6 minute read
Tech-Knowledgy: Advancing Concussion Care through the use of Modern Tech
Amy Mathews • Kathleen Bell
The use of technology in caring for patients with concussion is burgeoning, showing promise for education, assessment, and intervention. For assessment, healthcare providers, as well as non-medical personnel such as coaches, use applications to measure balance and ocular parameters in suspected concussion. Smart phone applications for symptom surveillance allow tracking of mood, pain, sleep, headaches, and heart rate. Information from these applications may be useful for both patients and providers, if shared by the patient, to help target interventions.1 There are also “gamified” symptom applications, using interactive games for reporting, promoting engagement and health management in pediatric or adolescent populations.2 Neuropsychological virtual reality (VR) assessments simulate real-life scenarios to assess cognitive domains, and may have improved generalizability compared with computerized or pencil-and-paper modalities.3 Wearable devices are on the rise in consumer markets. These bands, rings, garments and patches with sensors allow monitoring of movement, sleep, sweat, and cardiorespiratory function. This consumer technology is moving toward personalization and real-time feedback to users.4
From a management standpoint, emerging technologies can facilitate patient engagement and increase care access through telehealth, smart phone applications, and virtual reality. Telehealth has shown high rates of satisfaction, compliance, and ease of access to care, but limits physical examination, may pose technical difficulties, and may be difficult to use for those with cognitive deficits.5 Smart phone applications may provide strategies for users to manage individual symptoms. For example, device prompts may support impaired task initiation and memory for activities such as exercising, completing work tasks, or completing personal care.6 Cognitive and mood symptoms may benefit from applications to prompt deep breathing, cognitive behavioral techniques, meditation, and cognitive exercises. Training in immersive virtual reality environments can provide therapy experiences that are not immediately available or feasible in the “real world” and may improve compliance to recommended therapies by making exercises more enjoyable.7
The use of technology is not without potential risks. Concerns have been raised about the legal liability of non-medical providers using commercially available applications or devices for assessment.1 Additionally, although options for symptom tracking and surveillance are growing, the utility of tracking symptoms on long-term outcomes is still unknown, linkage with electronic medical records is mostly unavailable, and concerns for screen overuse persist1 The use of novel technologies or repurposing of existing technologies for new therapeutic purposes is an important part of concussion assessment and management. Providers and patients should remain up-to-date on new technologies that may improve outcomes while being vigilant for misdirected application of these devices and apps.
References
1. Kwan V, Bihelek N, Anderson V, Yeates K. A Review of Smartphone Applications for Persons With Traumatic Brain Injury: What Is Available and What Is the Evidence? J Head Trauma Rehabil. 2019;34(2):E45-E51. 2. Worthen-Chaudhari L, McGonigal J, Logan K, Bockbrader MA, Yeates KO, Mysiw WJ. Reducing concussion symptoms among teenage youth: Evaluation of a mobile health app. Brain Inj. 2017;31(10):1279-1286. 3. Santos FV, Yamaguchi F, Buckley TA, Caccese JB. Virtual reality in concussion management: from lab to clinic. J Clin Transl Res. 2020;5(4):148-154. 4. Peake JM, Kerr G, Sullivan JP. A Critical Review of Consumer Wearables, Mobile Applications, and Equipment for Providing Biofeedback, Monitoring Stress, and Sleep in Physically Active Populations. Front Physiol. 2018;9:743. 5. Subbarao BS, Stokke J, Martin SJ. Telerehabilitation in Acquired Brain Injury. Phys Med Rehabil Clin N Am. 2021;32(2):223-238. 6. Jamieson M, Jack R, O’Neill B, et al. Technology to encourage meaningful activities following brain injury. Disabil Rehabil Assist Technol. 2020;15(4):453-466. 7. Aida J, Chau B, Dunn J. Immersive virtual reality in traumatic brain injury rehabilitation: A literature review. NeuroRehabilitation. 2018;42(4):441-448.
Author Bios
Dr. Amy Mathews is currently an assistant professor in the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center. Her clinical interests include care of patients with concussion and spasticity management.
Dr. Kathleen Bell is the Chair of the Department of Physical Medicine and Rehabilitation (PM&R) at UT Southwestern Medical. Her research interests include concussion, sleep disorders after TBI, and exercise/ autonomic nervous system after concussion. She has been funded or an investigator on grants from NIH, NIDILRR, the Department of Defense, PCORI, and the CDC since 1998. Dr. Bell is currently a Past-President of the American Academy of Physical Medicine and Rehabilitation, the CoDirector of the Texas Institute for Brain Injury and Repair, an investigator for the North Texas Concussion Registry (CON-TEX) and co-PI for the North Texas TBI Model System.
7. The U.S. Consumer Products Safety Commission found more than 750 deaths and 25,000 hospitalizations in its 10-year study of the dangers of portable electric generators. https://www.cpsc.gov/es/content/briefing-events package-on-the-proposed-rule-safety-standard-forportable-generators 8. For the current guidelines: http://wedocs.unep. org/bitstream/handle/20.500.11822/8676/Select_ pollutants_guidelines.pdf?sequence=22022 9. In an April 2017 carbon monoxide poisoning at a hotel in Niles, Michigan, several first responders had to beSeptember hospitalized because they were not wearing masks while they treated severely poisoned children. In a recent Detroit poisoning, the first responders did not have21-24: Fourth International Conference carbon monoxide detectors and also might have beenon Paediatric Brain Injury, September poisoned. CO was not determined to be the cause for 20 21 – 24, New York, New York. For more to 30 minutes.information, 10. http://www.corboydemetrio.com/news-121.html Source: “This paper was presented at the Proceedings of the 1stvisit www.internationalbrain.org. Annual Conference on 11. Environmental Toxicology, sponsored by the SysteMed21-24: 2022 NABIS Conference on Brain Injury Corporation and held m Fairborn, Ohio on 9, 10th and , September 21 – 24, New York, New 11 September 1970.“ York. For more information, visit www.internationalbrain.org. ABOUT THE AUTHOR21-24: 2022 Conference on Medical & Gordon Johnson is a leading attorney, advocate Legal Issues in Brain Injury, September and author on brain injury. He is a 1979 cum 21 – 24, New York, New York. For more laude graduate of the University of Wisconsin law school and a journalism grad from Northwestern University. He has authored some of the information, visit www.internationalbrain.org. most read web pages in brain injury. He is the Past Chair of the Traumatic Brain Injury LitiOctober gation Group, American Association of Justice. He was appointed by Wisconsin’s Governor to 20 – 23: AAPMR Conference, October the state’s sub-agency, the TBI Task Force from 20 – 23, Baltimore, Maryland. For more 2002 – 2005. He is also the author of two novels information on the meeting, on brain injury, Crashing Minds and Concusvisit www.aapmr.org. sion is Forever.
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