By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Movement based testing of brain function is a concept that could be used to add objective information in the evaluation of an athlete with a suspected concussion
- One company is developing a testing method that bears watching as they go through scientific study to validate their service
The diagnosis of concussion for medical professionals can be tricky, and a determination of proper timing for return to play can also be somewhat subjective. To be clear, as far as the coach is concerned on the field of play I would not recommend that you make a “diagnosis”, you should suspect a young athlete may have had a concussion, remove him/her from play, and refer to a qualified medical professional for proper diagnosis and return to play guidance. Please download this free, simple on-field concussion guide if you’re a coach or parent from our website.
Trained medical professionals, however, like to rely on more than just judgment and suspicion. Ideally, we like to have some objective data obtained in the preseason for healthy athletes and then obtain data after a suspected concussion to compare. In the best cases, there is no ability for the athlete to “game” the system by manipulating the test in the preseason phase. (as a side note I’ve never actually seen any of our high school aged athletes do this in my 20+ years as a team doc, but stories of this type of behavior are common…).
With that in mind there are several attempts at objective measurements of brain function, too numerous to mention all of them in this brief post. Some of these include ImPACT computer based cognitive testing, the King-Devick test that tracks eye movements, and simple reaction time tests using home made equipment.
But there’s one company that’s caught my eye and is worth following as they progress: Performance Evaluation Group, based out of Cleveland, Ohio. As compared to the methods above that use primarily static (no body movement) testing, this method tests an athlete with movement through a foursquare grid with heart rate elevated. A baseline preseason evaluation is recommended, followed if necessary by a post-concussion evaluation. Physicians can use the data as an objective part of their overall concussion assessment and return to play planning.
I’ve had a chance to speak with Lee Miller and Pete Laikos of PEG. The company’s in the very early stages of their service rollout and at this point one of their main goals is to increase awareness of movement based methods in the overall concussion evaluation toolkit. They are working with a number of physicians in Ohio, including the world-renowned Cleveland Clinic to produce some data on effectiveness. They have currently unpublished data on about 1500 kids and also have another pilot study starting up. The company currently markets the service in northeast Ohio and plans a broader rollout after further validation.
If a young athlete is suspected of having a concussion, the company uses the most recent Zurich protocol, which calls for a slow return to activity once the athlete is completely symptom free. In the earliest phase the company would use their computerized balance-only assessment and compare it to the baseline. As the athlete progresses through the Zurich protocol they can then participate in the movement based testing.
My thoughts are that this is a technology worth watching. Movement based testing is interesting, as it does tend to recreate game situations, and even the balance testing is done in a highly objective fashion. The testing itself looks fun and my guess is that kids will actually give their best effort in the preseason testing. Additionally, our current return to play protocols include gradual resumption of activity, ranging initially from very light activity and increasing to full practice activity over a minimum of 5 days. The PEG movement technology could be used on about day 3 of the post concussion protocol and may be able to help predict ability to advance further. It will be very important to see the data they produce in the next phase of their scientific study to validate this point. This company is in the early phase of some reasonably uncharted territory, but has the potential to be a valuable tool if they can prove the validity of their method.