What’s the impact of multiple deployments and repeated traumatic stressors on service members? Why are a significant number of military personnel experiencing psychological injuries following their deployments? What treatment options are available? What’s being done to help advance the field of traumatic brain injury (TBI) and psychological health?

If these questions are on your mind, consider reading the special edition of “Military Medicine.” Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) subject matter experts and others share updated research to better understand current psychological health and TBI conditions affecting the health, occupational and personal functioning of service members and veterans. Published by The Association of Military Surgeons of the United States (AMSUS), the journal identifies effective screening tools, diagnostic technologies and treatments for major areas of concern like posttraumatic stress disorder (PTSD), depression, substance use disorder and TBI.

	Shaquille Vance, a U.S. Paralympian, trains at the fitness center track at RAF Lakenheath, England, Aug. 20, 2012. More than 50 U.S. Paralympians and hopefuls, including wounded and injured U.S. service members, were honing their skills and making final preparations for competition in the 2012 Paralympic Games in London. (U.S. Air Force photo by Senior Airman Connor Estes)

From the start of the London Olympics through the closing ceremonies, we watched American athletes compete every day filled with patriotism and excitement. But for some athletes currently competing in the London Paralympics, Aug. 29 to Sept. 9, they are doing more than just wearing the American flag – they are wearing or have worn a uniform.

Of the 227 members of the 2012 U.S. Paralympic Team, 20 are active-duty service members or veterans, some injured during their service in Iraq and Afghanistan. These world-class athletes are showing their countrymen and the world that it’s possible to overcome physical injuries, psychological health challenges and still excel.

The predecessor to the modern-day Paralympics was first held in England in 1948, for World War II veterans with spinal cord injuries. The Paralympics have since expanded to include athletes with physical, visual and intellectual disabilities competing in 19 sports – it’s now the world’s second largest sporting event after the Olympics, with a record 165 nations competing this year with 4,200 athletes.

	U.S. Army photo by Jasmine Chopra-Degadillo

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

I spent a few days this month in Orlando, Fla., attending the 127th annual American Psychological Association (APA) Convention, which is the largest gathering of psychologists and psychology students in the world. The convention allows health care providers from all areas of specialization in psychology and from research, practice, education and policy to get together for four days to learn about the latest advances in psychology. For the third year, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) subject matter experts presented at this convention to increase psychologists’ knowledge of the unique needs of the military population, including treatment options for psychological health conditions and traumatic brain injury (TBI).

Jagged debris lacerates the Marine’s face and hands as he dives behind the jeep seeking cover from an improvised explosive device blast 50 meters away. He’s not sure how long it is before the unit corpsman reaches him and finds him conscious with superficial wounds. Things seem a little fuzzy at first but he believes he’s ready to move back to his patrol. The corpsman asks him the first two questions from the Military Acute Concussion Evaluation (MACE) card he carries and that yields a clear decision — the next move for this Marine is a full MACE screening.

This all-too-common scenario illustrates the need for MACE, the Defense Department’s standard for clinical assessment of mild traumatic brain injury (TBI), also known as concussion, in deployed settings. It’s the most widely-used clinical interview tool for early detection of concussion, the most common form of TBI sustained in the military. This year, the Defense Department redesigned MACE and the “Concussion Management in Deployed Settings” clinical algorithms, two critical tools used in conjunction with clinical judgment to help first-tier health care providers—combat medics, corpsmen and initial providers—improve cognitive and symptom screening, and neurological evaluation in theater.

	Download the Mild Traumatic Brain Injury Pocket Guide mobile app and then share your feedback with DCoE.

We want to hear from you! Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) encourages health care professionals to share their thoughts on the Mild Traumatic Brain Injury Pocket Guide and corresponding mobile app. Your feedback will help us make improvements to the pocket guide and other traumatic brain injury-related products.

How often do you refer to the pocket guide? What aspect of it do you find most useful? Based on your experience with the pocket guide, tell us everything from advantages and disadvantages to recommendations and suggestions for future traumatic brain injury (TBI) clinical resources and tools.

The pocket guide, developed by DCoE, is an all-encompassing, quick reference clinical guidance tool to help primary care providers assess and treat service members and veterans who have sustained a concussion. It includes a summary of the clinical practice guidelines and recommendations from the Defense Department and Department of Veterans Affairs on the management of mild TBI and provides information on treating common mild TBI symptoms; coding guidance; clinical recommendations for cognitive rehabilitation and driving following TBI; patient education materials; and additional clinical tools and resources related to TBI prevention and care.