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Treating TBIs in College Athletes and Servicemembers

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By Leslie McManus
Faculty Member, School of Health Sciences, American Public University

When children reach the age of 18, they often think that the world is theirs. However, they have many decisions to make about their future.

Some young adults may choose to go to work; others opt for college. Some students may become athletes and some young adults may choose to serve in the military. Each of these choices is important and affords young adults a chance to grow and achieve their dreams.

But what happens when an athlete or a servicemember sustains a traumatic brain injury (TBI) that affects their life forever?

Studying TBIs of College Athletes and Servicemembers Leads to Insights

Although nearly 80% of traumatic brain injuries do not happen on an athletic field, athletes and servicemembers are ideal groups to study. In fact, according to a publication by the National Collegiate Athletic Association (NCAA), college athletes suffered an average of 10,500 concussions in the last five years and servicemembers sustained 320,000 brain injuries over the last 10 years.

By studying these patients, researchers develop new treatment plans and learn how these plans affect both long- and short-term recovery.

NCAA Best Practices for Concussion Treatment

In 2017, the NCAA Sports Science Institute updated its 2014 Concussion Diagnosis and Management Best Practices. NCAA member institutions are required to provide education to student-athletes, coaches and sports medicine personnel. This education includes a pre-participation physical assessment, recognition and diagnosis, as well as post-concussion management.

However, the specifics of these best practices and the recommendation to return to playing a sport are left to individual institutions’ discretion. Institutions are encouraged to base their protocol on the Consensus Statement on Concussion in Sport published in the British Journal of Sports Medicine in 2017. The NCAA also notes that the current guidelines are not based on evidence-based studies, but rather on “expert consensus.”

Military Guidelines for TBI Treatment

In 2015, Dr. Karen L. McCulloch of the University of North Carolina introduced new military TBI guidelines with the following statement: “Although servicemembers share similarities with athletes, guidance for sports-related concussion is not always relevant to military contexts and does not incorporate the complexities of military demands, decision-making under stressful conditions, and multitasking in extreme environments.”

Clearly, the treatment of our military servicemembers cannot be the same as our treatment of college athletes. But are we treating them better or worse than our collegiate athletes?

New clinical guidelines outlined by the Defense and Veterans Brain Injury Center (DVBIC) recommend a gradual, six-step return to duty program with regular testing to ensure the safety of servicemembers and members of their unit. The DVBIC also provides pocket-size reference cards, educational presentations on the progressive return and educational materials for TBI patients.

It is important to note that this information is provided in two formats: one for primary care providers and one for rehabilitation providers. The Army provides a concussion management card for those providers in garrison (on home base), rather than in combat.

The DVBIC offers a Military Acute Concussion Evaluation (MACE) card that is standard through the armed services. It was revised for the tenth time in 2015 and medical personnel are trained to use the new information of each revision.

More Work Still to Be Done on TBIs

We have much more to learn about the cause, progression and treatment of traumatic brain injuries. But the NCAA and the Department of Defense have come together to do just that.

They have begun a $30 million initiative called the “NCAA-DoD Grand Alliance.” A major part of this alliance will be the Concussion Assessment, Research and Education (CARE) Consortium. This goal of this three-year study of sports-related injuries is to be the most comprehensive study to date.

About the Author

Leslie McManus is an adjunct faculty member of the School of Health Sciences at American Public University. She is a graduate of Pennsylvania State University and earned her M.S. in kinesiology from the University of Texas-Pan American.

Mrs. McManus has worked in the field of sports medicine for over 20 years and has worked as an AT at all levels of athletics from middle school through the NBA, WNBA and NHL. She has also worked as a sports medicine manager for a hospital group in Maryland, which includes the Brain and Spine Institute at Sinai.

Mrs. McManus resides in a Philadelphia suburb. In her spare time, she enjoys spending time with her two children and her husband Tim, a member of the Pennsylvania Air National Guard.


Wes O'Donnell

Wes O’Donnell is an Army and Air Force veteran and writer covering military and tech topics. As a sought-after professional speaker, Wes has presented at U.S. Air Force Academy, Fortune 500 companies, and TEDx, covering trending topics from data visualization to leadership and veterans’ advocacy. As a filmmaker, he directed the award-winning short film, “Memorial Day.”

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