The "Physiological/Symptom Control and Interdisciplinary Care Team" course focuses on the physiological symptoms unique to returning OEF/OIF/OND wounded warriors associated with blast-incurred neurological trauma sustained during military theatre operations, including TBI, comorbidities such as PTSD, and other polytraumatic injuries. 

Course 1 provides

  • A working definition of traumatic brain injury and introduces terminology as recommended by the American Congress of Rehabilitation Medicine and the Defense and Veterans Brain Injury Center 

  • Neuroanatomy and biology of blast-induced traumatic brain injury in the Wounded Warrior  

  • Identifying factors on outcomes and long-term consequences of blast-induced traumatic brain injury in the Wounded Warrior

  • Assessment and management of traumatic brain injury, reviewed from the perspective of evidence-based interdisciplinary management

  • An understanding of comorbidities (i.e. PTSD), polytraumatic injuries and symptom control   



Unit 1:  Evidence-based knowledge on the Pathophysiology of TBI Incurred During Military Service.


  • Physiological Symptom Control and Interdisciplinary Care Team Module 
  • Traumatic Brain Injury
  • Pathobiology of Blast-Induced Neurotrauma 
  • Mechanism of Blast Injury 
  • General Medical Effects of Blast Injury 
  • Blast-Induced Neurotrauma 

Continuing Education Units: 2 Hours

Learning Objectives

  1. Discuss the rationale for the types of injury seen in OIF and OEF compared to previous wars.
  2. Discuss primary prevention mechanisms to decrease blast-related injuries in the OIF and OEF wars.  
  3. List the common causes of TBI:  compare and contrast civilian versus military causes of mild TBI. 
  4. Identify the epidemiology of the types of TBI:  compare and contrast civilian versus military epidemiology.
  5. Describe the various classifications of TBI and discuss how blast injuries are classified.
  6. Discuss the mechanism responsible for TBI in the wounded warrior.
  7. Discuss the principles of blast wave physics as it relates to TBI in the wounded warrior. 
  8. Discuss the following factors which contribute to the blast injury:  high and low order explosives, location factors, distance factors.
  9. Discuss the difference between primary, secondary, tertiary and quaternary injury in TBI.
  10. Discuss gender-related types of TBI in the wounded warrior.
  11. Describe the current research relating to pathobiology changes in the brain resulting from blast-related TBI.
  12. Discuss the general medical effects other than TBI in blast-induced injury.
  13. Discuss the consequences of repetitive blast-induced head injury in the wounded warrior.
  14. Discuss the long-term outcomes relevant to blast-induced TBI.



Unit 2:  Evidence-Based Assessment of the Wounded Warrior who has Sustained a TBI.


  • Outcomes of Blast-Induced Injury 
  • Assessment of TBI
  • TBI Evaluation and Treatment in the Veteran Population 

Continuing Education Units:  1 Hour

Learning Objectives

  1. Describe the tools for classifying the severity of brain injury in the wounded warrior.
  2. Discuss the initial evaluation of TBI in the field:  compare and contrast this with evaluation of mild TBI in the civilian population. 
  3. Discuss the limitations of the battlefield assessment of TBI.
  4. Describe the factors that may complicate the assessment of TBI in the wounded warrior (i.e. PTSD, poly-traumatic injury).
  5. Recognize common medical problems in the post-acute phase of TBI in the wounded warrior.
  6. Identify common medical complications seen in the acute recovery period after TBI:  compare and contrast civilian versus military individuals.
  7. Discuss the recommended evaluation of TBI in the non-acute patient.



Unit 3:  Evidence-Based Management of the Wounded Warrior who has Sustained a Traumatic Brain Injury.     


  • Post-Concussion Syndrome
  • Traumatic Brain Injury and Co-Occurring Disorder 

Continuing Education Units:  1 Hour

Learning Objectives

  1. Discuss the guidelines for the treatment of TBI within the military health care system.
  2. Discuss the time-related recovery paths of TBI recovery.
  3. Discuss the common scales used to track cognitive recovery.
  4. Discuss the typical course of recovery in TBI:  compare and contrast the wounded warrior and civilian patient.
  5. Describe the benefits of interprofessional rehabilitation after TBI in the wounded warrior.
  6. Discuss a framework for intervention with post-acute medical manifestations in the wounded warrior with TBI.
  7. Discuss the recommendations for treatment (pharmacologic and non-pharmacologic) of post-concussion syndrome in the wounded warrior.
  8. Recognize indications and contraindications for pharmacological interventions for TBI.






Theresa Bacon-Baguley, PhD, RN, is a GVSU Professor, and Director of Research who has over 19 years of experience educating undergraduates and graduates, and providing clinical services for Physician Assistants.

Contributing Author:

Percival Pangilinan Jr, MD, is an Assistant Professor at the University of Michigan Health System, Department of PM&R.  Also serves as the Section Chief of TBI/Polytrauma at the VA Ann Arbor.  His clinical interests focus on rehabilitation following traumatic brain injury or stroke.                                




This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Michigan State University and Grand Valley State University. The Michigan State University is accredited by the ACCME to provide continuing medical education for physicians. 


This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.  Approval valid through 10-28-15.  Assigned ONA# 16321

Page last modified March 22, 2016