall into one 

of three cohorts: (a) those who 

have sustained a mild, moderate 

or severe TBI, (b) those who have 

sustained a non-TBI related injury 

such as an orthopedic or soft tissue injury (injured non-TBI trauma 

controls), or (c) are those who are 

injury free (non-injured controls) . 

There will be 2,800 study participants .

This 15-year longitudinal study 

will also address health-related 

quality of life issues for caregivers 

of service members and veterans with moderate or severe TBI . 

Focus groups, cognitive interviews 

and field-testing will be used to 

assess the mental and physical 

health of these caregivers, as well 

as develop validated TBI quality 

of life care items to measure their 

well-being and health care needs . 

The study began at the former 

Walter Reed Army Medical Center 

and was transferred to the Walter 

Reed National Military Medical 

Center (WRNMMC) with the Base 

Closure and Realignment (BRAC) . 

In April 2011, the study achieved 

the milestone of receiving all final 

regulatory approvals and started 

enrolling patients . By the end of 

2011, 43 service members had 

been enrolled into the comprehensive pathway . In 2012, enrollment 

into the comprehensive pathway 

will continue, and enrollment into 

the brief pathway and caregiver 

studies will begin .

Photo courtesy of iStockphoto
6

RESEARCH

2011 Annual Report

Head-to-Head Study

The DVBIC study titled, “A psychometric comparison of brief 

computerized neuropsychological 

assessment batteries,” abbreviated as H2H for “Head-to-Head” 

study was developed as a result of 

HR 4986, Section 1673 of the 2008 

NDAA requirements, to improve 

assessment of cognitive functioning of a deployed service member 

after a potential mild TBI . The time 

requirements for administering 

pencil-and-paper neuropsychological evaluation (traditionally 

used to test cognitive functional 

abilities) limit its feasibility for use 

in-theater where quick decisions 

need to be made and space and 

resources may be sparse . The 

H2H study, being conducted at 

Fort Bragg, N .C ., was designed to 

provide information regarding the 

utility of four different computerized tests to identify soldiers who 

are at risk for brain injury-related 

problems . This study will compare 

the psychometric properties of 

commercially available computerized neuropsychological tools 

(ANAM, ImPACT, CogState Sport, 

and CNS Vital Signs) to establish 

the test-retest reliability and validity of these computerized batteries 

in an active duty military population, and to allow informed decisions regarding best practices for 

the use of a computerized mild TBI 

assessment program .

Phase I of this study seeks to 

establish the test-retest reliability 

of several leading computerized 

batteries . The goal is to measure 

the test-retest reliability in a homogenous sample of active duty 

military personnel with approximately 30 days between testing 

periods . This will allow for more 

direct comparisons of the psychometric properties of these assessment tools . This phase of the H2H 

study began recruiting participants 

in February 2011 . Enrollment was 

nearly complete by the end of the 

year . Data analysis is expected to 

begin in early spring 2012, with 

distribution of results and conclusion by the fall .

Phase II of this study seeks to establish the validity of the computerized neuropsychological batteries to detect cognitive dysfunction 

as determined by traditional 

neuropsychological evaluation, in 

service members with and without 

mild TBI . Phase II of H2H received 

all required regulatory approvals 

in June 2011, and had enrolled 22 

of a target of 260 participants with 

mild TBI, 5 of a target of 260 control participants, and 0 of 260 nonTBI injured control participants . 

Enrollment will continue in 2012 .

SCORE! Study

The DVBIC Division of Research 

responded to HR 2647, section 

723 of NDAA 2010, by developing the Study of Cognitive Rehabilitation Effectiveness for Mild 

Traumatic Brain Injury (SCORE!), 

being conducted at San Antonio 

Military Medical Center in Texas . 

This is a prospective, randomized, 

control treatment trial of cognitive 

rehabilitation for OEF/OIF service 

members with a history of mild TBI 

and persistent (3-24 months postinjury) cognitive complaints . This 

study will assess the efficacy of 

computerized, group, and individual therapies in order to provide 

TRICARE Management Activity an 

evidence-based assessment of the 

effectiveness of cognitive rehabilitation therapy to care for service 

members with mild TBI . Recruitment began in June 2011, with 28 

participants enrolled in the study 

by the end of the year . Enrollment 

will continue in 2012 .

Photo courtesy of Department of Defense
7

RESEARCH

2011 Annual Report

DVBIC RESEARCH PORTFOLIO

TBI Screening

The Division of Research is committed to the care of wounded 

warriors across the continuum 

of care for TBI . Early identification of TBI is critical in delivering 

appropriate services and support 

to those who need them . In the 

area of TBI screening, DVBIC’s 

research portfolio includes studies 

designed to validate or improve 

TBI screening tools . In one such 

study that was completed in 2011, 

DVBIC collected normative data 

in a military population on the 

Military Acute Concussion Evaluation (MACE) . Across three DVBIC 

study sites (Naval Medical Center 

at San Diego/Camp Pendleton, 

Brooke Army Medical Center, 

and Carl R . Darnall Army Medical 

CenterFort Hood), 544 normative 

cases were collected by the spring 

of 2011 . This study concluded 

that the different versions of 

the standardized assessment of 

concussion (SAC) were equivalent 

across all forms (including the new 

additional forms), and that MACE 

performance and score distribution for the military population is 

highly consistent with SAC data in 

athletes .

TBI Assessment

Once an individual has been 

diagnosed with a TBI, determining the severity of the injury will 

help inform injury prognosis and 

guide the course of treatment . The 

DVBIC research portfolio includes 

a number of studies in the area of 

TBI assessment, including the H2H 

study described above . 

Another study which is designed 

to meet the goal of improving TBI 

assessment is A Provider Validated 

Traumatic Brain Injury (TBI) Assessment Trial in Post Deployed Soldiers, 

being done at Fort Carson DVBIC . 

The aims of the study are: to 

establish the cutoff criteria that 

optimize sensitivity and specificity, 

as well as the positive and negative predictive value of the VA/DoD 

TBI screening tool in relation to clinician-confirmed diagnosis of TBI 

using the Warrior Administered 

Retrospective Casualty Assessment Tool (WARCAT) as the instrument for the basis of a Structured 

Clinical Interview (WARCAT Plus); 

to determine the degree to which 

positive TBI screening using the 

VA/DoD screening tool and WARCAT Plus predict post-concussion 

symptom reporting, independent 

of PTSD status; and to determine 

the degree to which positive TBI 

screening using a VA/DoD screening tool and WARCAT Plus each 

predict increased psychiatric and 

other health care utilization and 

outcomes, as well as discharge 

from military service at one year 

post screening . Enrollment for this 

study closed in 2011 . Results from 

this research were published in 

the following manuscript: Terrio HP, Nelson LA, Betthauser 

LM, Harwood JE and Brenner LA . 

2011 . Postdeployment traumatic 

brain injury screening questions: 

sensitivity, specificity, and predictive values in returning soldiers . 

Rehabil Psychol 56(1):26-31 .
8

RESEARCH

2011 Annual Report

TBI Treatment

Taking care of all of our wounded 

warriors is a top priority for DVBIC, 

and the Division of Research is 

working to find the best therapies 

for every challenge that TBI presents to this population . No current 

FDA-approved treatment exists for 

TBI, so it is very important to find 

the best treatments for the various 

symptoms that present following 

a TBI and the common co-morbidities co-occurring with TBI . 

DVBIC is conducting a TBI clinical treatment trial at San Antonio 

Military Medical Center (SAMMC) . 

This trial, known as ProTECT III, 

will determine if progesterone, a 

hormone normally found in the 

human body, is useful in limiting 

the amount of brain damage from 

TBI . Progesterone is inexpensive 

and safe, and early studies show 

it is effective for moderate and 

severe TBI . ProTECT III will test intravenous progesterone in improving functional outcomes in adults 

acutely after moderate to severe 

TBI . This national, multisite study 

is using the National Institutes 

of Health Neurological Emergencies Treatment Trials network and 

includes 17 civilian sites . DVBIC 

SAMMC was invited to collaborate 

and participate in the study as the 

only DoD arm of the trial . In 2011, 

the study team completed the 

community consultation and public disclosure, and had received 

conditional regulatory approval, 

pending an approval from the Secretary of Defense for waiving the 

informed consent requirement for 

this research . 

Post-traumatic headache is one of 

the most commonly occurring sequelae after TBI and can persist or 

become recurring in the months or 

years after the brain injury . DVBIC 

WRNMMC is conducting a study 

entitled A Randomized Exploratory 

Study to Evaluate Two Acupuncture Methods for the Treatment of 

Headaches Associated with TBI . The 

purpose of the study is to determine if standardized auricular 

acupuncture or semi-standardized 

traditional Chinese acupuncture 

alleviates headaches more effectively than usual care alone, 

in a cohort of active duty service 

members with mild to moderate 

TBI . DVBIC hopes to use the study 

to obtain preliminary estimates 

for future trial design . By the end 

of 2011, 17 of 90 participants had 

been enrolled . Enrollment continues in this study and is expected 

to increase in 2012, after the study 

team settles into its new space . 
9

RESEARCH

2011 Annual Report

TBI Rehabilitation

Rehabilitation is a vital part of the 

recovery process for TBI patients 

to return to their pre-injury state . 

The Division of Research is working on exciting studies to find the 

best possible solutions for successfully rehabilitating survivors 

of TBI . As mentioned previously, 

the SCORE! study is a randomized clinical trial determining the 

efficacy of cognitive rehabilitation 

for persistent symptoms after 

mild TBI . In concert with this study 

at SAMMC is the Imaging Support 

of Study of Cognitive Rehabilitation Effectiveness in Mild Traumatic 

Brain Injury (iSCORE) . DVBIC is 

planning to partner with the 

Research Imaging Institute at the 

University of Texas Health Science 

Center at San Antonio to conduct 

this study . The goals of this study 

Also in the area of TBI rehabilitation, the research team at DVBIC 

Fort Carson is conducting a study 

entitled A Randomized, Controlled, 

Trial of Interactive Metronome 

(IM) Technology for Remediation 

of Cognitive Difficulties Following Blast-Related Traumatic Brain 

Injury . This study is designed to 

determine whether the addition of 

IM training leads to improvements 

in attention and memory, better 

secondary outcomes such as postconcussion symptom status, vocational functioning, and quality of 

life, and normalization of electrocortical functioning at six months 

in comparison to rehabilitation 

treatment as usual . This study 

enrolled 38 of 50 total participants 

in 2011 . In 2012, enrollment will 

continue until completion, and the 

research team will begin analyzing 

the data .

are to investigate longitudinal 

structural and functional imaging 

changes over time that correlate 

with outcome following a trial of 

cognitive rehabilitation, as well as 

to investigate the neural correlates of fatigue and misperception 

of effort as they relate to treatment outcome following mild TBI . 

Patients enrolled in SCORE! who 

agree to participate in iSCORE are 

consented, enrolled and undergo 

MRI imaging, complete several 

behavioral measures, a submaximal grip strength measurement 

and a cognitive task . Enrollment 

for this study began at the end of 

2011 and will continue until there 

are 200 subjects, which could take 

until 2013 .

Photo courtesy of Department of Defense
10

RESEARCH

2011 Annual Report

Photo courtesy of iStockphoto

Studies Crossing Multiple 

Categories of Research

Some of DVBIC’s studies do not 

naturally fall into just one of the 

research categories listed above . 

These more widely scoped studies 

tend to be longitudinal or observational, and include many stages of 

the care continuum of TBI from injury to the final state of recovery, 

such as the previously described 

15 Year Longitudinal Study . 

The Prospective Brain Injury Tracking Protocol continues as a DVBIC 

study underway at eight sites . The 

ultimate goals of this study are to 

ensure that all military and VA patients with TBI receive TBI-specific 

screening, treatment and followup while standardized patient 

outcome data is being collected; 

to determine the effectiveness 

and relative cost of TBI evaluation and treatment strategies for 

military and VA medical systems; 

and to provide the military medical 

communities with evidence-based 

guidelines to optimize care for survivors of TBI . Enrollment for this 

study continues at multiple DVBIC 

sites with the goal of creating a 

collective database of clinical data 

which will be used to gather valuable information leading to future 

best practices . 

Another study, the Traumatic Brain 

Injury Model Systems, is being 

conducted at DVBIC Tampa, DVBIC 

Richmond, and DVBIC Minneapolis, with DVBIC Palo Alto partnering with the Model Systems team 

at the Palo Alto VA . This study 

involves the creation and management of a database associated 

with injury severity and outcomes 

associated with the longitudinal 

recovery course associated with 

TBI . The primary purpose of these 

data will be to gauge performance 

of VA Polytrauma Rehabilitation 

Centers’ inpatient rehab programs 

relative to the private sector TBI 

inpatient rehabilitation programs . 

Data elements will be abstracted 

from medical records . Data characterizing injury severity, course 

of hospitalization, adjustment, and 
11

RESEARCH

2011 Annual Report

rehabilitation outcomes will be 

collected during acute hospitalization for participants . Rehabilitation 

outcomes, medical complications, 

psychological adjustment, and 

socio-economic variables will be 

collected at annual follow-up intervals (1, 2, 5, and 5 year intervals 

thereafter) for a total of 20 years . 

Enrollment continued in 2011 and 

looks to continue in 2012 . 

The DVBIC Richmond VA site is 

conducting a study entitled Epidemiological Study of Mild Traumatic 

Brain Injury Sequelae Caused by 

Blast Exposure During Operations 

Iraq and Enduring Freedom, collaborating with others from Virginia 

Commonwealth University, Marine 

Corps bases Quantico and Camp 

Lejeune and Army Base Fort Lee . 

The purposes of this study are to 

determine prevalence of post-concussive symptoms after blast-related mTBI; determine early predictive factors for the development 

of post-concussion syndrome 

after blast injury; characterize late 

objective impairments after blastinduced mTBI to aid in the development of targeted interventions 

and measures, and to determine 

trajectory of symptoms to better 

characterize outcomes following 

TBI . Enrollment continued to reach 

its goal of 748 subjects in 2011 

and will continue to recruit well 

into 2012 . A manuscript based on 

this research was under review at 

The Journal of Head Trauma Rehabilitation at the end of the year .

Looking Forward

In 2012, the DVBIC Division of 

Research will continue the mission 

of conducting research aimed at 

informing best practices for the 

care of service members and veterans who have sustained a TBI, 

and better understanding of the 

needs of caregivers and families . 

We will continue to progress on 

all of our ongoing studies, and our 

researchers will listen to the TBI 

community to help address unmet 

needs . 
12

CLINICAL AFFAIRS

2011 Annual Report

DIVISION OF 

CLINICAL AFFAIRS

The Division of Clinical Affairs 

provides services to support high 

quality medical care and education 

through facilitation of direct clinical care, care coordination, policy 

development, and educational 

programs for patients, caregivers 

and providers . The clinical affairs 

team also is active in increasing 

TBI awareness and prevention 

in both the military and civilian 

communities through providers 

and educational outreach events, 

multimedia, and collaborations 

with external partners . Staff within 

the division oversee neurocognitive testing for deploying service 

members, improve standards of 

care by updating clinical practice 

guidelines and determining effective medical practices through 

objective metrics, and support 

service members and veterans 

though the DoD and VA health 

care systems as they make the 

transition to civilian life . The Division of Clinical Affairs is comprised 

of the Office of Care Coordination, 

the Office of Clinical Initiatives, 

and the Neurocognitive Assessment Test (NCAT) Office . Each of 

these offices provides unique services, yet maintains close collaborations with other DVBIC divisions 

as well as government and civilian 

organizations that support service 

members and veterans with TBI .

Office of Care Coordination 

The DVBIC regional TBI care coordination system ensures that service members and veterans with 

TBIs have access to appropriate 

medical care, support, and available resources throughout the recovery process . DVBIC’s network of 

TBI care coordinators assists active 

duty service members — including National Guard and reservists 

— and veterans with diagnosed 

TBIs as they navigate the systems 

of care . Regional Care Coordinators (RCCs) provide standardized 

follow-up and support as patients 

transition between treatment 

settings . Moreover, RCCs serve 

as points of contact to assess TBI 

resources in communities where 

individuals reside, facilitate access 

to those services, and ensure that 

individual plans of care are appropriate in the short and long term 

to optimize positive outcomes .
13

CLINICAL AFFAIRS

2011 Annual Report

In 2011, the care coordination 

program followed a 1,129 service

members and veterans across the 

continuum . Intake interviews provide the service member with an 

understanding of the program as 

well as make the connection to the 

TBI Care Coordinator assigned to 

their geographical catchment area . 

Subsequent interviews are conducted at standardized intervals to 

ensure that the service member is 

connected to appropriate services . 

In 2011 the RCCs conducted a 

total of 2,764 intake and follow-up 

interviews with service members 

and veterans .

Army 

60%

Army 

Reserves

4%

ARNG

10%

Navy

2%

Air Force

3%

Marines

21%

2011 Referral Source Breakdown 

by Service Branch

Military

Treatment

Facility 16% 

Landstuhl Regional 

Medical Center 82%

Self 1% 

Other 1% 

2011 Referral Source

0

300

600

900

1200

1500

Intakes 3 mos I U 6 mos I U 12 mos I U 24 mos I U non standard I U

1425

628

379

217

91

24

2011 Completed Interviews

N=2764

Total Caseload 1129

Army 

60%

Army 

Reserves

4%

ARNG

10%

Navy

2%

Air Force

3%

Marines

21%

2011 Referral Source Breakdown 

by Service Branch

Military

Treatment

Facility 16% 

Landstuhl Regional 

Medical Center 82%

Self 1% 

Other 1% 

2011 Referral Source
14

CLINICAL AFFAIRS

2011 Annual Report

Office of Clinical Initiatives

The Office of Clinical Initiatives 

(OCI) undertakes projects to 

strengthen the DVBIC network, 

improve the quality of care across 

the DoD and VA health care systems, and expand TBI knowledge 

across the military and civilian sectors . OCI collaborates with the TBI 

representatives and/or program 

manager from each branch of 

service and other DoD and VA organizations to develop and update 

clinical practice guidelines and create clinical content for TBI trainings across a variety of platforms . 

Projects and programs undertaken 

by the Office in 2011 include:

• Providing TBI Subject Matter Expertise: OCI staff act as subject matter 

experts (SMEs), serving on panels, workgroups and committees with 

the goal of establishing and updating clinical practice guidelines and 

policies . DVBIC SMEs work both independently and with external stakeholders to maintain the highest standards of TBI care and education 

across the DoD and VA. SMEs worked on the following projects: 

• Military Acute Concussion Evaluation update

• Centers for Disease Control and Prevention Concussion Definition 

Workgroup

• Development of 

Course

BrainLineMilitary.org Civilian Provider Training 

• Development of Armed Forces Health Longitudinal Technology 

Application-Theater (AHLTA-T) Alternate Input Methods Forms, 

known as AHLTA-T forms

• TBI Co-occurring Conditions Toolkit development and focus group 

for second edition

• Consultation on ICD-10 Coding

• TBI Educational Training: Staff within OCI works with government and 

civilian organizations to provide TBI education to civilian and military providers caring for service members and veterans . In 2011, the 

Office provided training at five educational events for the Center for 

Deployment Psychology, three for the American Red Cross and four 

for military organizations (Walter Reed Army Institute of Research, The 

United States Military Academy at West Point, Operation Headed Home 

in Fort Knox, Ky ., and a two-day webinar for the Army Wounded Warrior Program) . In addition to collaborating with outside organizations 

to train medical providers, the OCI plays a key role in developing the 

educational content for the Annual Defense and Veterans Traumatic 

Brain Injury Summit, which trains approximately 1,000 TBI providers 

across the DoD and VA . 

• Info@DVBIC.org: DVBIC provides an integral service to the TBI community through Info@DVBIC.org . This online service assists service members, veterans, caregivers and providers dealing with the complexities 

of TBI care . Staff in the Office of Clinical Initiatives and the Division of 

Education answer clinical inquiries and provide educational materials and other resources to patients, families and medical providers . In 

2011, more than 3,000 inquiries were answered by DVBIC personnel . 

• TBI Consult: This online service provides rapid response consultation 

to clinicians providing in-theater TBI care . More than 65 consultations 

were completed with the assistance of OCI staff during 2011 . 
15

CLINICAL AFFAIRS

2011 Annual Report

• Clinical Outcomes Project: This project aims to improve individual care 

and provide methods for quality improvement across TBI clinics in the 

DVBIC network . During 2011, the Project established appropriate pilot 

sites and initiated the development of a clinical database that will enable clinics to track and measure the quality of care delivered to their 

patients . 

• Interactive Cognitive Training Modules: In collaboration with the 

National Center for Telehealth and Technology, OCI staff created an 

interactive platform to engage and educate patients and their families 

about rehabilitation for cognitive symptoms following a TBI . These 

modules resemble cognitive care provided in the clinical setting and 

provide patients the opportunity to relate to real-life, cognitively challenging situations . Through the use of these programs, patients can 

implement strategies to enhance recovery and reintegration . 

• Tele-TBI Clinic: OCI staff worked closely with the James A. Haley 

Veterans’ Hospital (JAHVAH) in Tampa, Fla ., to determine and implement innovative ways to reach patients diagnosed with TBI . Through 

technological advancements, the James A . Haley Veterans’ Hospital 

Physical Medicine and Rehabilitation Service seeks to use clinical video 

telehealth (CVT) services to reach outpatient centers closer to the patient’s home, allowing for improved access to care . In addition, home 

telehealth pilot programs are being implemented, providing video 

telehealth services directly into the home . Full implementation of the 

JAHVAH tele-TBI clinic is planned for 2012 with DVBIC’s facilitation . 
16

CLINICAL AFFAIRS

2011 Annual Report

Neurocognitive Assessment Test (NCAT) Program Office

A 2008 Office of Health Affairs Memorandum designated DVBIC as the 

office of responsibility for oversight of the implementation of pre-deployment Automated Neuropsychological Assessment Metrics (ANAM) 

baseline testing program in the DoD . The program was named the 

Neurocognitive Assessment Tool (NCAT) Program . In 2009 the decision 

was made to create a web-enabled system to facilitate access to ANAM 

in remote locations and to better enable access to baseline studies for 

comparison when a post-injury study was obtained . The system is currently undergoing field studies and will soon be ready for deployment . 

As of December 31, 2011, a total of 1,069,068 ANAMs had been obtained 

in the DoD . These numbers represent both the pre-deployment and 

post-injury tests accomplished since the Army began ANAM testing in 

June 2007 . While there were only 50,000 to 100,000 studies done during 

the first 2 years of the program (2007, 2008), total ANAMs obtained each 

year for the past three years has remained relatively constant at approximately 300,000 per year:

As mentioned, the number above represents pre-deployment baseline 

ANAM tests as well as post-injury tests . Some Service members have 

multiple ANAM tests as post-injury serial testing may be performed as 

part of the return to duty assessment . 

Examining solely the pre-deployment ANAM tests, required by the DoD 

to be obtained within 12 months prior to deployment, the total number 

is considerably smaller (696,261) . The service breakdown of pre-deployment ANAM tests provided since inception of the program in June 2007 

include:

The average rate of pre-deployment ANAM tests completed 

across services in 2011 was 77 

percent of service members deploying . The pending release of 

the web-based NCAT system will 

lead to an improvement in the rate 

of baseline testing due to the ease 

of use and accessibility . 

The DVBIC NCAT program office 

continues to support tracking and 

trending pre-deployment baseline 

and post-injury ANAM testing, 

and investigating ways to improve 

post-injury ANAM testing . DVBIC 

also coordinates with Health Affairs Force Health Protection and 

Readiness and the Army Neurocognitive Assessment Branch 

Office to promote full implementation of web-based NCAT implementation . The NCAT program 

office worked closely with the Concussion Management Algorithm 

Workgroup that included representatives from all of the services, 

the VA, DVBIC’s national director, 

and representatives from DCoE to 

incorporate specific recommendations and indications for the use of 

post-injury NCAT . This strategy is 

expected to increase significantly 

the number of post-injury NCAT 

studies obtained .

Army Marines Air Force Navy Coast

Guard

Total

477,961 97,091 110,471 9,708 1,030 696,261

0 50,000 100,000 150,000 200,000 300,000 350,000

2011

2010

2009 301,590

300,966

307,969
17

SURVEILLANCE

2011 Annual Report

SURVEILLANCE

The Office of Surveillance is 

responsible for collecting and 

reporting data on the incidence 

and prevalence of TBI among DoD 

service members. In accordance 

with congressional mandate, the 

foundation of this program is the 

reporting of data; as such, data 

analysis remains a major focus of 

the surveillance program at DVBIC.

Through collaborative initiatives 

with federal and non-federal entities, this office serves to coordinate and collect the data, conduct 

statistical analysis, and offer 

TBI-related information to senior 

leaders of the military, policymakers, clinicians and researchers.

In addition to maintaining official 

reporting requirements, this office 

also publishes quarterly incidence 

data on the organization’s website 

at www.DVBIC.org, providing the 

general public a unique opportunity to view TBI-related information within the Military Health 

System. The updated website 

includes graphics on annual trends 

by branch of service, severity and 

annual incidence rate.

In 2011, the surveillance office revised the protocol and procedure 

used for the collection of TBI data 

conducted at the network sites, to 

obtain a comprehensive account 

of the characteristics surrounding 

TBI events. The DVBIC surveillance 

office also participated in a multiagency research data request 

between the Armed Forces Health 

Surveillance Center and researchers at the United States Army 

Aeromedical Research Laboratory 

and University of West Florida, 

offering advice on the diagnoses 

and occupational codes used to 

investigate the most affected occupational specialties by injury type 

and impact on return to duty. Furthermore, this office also ventured 

into and succeeded in collecting 

and reporting data on distribution 

of TBI medical encounters occurring in the direct and purchased 

care systems. The analysis projects 

service-specific information including TBI medical encounters in the 

private sector. The surveillance office continues to investigate alternative resources and collaborators 

to support the program mission 

to collect and report timely and 

actionable information to better 

serve the TBI population and those 

charged with their care.
18

EDUCATION

2011 Annual Report

EDUCATION

Multimedia Education and 

Materials Distribution

The DVBIC Division of Education 

provides TBI education, outreach 

and training materials to service 

members – active duty, Guard, Reserve, veterans, families, military 

and civilian clinical providers, military line leaders and policymakers.

Its initiatives include multimedia 

educational materials, the Family 

Caregiver Guide, support of three 

authoritative TBI websites (DVBIC.

org, BrainLine.org, and – new in 

2011 – BrainLineMilitary.org) and 

various venues for TBI training 

including a key annual summit for 

military and VA providers.

Educational resources are made 

available through the education division’s network of regional education coordinators (RECs) stationed 

in military, VA and community 

locations around the country and 

overseas. Their purpose is to promote awareness and prevention 

of TBI and help educate providers, 

which leads to the improved care 

of TBI patients.

In 2011 the Division of Education launched a DoD-oriented TBI 

site—BrainLineMilitary.org, as 

well as its sister site, BrainLine.

org, also became available as 

smartphone-accessible mobile 

sites. The sites host two new TBI 

public service announcements 

(PSAs) that debuted in 2011 on the 

American Forces Network (AFN). In 

addition, the Division of Education 

designed a new handout on the 

signs and symptoms of mild TBI/

concussion. Surveys, interviews 

and focus groups provided valuable feedback, enhanced Education’s products and ensured the 

right messages are delivered to 

the right audiences.

Print Materials

In 2011, DVBIC disseminated 

almost one million print materials, an increase of more than 150 

percent from 2010. This included 

more than 300,000 pocket-sized 

HEADS cards to equip deploying 

service members with essential 

concussion information. In addition, more than 45,000 copies of 

both the Military Acute Concussion 

Evaluation (MACE) and the DoD’s 

Clinical Practice Guidelines for 

Concussion in Deployed Settings 

reached health care providers.

Nearly 60,000 items went to units 

that were deployed in-theater. Approximately 50 different products 

were available in 2011.

Patient and Family 

Education Materials

236,153

Outreach 

Materials

119,807

Awareness and Prevention 

Materials

71,633 Tip Card Materials

20,931

Clinical 

Education 

Materials

515,194

HEADS Cards

New Signs and 

Symptoms 

Handout

Total Educational Materials Distributed during 2011: 963,718

2011 Education Materials Distribution by Category

Each Color Gradient represents a different product
19

EDUCATION

2011 Annual Report

A new handout, Concussion Signs 

and Symptoms, quickly emerged 

as one of the top 10 most popular 

products following its release in 

2011. It is available in nine languages (English, Spanish, Estonian, 

French, Georgian, German, Italian, 

Polish and Romanian) to meet the 

needs of NATO forces and those in 

the continental United States who 

prefer information in a language 

other than English. In focus groups 

with family caregivers, providers 

and DVBIC Regional Education Coordinators (RECs), this new product rated higher than any item.

[PHOTO OF S&S FLYER]

Additional print materials provided 

by DVBIC include information on 

TBI awareness and prevention, 

materials for outreach, tools for 

clinicians and patient education, 

and support resources. Subject 

matter experts from the military 

and the VA lend their knowledge 

to the materials’ development 

process.

Other items added to the DVBIC 

product line in 2011 include the 

hardcover children’s book, Our 

Daddy Is Invincible. The book 

was written by Shannon Maxwell, 

whose husband sustained a penetrating head injury in Iraq, and 

illustrated by Liza Biggers, whose 

brother died a year after a sniper’s 

bullet penetrated his brain in Iraq.

Print materials may be requested 

by email via info@DVBIC.org at no 

cost. DVBIC ships materials worldwide. The DVBIC REC network also 

plays a key role in distributing 

materials.

Web-Based Resources 

and Support

In 2008 DVBIC began a collaboration with WETA-TV-FM, a Washington, D.C. public broadcaster, to 

produce BrainLine.org, an authoritative TBI website with multimedia 

resources including interviews, 

videos, articles and social networking. Unique visitors to the website 

doubled from 2009 to 2011 (see 

chart on page 20). BrainLine.org

received nine awards in 2011, 

including two from the W3 competition which is judged by the 

prestigious International Academy 

of the Visual Arts. This brings the 

website’s total award count to 20.

The 2011 awards include:

• Association of Public Television 

Stations EDGE Award 

• Interactive Media Award, Outstanding Achievement, Health/

Nutrition 

• W3 Award, Silver, Health 

• W3 Award, Silver, Non-Profit 

• Web Health Award, Bronze, Association/Non-Profit Website 

• Web Health Award, Bronze, Media/Publishing Mobile Website 

• Web Health Award, Merit, Association/Non-Profit Mobile Website 

• Web Health Award, Silver, Other/

Miscellaneous Website 

• Web Marketing Association 

WebAward, Outstanding Achievement in Web Development 
20

EDUCATION

2011 Annual Report

In August, 2011, the Division of 

Education and WETA launched a 

TBI site geared to the military and 

veteran communities — BrainLineMilitary.org. This new website 

provides comprehensive resources 

targeted to service members, veterans and their families. Both sites 

are uniquely designed to serve 

those in minority, underserved 

and rural communities with a 

particular focus on National Guard 

and Reserve members and the 

home communities in which they 

reside.

BrainLineMilitary.org drew 10,512 

unique visitors and 45,375 page 

views in its first four months.

The original site, BrainLine.org, 

drew 433,419 unique visitors and 

1,254,254 page views in 2011. This 

is a 42 percent increase in traffic 

compared to 2010.

Mobile sites for both BrainLine.

org and BrainLineMilitary.org also 

launched. Access to the BrainLineMilitary.org platform is free 

and available to all users (iPhone, 

Android or Blackberry). Designed 

to be viewed on a smartphone, the 

web pages are much easier to read 

on a handheld device than would 

content from a website designed 

for a standard computer monitor.

In addition, WETA began creating 

a military Brain Injury Resource 

Directory, nicknamed mBIRD, 

which is similar to the Brain Injury 

Resource Directory on BrainLine.

org. The mBIRD, slated to launch 

in January 2012 on BrainLineMilitary.org, will feature an interactive 

map that allows users to click on a 

state and view a list of VA medical centers and DVBIC sites. This 

makes it convenient for users to 

find local resources.

All three DVBIC-supported websites featured a new PSA with Navy 

doctor and TBI patient Capt. James 

Hancock. The PSA also aired on 

the AFN. In it, Capt. Hancock recounts his injury and encourages 

individuals who have sustained a 

TBI to contact DVBIC. DVBIC RECs 

use the video clip in outreach efforts.

2009 2010 2011 

182,615 

304,963 

433,419 

0 

50,000 

100,000 

150,000 

200,000 

250,000 

300,000 

350,000 

400,000 

450,000 

500,000 

BrainLine.org Unique Visitors
21

EDUCATION

2011 Annual Report

Annual TBI Training Summit

DVBIC hosted the 5th Annual 

Defense and Veterans Traumatic 

Brain Injury Summit in August, 

2011. More than 1,000 DoD and 

VA health care providers from 

deployed and stateside settings, 

representing more than 15 health 

care disciplines, met for two and 

a half days in National Harbor, 

Md., (about 10 miles south of 

Washington, D.C.) to explore the 

challenges and advances in TBI 

care in complex VA Polytrauma 

facilities, military treatment facilities, clinics, and community-based 

facilities. Developed with input 

from the services, VA leadership 

and TBI subject matter experts 

across the DVBIC network, the 

summit offered a unique opportunity for collaboration and sharing 

of best practices. Lt. Gen. Eric 

B. Schoomaker, M.D., Ph.D., The 

Surgeon General/Commander, U.S.

Army Medical Command, delivered the keynote address. Harvey 

S. Levin, Ph.D., was awarded the 

prestigious Deborah L. Warden 

Lectureship Award in recognition 

of his leadership in neuroscience 

research that has contributed to 

significant advances in the care 

and treatment of TBI.

Despite a rare 5.8-magnitude 

earthquake that shook the East 

Coast on the second day of the 

summit, no one was injured at 

the event. The planning team was 

able to regroup, continue training 

and shift schedules to make up 

for the lost time. Participants took 

home a compendium of the latest 

TBI knowledge in a comprehensive Clinical Tools and Resources 

binder, as well as other DVBIC 

education materials to use in their 

clinical settings.

Photo courtesy of DVBIC
22

EDUCATION

2011 Annual Report

Family Caregiver Guide

Traumatic Brain Injury: A Guide 

for Caregivers of Service Members 

and Veterans was developed as a 

result of a congressional mandate 

to help families who are struggling to care for their injured loved 

ones. The guide is intended specifically for families caring for service 

members and veterans who have 

sustained a moderate, severe or 

penetrating TBI. With the guidance of a provider, the curriculum 

is used to provide coordinated, 

uniform and consistent support 

for family members who are struggling to cope with the challenges 

of caregiving and life management 

while navigating complex health 

care systems. The Center of Excellence for Medical Multimedia hosts 

the guide online along with oncamera interviews with caregivers 

at traumaticbraininjuryatoz.org.

(Links have been featured on BrainLine.org and BrainLineMilitary.

org.) Most families benefit from 

working through the guide with the 

support of trained providers.

In 2011, DVBIC trained 467 providers in the guide’s use and distributed 681 copies of the curriculum.

Since 2010, 679 providers have 

taken part in training and 1,154 

guides have been distributed.

DVBIC released a new family 

caregiver PSA, which aired on the 

AFN and online at BrainLineMilitary.org, in 2011. In it, Shannon 

Maxwell shares her experience 

and explains how family caregivers 

can benefit from the curriculum.

DVBIC RECs also use the video clip 

when they have resource tables 

at large conferences or outreach 

events, such as Yellow Ribbon 

events.

Moving Forward: 

2012 Projected Activities

DVBIC’s Division of Education has 

several goals for 2012:

• Equip medical personnel to 

evaluate and manage concussion: DVBIC plans to finalize 

revisions of the Military Acute 

Concussion Evaluation (MACE), 

the Clinical Practice Guidelines 

for Concussion in Deployed Settings and the acute concussion 

patient educational brochure.

• Empower service members 

returning home: Revisions have 

been underway to improve 

existing symptom management 

handouts aimed at individuals 

recovering from concussion.

A new fact sheet will address 

moderate to severe TBI. Two new 

product lines on the topics of 

family needs and getting back to 

school will cover these important 

reintegration issues. In addition, 

WETA will release another PSA to 

promote BrainLineMilitary.org.

• Build capacity among civilian 

providers: A new online course 

will be available on BrainLineMilitary.org to train civilian providers how to evaluate and treat 

service members and veterans 

with possible TBI.

Photo courtesy of DVBIC

Providers Trained Guides Distributed

212

467

679

1,514

681

473

Family Caregiver Guide 

Cumulative Numbers

Providers Trained and Guides Distributed 

■ 2010

■ 2011
23

EDUCATION

2011 Annual Report

• Ensure DVBIC products reflect 

up-to-date clinical content: An 

update for the head injury and 

dizziness symptom management 

handout will be available and will 

include the most current information on managing TBI-related 

dizziness.

• Connect individuals to the TBI 

support they need: Launch the 

Military Brain Injury Resource 

Directory (mBIRD) on BrainLineMilitary.org by the end of 

January 2012.

Far-reaching TBI Education 

Education has been central to 

DVBIC’s mission since the organization’s inception in 1992. DVBIC 

formalized the REC program in 

2007. A network of 16 RECs serve 

as designated regional TBI education points of contact. This team 

works with service members – 

active duty, Guard, and Reserve 

— veterans, families, health care 

providers, military line leaders and 

policymakers to promote awareness and prevention of TBI, and 

to improve the clinical management of TBI in their region. RECs 

accomplish this by conducting or 

facilitating classes and briefings 

for families and service members.

They also set up resource tables at 

events and conferences to reach 

out to stakeholders in person.

The REC network spans four military medical centers, six military 

installations, four VA hospitals, 

and two neurorehabilitation and 

community reintegration centers. RECs aim to meet the TBI 

education needs at their site and 

throughout their regional catchment areas.

Map of DVBIC Sites and Regions

Naval Medical Center

San Diego, CA

DVBIC Charlottesville

Charlottesville, VA

Fort Belvoir,

Fort Belvoir, VA 

Hunter Holmes McGuire

Veteran Affairs Medical Center

Richmond, VA 

DVBIC Headquarters

Silver Spring, MD

Veterans Affairs

Boston Healthcare System

Boston, MA 

Womack Army 

Medical Center

Fort Bragg, NC

James A. Haley 

Veterans Hospital

Tampa, FL

Naval Hospital

Camp Pendleton, CA

DVBIC Johnstown

Johnstown, PA

Minneapolis Veterans 

Affairs Medical Center

Minneapolis, MN 

Evans Army 

Community Hospital

Fort Carson, CO

Naval Hospital

Camp Lejeune, NC

Walter Reed National 

Military Medical Center

Bethesda, MD 

San Antonio 

Military Medical Center

San Antonio, TX  

Veterans Affairs Palo Alto

Health Care System

Palo Alto, CA 

Carl R. Darnall 

Army Medical Center

Fort Hood, TX

Landstuhl Regional 

Medical Center

Landstuhl, Germany

Defense and Veterans Brain Injury Center Network Sites and Regions
24

EDUCATION

2011 Annual Report

The REC program had a banner 

year in 2011, reaching more than 

90,000 stakeholders. On average, RECs nationwide staged 23 

TBI education events every week.

These encounters included:

• One-time events such as trainings, briefings, and presentations 

either delivered by an REC or in 

which the REC arranged for a 

subject matter expert to speak; 

• Multi-session educational activities such as TBI classes and support groups; and

• Brief encounters with the public at conference exhibits and 

resource fairs.

Partnerships with the Military

RECs are able to reach thousands 

of people each year because of 

DVBIC’s unique collaboration with 

the military services. Together, 

strong collaborative efforts ensure 

delivery of TBI education for all 

types and levels of military 

personnel.

The services recognize that TBI 

education is critical for the troops 

both pre- and post-deployment.

Many DVBIC RECs present or 

facilitate pre- and post-deployment briefs or resource tables at 

sites such as Fort Carson, Camp 

Lejeune, Fort Hood and Fort Bragg.

Clinical trainings for military medical personnel help to ensure that 

key individuals have up-to-date 

knowledge of TBI prior to deployment. They are also an opportunity to equip providers with 

clinical tools to use in the field.

For example, in Texas, the REC 

program has an active role in predeployment provider education at 

the San Antonio Military Medical 

Center. Courses at the Army Medical Department Center and School 

and the Defense Medical Readiness Training Institute routinely 

include lectures by TBI subject 

matter experts, whose participation DVBIC coordinates. Army 

cadre staff who will be in charge 

of the Warrior Transition Units 

receive mTBI briefs during their 

national training course.

2011 Regional Education Events and Participants

Participants by Category

Service Members Providers

Type of Educational 

Activity

Number 

of Events

Total 

Number of 

Participants

Active 

Duty

Guard Reserve Military 

Family 

Members*

Veterans Civilians DoD VA Civilian

One-time events: 

trainings, briefings, 

and presentations

638 72,822 53,826 1,938 2,517 4,105 691 2,595 4,074 668 2,408

Multi-session activities: 

classes and support 

groups

366 5,075 471 6 12 888 72 1,107 792 649 1,078

Brief encounters with 

the public: conference 

exhibits and resource 

fairs**

188 13,258 ~34% ~10% ~5% ~37% ~3% ~3% ~3% ~2% ~3%

Total 1,192 91,155 75,151 4,745 11,099 29,160 2,328 5,729 6,925 2,740 5,295

* Figures include an unknown number of service members

** Percentage of participants reflects the proportion of conference or resource fair attendees in that category, not all of whom visited the DVBIC booth
25

EDUCATION

2011 Annual Report

TBI affects the military community 

off the battlefield and outside of 

the clinic. The legal community 

is another integral stakeholder.

DVBIC Charlottesville, for example, 

has facilitated TBI training for the 

military leaders who attend the 

Judge Advocate General (JAG) Legal 

Center and School. Dr. Cynthia 

Boyd, co-senior scientific director 

of DVBIC-Naval Medical Center San 

Diego, has been invited to provide 

TBI and PTSD educational trainings to members of law enforcement, district attorneys, public 

defenders, Navy JAG and California 

superior court judges. RECs at San 

Antonio Military Medical Center, 

Fort Carson and DVBIC Johnstown 

also prepared or facilitated TBI 

presentations to the legal community.

Provider Education as 

a Force Multiplier

The REC program works closely 

with DVBIC’s Office of Clinical 

Initiatives to provide TBI training 

to key providers in the DoD and 

VA health care systems. At Walter 

Reed National Military Medical 

Center, the DVBIC REC program 

hosts a monthly TBI Grand Rounds 

series. These trainings are video 

teleconferenced to more than 15 

DoD and VA sites nationwide.

Provider training is a critical activity and a way to leverage DVBIC’s 

education efforts. Trained providers can pass TBI knowledge on to 

service members and veterans, 

who in turn can pass the information on to family and friends.

Ongoing TBI training is especially 

important for new providers. Furthermore, managing the care of a 

warrior who has sustained a TBI 

requires many types of clinicians.

For this reason DVBIC coordinates 

provider training opportunities for 

clinical personnel of many professional backgrounds.

In 2011, a total of 7,150 DoD, VA 

and civilian providers participated 

in TBI training through the REC 

program.

Increasing the Visibility of TBI at 

Professional Conferences

The REC program brings TBI education to professional military and 

civilian conferences throughout 

the year and across the country.

More than 4,500 DoD, VA and 

civilian providers interacted with 

a DVBIC REC at a professional 

conference last year. During those 

brief encounters, providers reported to the RECs that they have 

used DVBIC resources while they 

were deployed as well as in their 

clinics. Many contact an REC at a 

later date to arrange TBI training 

for their clinic or request more 

materials.

Many conference attendees who 

visit a DVBIC exhibit have not 

heard of DVBIC or are not aware 

of our newest products and initiatives. By speaking with an REC, 

they increase their awareness of 

available TBI resources and establish a relationship with a valuable 

TBI point of contact in their region.

In 2011, RECs shared DVBIC’s 

resources with professionals attending the Armed Forces Public 

Health Conference, the Special 

Operations Medical Association 

Conference, the Armed Forces Operational Medical Symposium, the 

Association of Military Surgeons 

of the United States’ 117th Annual 

Meeting, the 4th Annual Trauma 

Spectrum Conference, the 9th Annual U.S. Army EMS Conference, 

and the Association of the U.S.

Army’s Medical Exposition, among 

others.
26

EDUCATION

2011 Annual Report

TBI Education for Service 

Members, Veterans and Families

RECs at several DVBIC sites conduct a variety of TBI classes geared 

to meet the needs of patients 

and families. Coping with the 

symptoms of mTBI is the focus at 

Camp Lejeune, Fort Bragg and Fort 

Carson. Classes at Walter Reed 

National Military Medical Center 

and the Tampa VA are tailored to 

the challenges of recovering from 

moderate and severe TBI and the 

role of the family caregiver. For 

example, DVBIC Camp Lejeune 

offers a unique TBI education and 

therapy group taught by a multidisciplinary team. The class meets 

four times for a total of 70 hours 

over two weeks. In 2011, more 

than 150 service members participated in 10 class cycles. Across 

the entire DVBIC network, RECs 

led more than 175 class sessions 

in 2011.

Outreach to National Guard 

and Reserve 

In 2011, the REC program offered 

TBI resources to more than 27,000 

National Guard and Reserve members and their loved ones. This 

tremendous outreach effort was 

made possible by the Yellow Ribbon Reintegration Program (YRRP).

The YRRP is a DoD-wide effort to 

promote the well-being of National 

Guard and Reserve members and 

their families by connecting them 

with useful resources throughout 

the deployment cycle. This year 

RECs participated in more than 50 

Yellow Ribbon events in more than 

a dozen states – 34 with U.S. Army 

Reserve Regional Support Commands, 17 with the Air National 

Guard, and eight with the Navy 

and Marine Reserves. In addition, 

DVBIC presented a leadership 

brief via teleconference to the Yellow Ribbon program specialists.

Photo courtesy of Professional Image Photo
27

EDUCATION

2011 Annual Report

Brain Injury Awareness Month

Every March, the REC program 

rallies its efforts for Brain Injury 

Awareness Month. In addition to 

the ongoing educational activities, 

RECs organized numerous events 

this year to focus their regions’ 

attention on TBI prevention and 

awareness. These included TBI/

DVBIC displays in community 

locations such as local bookstores 

in Jacksonville, N.C., displays at 

the local DVBIC sites as well as 

throughout their bases. DVBIC 

displays were part of Open House 

and Awareness Day events at VA 

facilities. San Antonio had a TBI/

DVBIC exhibit at the National 

Guard Association of Texas conference. RECs contributed to the 

annual DVBIC display at the Brain 

Injury Awareness Day on Capitol 

Hill. Richmond VA reached out to 

thousands of military providers 

through an exhibit at the annual 

Armed Forces Public Health Conference. DVBIC Johnstown presented at the 1st Annual Pennsylvania 

State Jail Diversion and Trauma 

Recovery Conference.

Preparing Communities 

to Welcome Veterans

Civilian communities ultimately 

will have to support veterans 

who sustained a TBI during their 

military career. The REC network 

reaches into local communities 

whenever there is an opportunity 

to support reintegrating veterans.

In 2011, this included attending 

Brain Injury Association conferences in 10 states and exhibiting 

DVBIC resources at various civilian 

health care and veterans’ conferences. RECs also extended TBI 

training opportunities to local professionals in the sectors of health 

care, law and education. One such 

example comes from California 

where the VA Palo Alto Health 

Care System and DVBIC hosted the 

third Community College Workshop, “Strategies for Academic 

Success,” in collaboration with 

the War Related Illness and Injury 

Study Center. Attendees worked 

with active duty and veteran students who sustained TBIs and are 

now preparing to fully reintegrate 

in their communities.

Next Up in 2012

The REC program plans to add additional REC staff in 2012. The new 

DVBIC sites at Fort Belvoir, Va., 

and Joint Base Elmendorf-Richardson, Alaska, will each have an 

REC asset. Camp Pendleton, Calif., 

also will gain an REC. Collaboration 

with the services on pre- and postdeployment TBI education will be 

enhanced. With a fully staffed, robust REC team, the program plans 

to increase community awareness 

activities and expand its reach 

within the catchment regions to 

include not just service members 

but their families and communities.
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NETWORK SITES

2011 Annual Report

MILITARY TREATMENT FACILITIES

Landstuhl, Germany

Landstuhl Regional Medical Center (LRMC) is the 

largest medical facility in the European Regional 

Medical Command. Highlights of LRMC’s work include 

more than 11,000 TBI-related patient encounters and 

8,000 TBI screenings. TBI research continues to be an 

important aspect of the Landstuhl team’s work, with 

multiple ongoing trials, including two studies funded 

by the Congressionally Directed Medical Research 

Program.

Marine and Sailor Concussion Recovery Center, 

Camp Lejeune, N.C.

The DVBIC team at Camp Lejeune served 4,096 

patients in 2011 providing evaluations, plans of 

care, occupational and speech/language therapy, 

vestibular rehabilitation, psychological evaluations, 

case management, care coordination and alternative 

medicine therapies. In 2011 our RECs educated 

10,548 people including service members, Command 

officials, medical officers, providers and the 

surrounding community.

Camp Pendleton, Calif.

DVBIC Camp Pendleton hosted Clinical Neuropsychologist Michael McCrea, Ph.D., executive director for 

Pro Health Care’s Neuroscience Center and co-creator 

of the Military Acute Concussion Evaluation, for a 

scientific update on mild TBI. This site also continues 

to provide post-deployment screening support in collaboration with 1st Marine Expeditionary Force (IMEF), 

and has further embedded services into the command at Naval Hospital Camp Pendleton including 2.5 

DVBIC positions. For the Prospective Clinical Tracking 

study, Camp Pendleton collected 512 clinical tracking 

forms in 2011.

Fort Bragg, N.C.

In 2011, DVBIC Fort Bragg clinical personnel provided 

treatment and testing to 461 soldiers during 1,643 

office visits and had a return to duty rate of 96.5. percent. The H2H Research Study team tested 657 participants in 2011. As part of its ongoing TBI education 

mission, DVBIC Fort Bragg conducted 2,758 inprocessing briefings to soldiers during the year.

Evans Army Community Hospital, 

Fort Carson, Colo.

The DVBIC team at Fort Carson is uniquely situated 

within the Warrior Recovery Center at the Evans 

Army Community Hospital, which is the primary clinic 

for the treatment of TBI at the Mountain Post. This 

embedded site allows a high level of soldier contact 

by DVBIC staff. In 2011 Fort Carson’s DVBIC Research 

Program enrolled 32 subjects in the Interactive 

Metronome Study; this DVBIC Education Program provided classes and briefs to 33,666 individuals; and the 

care coordination program managed a caseload of 

229 service members.

Carl R. Darnall Army Medical Center, Texas

Fort Hood is the largest deploying base in the continental U.S. and is home to IIICORPS, 1st Calvary Division and First Army Division West. DVBIC staff provided education and training on mild TBI/concussion 

awareness to more than 26,000 troops and providers.
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NETWORK SITES

2011 Annual Report

Fort Belvoir Community Hospital, Va.

The TBI Clinic at Fort Belvoir Community Hospital 

opened its doors in July 2011, welcoming mild, moderate and severe TBI patients with complete evaluations, interdisciplinary treatment services and careful 

care coordination. The TBI team and three DVBIC 

staff evaluated, treated and educated more than 100 

service members, dependents and retirees.

Naval Medical Center San Diego (NMCSD), 

Calif.

In 2011, NMCSD collected 136 protocols for the Clinical Tracking Form national study, while also increasing the understanding of TBI among over 1,000 DoD, 

VA and civilian providers via 38 trainings in five states.

NMCSD also equipped more than 2,000 individuals 

with clinical tools and public awareness materials 

through 10 DVBIC exhibit tables.

San Antonio Military Medical Center, Texas

This year all DVBIC personnel in San Antonio moved 

into Brooke Army Medical Center, now known as 

San Antonio Military Medical Center (SAMMC). DVBIC 

staff reviewed post-deployment questionnaires and 

screened medical records of more than 1,700 service 

members for TBI, identifying 193 as TBI positive for 

the DVBIC TBI database, and enrolling 168 of those 

members in the DVBIC Prospective TBI Tracking 

Protocol. DVBIC San Antonio also updated more than 

1,400 providers with the latest TBI information. DVBIC 

personnel are involved in eight ongoing research protocols, including a congressionally mandated cognitive rehabilitation trial for OEF/OIF service members 

and a complementary longitudinal neuroimaging 

study.

Walter Reed National Military Medical Center 

(WRNMMC), Md.

The Traumatic Brain Injury Department moved from 

the Walter Reed Army Medical Center in Washington, 

D.C., to WRNMMC in Bethesda, Md., at the campus 

of the National Naval Medical Center. DVBIC staff 

evaluated, treated and educated over 597 active duty 

personnel, 702 civilian and DoD providers and 57 

family members. DVBIC personnel also are involved in 

several ongoing research protocols, constantly geared 

towards perfecting the level of care for our wounded 

warriors.
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NETWORK SITES

2011 Annual Report

VETERANS AFFAIRS MEDICAL CENTERS

Boston

DVBIC Boston is actively conducting research in the 

areas of TBI and other combat-related mental health 

disorders. DVBIC works closely with the VA’s TBI 

Center of Excellence at Boston: the Translational 

Research Center for Traumatic Brain Injury and Stress 

Disorders (TRACTS). Ongoing research protocols 

include behavioral and neuroimaging characterization of TBI and comorbid deployment-related mental 

health conditions as well as measuring the functional 

outcomes (i.e. driving safety) among the OEF/OIF 

cohort.

Minneapolis

In 2011, the Minneapolis DVBIC team in conjunction 

with Minneapolis VA Physical Medicine & Rehabilitation has been able to leverage existing relationships 

in order to collect and organize accessible data from 

multiple sources to create a multi-user relational database comprised of clinically relevant data. This data 

is being used to support the internal assessment and 

subsequent improvement of patient care, improve 

processes and procedures, collect clinical outcome 

measures and determine patient rehabilitation readiness. Additionally, the DVBIC team is developing new 

research protocols that will explore the relationships 

between TBI and neurodegenerative disease and TBI 

and cognitive control.

Palo Alto, Calif.

DVBIC Palo Alto is an integral part of the clinical, 

research, and education/outreach success of the Polytrauma System of Care at VA Palo Alto Health Care 

System. In 2011, an RCC database was designed and 

developed at this site as an innovative and exemplary 

collaboration between DVBIC Palo Alto and DVBIC’s 

central office to facilitate effective management 

and documentation of the RCC caseload, streamline 

interaction with service members, and improve RCC 

efficiency and track outcomes.

Richmond, Va.

DVBIC Richmond continues to be an integral component of the Polytrauma Rehabilitation Center, Polytrauma Network Site, and the Polytrauma Transitional 

Rehabilitation Program. Highlights of work include active participation in eight collective research projects 

ranging from Prospective Traumatic Brain Injury (TBI) 

Tracking Protocol to Traumatic Brain Injury Model 

Systems (TBIMS) with a 2011 total enrollment of 342 

TBI subjects. The REC and RCC combined for a total of 

2,009 contacts with active duty service members and 

veterans for their TBI care and educational needs.

Tampa, Fla.

The 8th Annual Blast Injury Conference was held on 

Dec. 14, 2011, with 309 attendees. The purpose of 

this annual conference is to present the most current 

research findings and best practices relevant to blastinduced TBI. Assessment, treatment and rehabilitation are explored from the perspectives of the DoD, 

VA and the private sector.
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NETWORK SITES

2011 Annual Report

NEUROREHABILITATION SITES

DVBIC operates two Community Neurorehabilitation 

and Community Reintegration Centers — DVBIC Charlottesville and DVBIC Johnstown. These CARF-accredited centers are DoD programs where service members 

who have sustained a brain injury and continue to 

have ongoing problems as a result of their injury can 

receive multidisciplinary medical, psychological and 

rehabilitation care in a residential/community-based 

setting. The services are available to any service 

member who is active duty, including members of the 

Guard and Reserve while on active duty orders. The 

two programs provide intensive, short-term services 

(typically 90 to 180 days in duration) in the post-acute 

stages of clinical care, providing needed rehabilitation services during the transition period between 

the hospital setting and the return to home or duty.

Embedded in the community, the programs are able 

to assess and treat service members in a large variety 

of settings where recovery and skills will be needed 

after discharge. The treatment options are individualized for each service member’s needs in order to 

optimize their functioning and abilities. Programming 

addresses complex issues such as behavioral challenges, cognitive challenges, substance use/abuse, 

family issues, post-traumatic stress, and adaptation 

to disability. Comprehensive care includes neurocognitive rehabilitation, cognitive behavioral therapies, 

physical therapy, activities of daily life, primary and 

specialty medical care, aquatic therapy, therapeutic 

horseback riding, vocational trials and case management. Goals are individualized and focus upon skill 

acquisition as a foundation for independent living, 

community engagement and work reentry. Treatment 

occurs at the home residence, the therapy center, and 

in real world environments to facilitate transfer of 

learning and optimize life potential. 

Charlottesville, Va.

DVBIC Charlottesville, located in Virginia, is one of 

two Community Neurorehabilitation sites in the 

DVBIC network. DVBIC Charlottesville is an intensive 

and structured DoD program for capacity of up to 

10 service members at a time who have sustained a 

brain injury and continue to have ongoing problems 

for which they can receive multidisciplinary medical, 

psychological and rehabilitation care in a residential/

community-based setting.

DVBIC Charlottesville is unique in providing postacute vocational training and a work reintegration 

program. Cooperative arrangements have been made 

with more than 25 businesses and governmental 

agencies within the Charlottesville community, where 

service members can gain practical job skills for preparation for return to duty or successful reintegration 

into their home communities. One such opportunity is 

our integral work with The Judge Advocate General’s 

Legal Center and School (TJAGLCS) and the U.S. Army 

on a number of mutually beneficial activities, such as 

collaborating on TBI and PTSD briefings at TJAGLCS, 

the availability of a Judge Advocate General (JAG) officer to work with service members in the program, and 

co-presenting at legal conferences on TBI, PTSD, and 

legal issues. In addition, working with the local crisis 

management team allows us to educate law enforcement officers to recognize service members with TBI 

and PTSD in the local community and treat them accordingly if encountered. Other collaborations include 

the Virginia Wounded Warrior Program, VA Department of Rehabilitation Services, and the University of 

Virginia Health System.

These programs augment, but do not duplicate, resources provided within the VA health care system.
32

NETWORK SITES

2011 Annual Report

2011 Specifics:

• Of the 20 service members in the program during 

2011 (average daily census at 90% of capacity in 

2011), dispositions of four are currently determined.

Ten percent of enrolled service members have medically retired from the military, 10% have returned 

to duty in the military, and 80% have returned to 

their community or military base and are awaiting 

disposition from the military. Satisfaction ratings 

are completed independently by quality assurance 

officers from NeuroRestorative who are not located 

on the premises and remain consistently high across 

all service members in the program across 7-10 

variables.

• All service members have been evaluated for ability 

to perform and are ultimately placed in one or more 

of over 25 volunteer vocational trial opportunities, 

such as working at the JAG School/NJS, local hospital, bookstore, retail stores, real estate firm, the 

National Ground Intelligence Center, the Society for 

Prevention of Cruelty to Animals, Crisis Intervention 

Team and local law enforcement.

• Community outings are used to evaluate/observe 

behavior as part of overall program to move service members toward reaching their therapy goals 

of appropriate social interaction and community 

integration. In addition, in vivo intervention occurs 

to address goals from each outing. Examples include working on social skills, grocery shopping and 

problem-solving skills, and practicing PTSD coping 

strategies.

• Comprehensive neuropsychological assessments 

as well as other specialty services assessments 

(speech, occupational, physical and/or vocational 

therapy) have been carried out on all incoming 

service members to document cognitive and behavioral strengths and weaknesses and aid in treatment planning and goal development. Discharge 

assessments have been carried out to document 

treatment progress and goal attainment, and assist 

in return to duty considerations, medical board determinations, and community and family reintegration planning. Neuropsychology TBI subject matter 

experts (SME) have offered education and training 

to service members, their families, the community, 

and health care professionals in the region and in 

national forums. Our neuropsychology TBI SMEs are 

the principal investigators for TBI/PTSD technology 

research at DVBIC Charlottesville, Hunter Holmes 

McGuire VA Medical Center, Fort Lee and the University of Virginia.

• In 2011 DVBIC Charlottesville undertook 37 professional activities, such as national and regional conference presentations, and authored 13 professional 

and scientific publications.

Johnstown

DVBIC Johnstown, located in Pennsylvania, is the other Community Neurorehabilitation site in the DVBIC 

network. DVBIC Johnstown is an intensive and structured residential DoD program with the capacity for 

20 service members at a time who have sustained a 

brain injury and are not successfully integrating back 

into their community, social relationships or their job 

as an active duty service member. The program uses 

a transdisciplinary team approach to teach patients 

the skills necessary to live successfully in the community (be it military or civilian) and within their family/

social groups, and to engage in purposeful activities.

2011 Specifics:

• DVBIC Johnstown served 20 residential patients in 

the program during 2011. The average daily census 

for 2011 was 65%. There were six carry-over patients from 2010 to 2011, of which 33% were active 

duty and 66% were veterans. There were 14 unique 

admissions in 2011, of which 57% were active duty 

and 43% were veterans. There were 14 unique discharges during 2011, of which 86% were veterans.

The disposition of the 14 patients discharged is: 7% 

returned to duty without restrictions; 7% returned 
33

NETWORK SITES

2011 Annual Report

home without need of support, under the supervision of his community-based Warrior Transition Unit 

(CBWTU) to await completion of the medical evaluation board/physical evaluation board process; 50% 

were veterans who returned to their homes without 

the need of support (complete independence); 14% 

were veterans who returned to their homes with 

the need of support (family or paid caregiver); 21% 

were veterans who were placed in community-based 

long-term care facilities. All were placed with the 

assistance of their home VA medical center and 

Veterans Affairs Central Office (VACO), two of them 

through the VA Assisted Living TBI Pilot Program.

• All patients received complete evaluations from all

treating medical providers and therapy disciplines, 

including physiatry, psychiatry, nursing, rehabilitation psychology, physical therapy, occupational 

therapy, speech language pathology, vocational 

counseling, case management and recreation. Additionally, comprehensive neuropsychological assessments were provided for all patients who needed 

them. Evaluation information was used to educate 

patients and families, create treatment goals and 

measure individual patient success.

• Families are integrated into the treatment plan as

often as possible, frequently staying in the DVBIC 

Johnstown family suite and attending therapy sessions with patients to learn communication skills, 

coping strategies, compensatory techniques, participate in counseling, learn how to provide care or 

receive TBI education.

• Discharge evaluations and recommendations were

completed for all patients to document progress 

and to initiate follow-up care. Discharge follow-ups 

are completed by case management at three days, 

30 days and three, six and 12 months to measure 

maintenance of progress and reconnect patients 

with care if needed.

• All patients participated in at least one vocational

placement, which provides a real-world opportunity 

to observe and evaluate functional behavior, as well 

as an opportunity to practice skills and strategies 

learned in the program. DVBIC Johnstown has more 

than 20 vocational placement sites, including Meals 

on Wheels, the 458th Engineer Battalion, Army 

National Guard, Cambria County Library, Johnstown 

Welding and Fabrication, and the Cambria County 

Humane Society.

• Community integration outings and activities are

utilized to observe, evaluate and provide intervention that is directed by patient treatment goals.

Examples of skills learned and practiced during 

outings include transportation planning, navigation, 

problem-solving, budgeting, social pragmatics and 

anger management techniques.

• DVBIC Johnstown embraces the concept of continuous quality improvement and is engaged in the following program development/process improvement 

activities in 2011: refinement of the therapeutic 

riding program, development of a sleep program, 

implementation of gait rounds, review of the driver 

simulation program, development of programming 

geared specifically to active duty service members, 

implementation of and participation with the PARF 

database and PARF benchmarking project, implementation of a patient wellness program, development of eight new skill-building groups, completed 

staff trainings on reverse activities of daily living, 

community access, cognitive changes after TBI, 

medication management, transfer training and crisis 

intervention.

• Although DVBIC Johnstown does not accept veterans

as patients, we continue to work collaboratively with 

VACO to ensure smooth transitions and appropriate services for those active duty patients who will 

transition soon after leaving the program.
34

PUBLICATIONS

2011 Annual Report

PUBLICATIONS

DVBIC researchers led or collaborated on the publication of 33 peer-reviewed manuscripts or book sections/

chapters in 2011.

Belanger HG, Proctor-Weber Z, Kretzmer T, Kim M, 

French LM and Vanderploeg RD. 2011. Symptom complaints following reports of blast versus non-blast mild 

TBI: does mechanism of injury matter? Clin Neuropsychol 25(5):702-15.

Cooper DB, Kennedy JE, Cullen MA, Critchfield E, 

Amador RR and Bowles AO. 2011. Association between 

combat stress and post-concussive symptom reporting 

in OEF/OIF service members with mild traumatic brain 

injuries. Brain Inj 25(1):1-7.

Cooper DB, Nelson L, Armistead-Jehle P and Bowles AO.

2011. Utility of the mild brain injury atypical symptoms 

scale as a screening measure for symptom overreporting in operation enduring freedom/operation 

iraqi freedom service members with post-concussive 

complaints. Arch Clin Neuropsychol 26(8):718-27.

Crowley D, Bender T, Chatigny A, Trudel TM and Ritchie 

EC. 2011. Women, mental health, and the military. In M.

K. Lenhart (Eds) pp.703-714. Borden Institute

Donnell AJ, Belanger HG and Vanderploeg RD. 2011.

Implications of psychometric measurement for neuropsychological interpretation. Clin Neuropsychol 

25(7):1097-118.

Duncan CC, Summers AC, Perla EJ, Coburn KL and Mirsky AF. 2011. Evaluation of traumatic brain injury: brain 

potentials in diagnosis, function, and prognosis. Int J 

Psychophysiol 82(1):24-40.

Finkel AG. 2011. Botulinum toxin and the treatment of 

headache: a clinical review. Headache 51(10):1565-72.

Folmer RL, Billings CJ, Diedesch-Rouse AC, Gallun FJ 

and Lew HL. 2011. Electrophysiological assessments of 

cognition and sensory processing in TBI: applications 

for diagnosis, prognosis and rehabilitation. Int J Psychophysiol 82(1):4-15.

French LM, Parkinson GW and Massetti S. 2011. Care 

coordination in military traumatic brain injury. Soc 

Work Health Care 50(7):501-14.

Gray H, Adefolarin AT and Howe TE. 2011. A systematic 

review of instruments for the assessment of work-related psychosocial factors (Blue Flags) in individuals with 

non-specific low back pain. Man Ther 16(6):531-43.

Harvey D, Freeman JR, Broshek DK and Barth JT. 2011.

Sports injuries. In J. M. Silver, T. W. McAllister and S.

C. Yodusfsky (Eds) pp.427-439. American Psychiatric 

Publishing

Iverson GL, Hakulinen U, Waljas M, Dastidar P, Lange 

RT, Soimakallio S and Ohman J. 2011. To exclude or not 

to exclude: white matter hyperintensities in diffusion 

tensor imaging research. Brain Inj 25(13-14):1325-32.

Iverson GL and Lange RT. 2011. Concussion versus mild 

traumatic brain injury: Is there a difference? In F. S. 

Zollman (Eds) pp.43-51. Demos Publishing

Iverson GL and Lange RT. 2011. The natural history of 

mild traumatic brain injury. In F. S. Zollman (Eds) pp.72-

77. Demos Publishing

Iverson GL and French LM. 2011. Treatment and rehabilitation services for mild to moderate traumatic brain 

injury in the military. In F. S. Zollman (Eds) pp.424-434.

Demos Publishing

Iverson KM, Hendricks AM, Kimerling R, Krengel M, 

Meterko M, Stolzmann KL, Baker E, Pogoda TK, Vasterling JJ and Lew HL. 2011. Psychiatric diagnoses and 

neurobehavioral symptom severity among OEF/OIF 

VA patients with deployment-related traumatic brain 

injury: a gender comparison. Womens Health Issues 

21(4 Suppl):S210-7.

Jaffee MS, Kennedy JE, Leal FO and Meyer KS. 2011. 

Posttraumatic stress disorder. In J. M. Silver, T. W. McAllister and S. C. Yodusfsky (Eds) pp.415-426. American 

Psychiatric Association Press

Lange RT, Iverson GL and Rose A. 2011. Depression 

strongly influences postconcussion symptom reporting 

following mild traumatic brain injury. J Head Trauma 

Rehabil 26(2):127-37.
35

PUBLICATIONS

2011 Annual Report

Lange RT, Iverson GL, Brubacher JR, Madler B and 

Heran MK. 2011. Diffusion Tensor Imaging Findings Are 

Not Strongly Associated With Postconcussional Disorder 2 Months Following Mild Traumatic Brain Injury. J 

Head Trauma Rehabil 

Lew HL, Kraft M, Pogoda TK, Amick MM, Woods P and 

Cifu DX. 2011. Prevalence and characteristics of driving difficulties in Operation Iraqi Freedom/Operation 

Enduring Freedom combat returnees. J Rehabil Res Dev 

48(8):913-25.

Lew HL, Pogoda TK, Baker E, Stolzmann KL, Meterko M, 

Cifu DX, Amara J and Hendricks AM. 2011. Prevalence 

of dual sensory impairment and its association with 

traumatic brain injury and blast exposure in OEF/OIF 

veterans. J Head Trauma Rehabil 26(6):489-96.

Lew HL, Cohen S and Hsu PT. 2011. Posttraumatic 

headache. In F. S. Zollman (Eds) pp.364-371. Demos 

Publishing

Maas AI, Harrison-Felix CL, Menon D, Adelson PD, 

Balkin T, Bullock R, Engel DC, Gordon W, LangloisOrman J, Lew HL, Robertson C, Temkin N, Valadka A, 

Verfaellie M, Wainwright M, Wright DW and Schwab K.

2011. Standardizing data collection in traumatic brain 

injury. J Neurotrauma 28(2):177-87.

Marion DW. 2011. Decompressive craniectomy in diffuse traumatic brain injury. Lancet Neurol 10(6):497-8.

Marion DW, Curley KC, Schwab K and Hicks RR. 2011.

Proceedings of the military mTBI Diagnostics Workshop, St. Pete Beach, August 2010. J Neurotrauma 

28(4):517-26.

Meyer KS, Ivins B, Doncevic S, Lew H, Trudel TM and 

Jaffee MS. 2011. Traumatic brain injury in the context 

of war. In J. M. Silver, T. W. McAllister and S. C. Yodusfsky (Eds) pp.415-426. American Psychiatric Association 

Press

Nakase-Richardson R, Sherer M, Seel RT, Hart T, Hanks 

R, Arango-Lasprilla JC, Yablon SA, Sander AM, Barnett 

SD, Walker WC and Hammond F. 2011. Utility of posttraumatic amnesia in predicting 1-year productivity 

following traumatic brain injury: comparison of the 

Russell and Mississippi PTA classification intervals. J 

Neurol Neurosurg Psychiatry 82(5):494-9.

Scher AI, Wu H, Tsao JW, Blom HJ, Feit P, Nevin RL and 

Schwab KA. 2011. MTHFR C677T genotype as a risk 

factor for epilepsy including post-traumatic epilepsy 

in a representative military cohort. J Neurotrauma 

28(9):1739-45.

Schiehser DM, Delis DC, Filoteo JV, Delano-Wood L, Han 

SD, Jak AJ, Drake AI and Bondi MW. 2011. Are self-reported symptoms of executive dysfunction associated 

with objective executive function performance following mild to moderate traumatic brain injury? J Clin Exp 

Neuropsychol 33(6):704-14.

Schultz BA, Cifu DX, McNamee S, Nichols M and Carne 

W. 2011. Assessment and treatment of common persistent sequelae following blast induced mild traumatic 

brain injury. NeuroRehabilitation 28(4):309-20.

Suratt PM, Diamond R, Barth JT, Nikova M and Rembold C. 2011. Movements during sleep correlate with 

impaired attention and verbal and memory skills in 

children with adenotonsillar hypertrophy suspected of 

having obstructive sleep disordered breathing. Sleep 

Med 12(4):322-8.

Terrio HP, Nelson LA, Betthauser LM, Harwood JE and 

Brenner LA. 2011. Postdeployment traumatic brain 

injury screening questions: Sensitivity, specificity, and 

predictive values in returning soldiers. Rehabil Psychol 

56(1):26-31.

Walker WC and McDonald SD. 2011. Does neurologic 

examination during inpatient rehabilitation help predict 

global outcome after nonpenetrating traumatic brain 

injury? PM R 3(1):6-12.

Walker WC and R K. 2011. Postconcussion Syndrome: 

Symptom Management. In F. S. Zollman (Eds) pp.119-

125. Demos Publishing
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