Heads Up on i-Concussion

There is a new face at Northern Arizona University (NAU) football games this fall.  No – not a new quarterback or coach – but a robot on wheels!

Making its debut at the season kick-off game against the University of Arizona in Tucson last Friday, the robot has the ability to assess a player for symptoms and signs of a concussion and to consult with sideline medical personnel thanks to a specialized camera system, remotely operated by a Mayo Clinic neurologist.

 Mayo Clinic will be working with NAU to test the feasibility of using a telemedicine robot to assess athletes with suspected concussions during football games as part of a research study. With sophisticated robotic technology, use of a specialized remote controlled camera system allows patients to be “seen” by the neurology specialist, miles away, in real time.

“Athletes at professional and collegiate levels have lobbied for access to neurologic expertise on the sideline. As we seek new and innovative ways to provide the highest level of concussion care and expertise, we hope that teleconcussion can meet this need and give athletes at all levels immediate access to concussion experts,” said Bert Vargas, M.D., a neurologist at Mayo Clinic who is heading up the research.

This study is the first to explore whether a remote neurological assessment is as accurate as a face-to-face evaluation in identifying concussion symptoms and making return to play decisions. Mayo Clinic physicians will not provide medical consultations during the study, they will only assess the feasibility of using the technology.

But, if it appears feasible, this may open the door for countless schools, athletic teams, and organizations without access to specialized care to use similar portable technology for sideline assessments.

“As nearly 60% of U.S. high schools do not have access to an athletic trainer, youth athletes, who are more susceptible to concussion and its after-effects, have the fewest safeguards in place to identify possible concussion signs and symptoms at the time of injury. Teleconcussion is one way to bridge this gap regardless of when or where they may be playing.” Says Dr Vargas.

Others involved collegiate sports agree.

“At NAU, our primary goal is to provide an outstanding student-athlete experience culminating in graduation,” says Dr. Lisa Campos, vice president for Intercollegiate Athletics at Northern Arizona University. “We charge our staff to research the most current and best practices to ensure the safety and care of our students. Partnering with the Mayo Clinic in its telemedicine study will further this research and potentially improve diagnosis for rural areas that may not have access to team doctors or neurologists. The study allows the NAU Sports Medicine Staff and team doctors to continue to make all diagnoses and return to play decisions for our students, while investigating the effectiveness and efficiencies of telemedicine. We are excited to have the teleconcussion robot on our sideline this fall.”

“There were a number of examples last football season where college football players clearly demonstrating concussion-like symptoms were quickly thrown back in games or weren’t even taken out of the game for an evaluation,” said Ramogi Huma, executive director of the National College Players Association. “College football players are in desperate need for independent concussion experts on the sidelines, and this study could help make that safeguard a reality.”

Telemedicine is not new to the Mayo Clinic in Arizona.  They first used the technology with the telestroke program in 2007, when statistics revealed that 40% of residents in Arizona did not live in an area where they were availed of stroke expertise. Since the telestroke program began nearly 3,000 emergency consultations for neurological emergencies have taken place.

We’ll be following the results of this study and will let you know the results as soon as they’re in.

Multitasking as a Diagnostic Tool?

Here at Word on Health we’re used to doing a million things at once. So over the years, we’ve  heard most of the multitasking jokes. Admittedly we’ve chuckled at the male definition known as chewing gum and breaking wind at the same time.  We’ve even been known to smile when men ask, “if women are so good at multitasking why can’t they have sex and a headache at the same time?”

However, it turns out that it’s no laughing matter.

Scientists hope to use a simple multitasking challenge – walking and thinking at the same time –  to quickly screen individuals who may have suffered brain injuries. According to researchers at the Georgia Tech Research Institute (GTRI) asking an individual to walk a short distance while saying the months of the year in reverse order, can determine if that person is impaired and possibly suffering from a concussion.

This simple test involving radar, which could be performed on the sideline of a sporting event or on a battlefield, has the potential to help coaches and commanders decide if athletes and soldiers are ready to engage in activity again.

“When a person with a concussion performs cognitive and motor skill tasks simultaneously, they have a different gait pattern than a healthy individual, and we can identify those anomalies in a person’s walk with radar,” said GTRI research engineer Jennifer Palmer.

More than 1 million concussions and other mild traumatic brain injuries are reported each year in the United States.  Catching them right after they happen can improve treatment and prevent further injury or other long-term health issues. Diagnosing concussion can be difficult, though, because the symptoms are not always easily visible or detectable, even though they last for weeks or months following the incident.

While methods exist for detecting concussion, most focus purely on cognitive impairment and do not assess accompanying motor skill deterioration.

Details of GTRI’s technique, which simultaneously examines a person’s cognitive and motor skills, were presented on April 26 at the SPIE Defense, Security and Sensing conference in Orlando. Using radar for gait analysis would be faster and less intrusive than existing techniques. The assessment would be done with radar systems similar to those used by police for measuring the speed of vehicles.

The GTRI research team compared how 10 healthy individuals walked normally and when impaired. For the impairment scenario, individuals wore goggles that simulated alcohol impairment. Past research has shown that concussion impairment is equivalent to having a blood alcohol level of 0.05%.

Each individual performed four 30-second walking tasks: a normal walk, walk while saying the months of the year in reverse order, walk while wearing the goggles, and walk while wearing the goggles and performing the cognitive task. For each task, the subjects walked away from the radar system, turned around and walked back toward the radar system.

By looking for differences in the gait patterns of normal and impaired individuals, researchers found that healthy individuals could be distinguished from impaired individuals wearing the goggles. Healthy individuals demonstrated a more periodic gait with regular and higher velocity foot kicks and faster torso and head movement than impaired individuals when completing a cognitive task.

The results also indicated that if no cognitive task was performed, a healthy individual’s gait pattern was not statistically different when wearing and not wearing the goggles.

“We found that we needed to examine a person’s physical and mental capabilities at the same time to see a change in gait and detect impairment,” said research engineer Kristin Bing. “It’s easy for a person to concentrate on one task, but when that person has to multitask we can begin to discriminate between someone who is impaired and someone who is not.”

In the future, the researchers plan to reduce the size of the system so that it becomes more practical to use.

Although approval from the Food and Drug Administration will be required before this system can be used to diagnose concussion, seems this multitasking tool is no joke.