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How to diagnose concussions earlier

by Matthew Coyte September 19, 2017
How to diagnose concussions earlier

Emerging technology aims to prevent athletes returning to the field too soon

“On average, there are eight concussions per team per year,” according to Dr. Alain Ptito,  a professor of neurology and neurosurgery at McGill University.

Those eight concussions per team refer to both the McGill varsity football and hockey teams. He has worked with them in his research to help determine a way to diagnose concussions more efficiently.

Emerging technology is improving the way researchers analyze injured athletes in sports such as hockey, football, soccer, basketball and rugby. According to a 2007 study by Ptito, concussions had become such a problem that “improved approaches to diagnosis, investigation and management are urgent.”

In an interview with The Concordian, Ptito talked about the introduction of new technologies being used in the diagnosis of mild traumatic brain injuries, otherwise known as concussions. He said he hopes more sports teams, both professional and collegiate, will begin using functional magnetic resonance imaging (fMRI) to provide a baseline brain scan to test athletes who may have a concussion.

“We’ve been interested in concussions for a while,” he said. Despite the presence of a concussion, some brain imaging technology cannot accurately diagnose the injury. “When you do a conventional test of imaging, such as a CT [computed tomography], or an MRI, almost 100 per cent of the time, they come up normal [despite the presence of a concussion].”

Ptito noted that an fMRI is significantly more accurate at diagnosing concussions than MRI or CT scans. The fMRI is able to detect activation in targeted areas of the brain when the subject is carrying out a task that will stimulate the specific region of the brain.

According to Ptito, when a certain region of the brain is stimulated, it requires more oxygen and blood. That stimulation of blood and oxygen is what the fMRI picks up, and is known as brain activation. The fMRI can capture a concussion by scanning certain regions of the brain to see how much they activate. When symptoms are severe, targeted regions of the brain will activate less or not at all.

In his research, Ptito worked with the McGill varsity football and hockey teams. Before the season began, he tested the athletes using the fMRI to get baseline results. During the season, if an athlete suspected they had concussion, they would go see Ptito to retake the test within 72 hours of the head trauma. Ptito would then compare their results to their baseline results to diagnose whether the athlete has a concussion.

Ptito explained how comparing athletes to a general baseline result is the “second-best option,” while the best option is using an athlete’s own baseline test to diagnose concussions.

“It’s great when you can compare to an athlete’s own baseline test,” he said.

Concordia’s own PERFORM Centre, located on the Loyola campus, has been conducting similar baseline testing. The centre works closely with Concordia athletes from the football, hockey and rugby teams, and has implemented its own concussion research.

In an interview with The Concordian, Deborah Cross, the manager of community and education programs, and Lee Ann Papula, the head athletic therapy internship instructor, explained some of their concussion diagnosis methods.

“We use the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing),” Papula said. “On the field, the athletic therapists use a Standardized Concussion Assessment Test (SCAT). That’s the major tool used in on-field scenarios. The ImPACT test was developed more clinically.”

This test is much like a computer game, with participants receiving a numerical score at the end. The athletes come in at the beginning of the season in order to obtain a baseline score. The athletes are asked questions that assess non-verbal problem solving, reaction time, memory and attention span.

“It’s known, in North America, if not the world, as one of the top tests. It’s backed by a ton of research,” Papula said. “I can say that 99.9 per cent of schools that have a certified athletic therapist go through SCAT and follow the protocols from the consensus of SCAT.”

“Do all the schools do ImPACT testing? We were probably one of the first. We started about four years ago,” she said. “More and more schools are using it, but I definitely don’t think all of them are.”

Stingers athletes who have been diagnosed with a concussion using the on-field SCAT test will go to the PERFORM Centre to retake an ImPACT test. Papula said they may take the ImPACT test multiple times after a concussion, and must return to their baseline results before being cleared to play.

The PERFORM Centre boasts an impressive array of top-of-the-line technology, and Cross discussed another reliable way of diagnosing concussions.

“We’ve just started using the NeuroCom, which is a balance assessment tool for, obviously balance, but also to look at any kind of vestibular disturbances (inner ear imbalances) if you had had a concussion,” she said.

The machine was accurately described by Cross as resembling a climbing wall. The subject is placed on a metal balance board and strapped into a harness attached to the ceiling while facing the colourful wall of the machine. The technician will then instruct the subject on whether or not to keep their eyes open or closed. While the subject’s eyes are either open or closed, the machine will begin to move and sway, and the subject will attempt to stay balanced.

According to the developer, Natus Medical Incorporated, a medical device and software provider, the NeuroCom uses the “vertical force exerted through the patient’s feet to measure centre of gravity and postural control.” Cross added that the PERFORM Centre was one of the first university centres to use the NeuroCom test.

Cross and Papula both explained how this, combined with eye-tracking technology, can accurately diagnose a concussion. As well, the NeuroCom can theoretically be used as a training mechanism for those recovering from concussions as a way to work on regaining balance.

With the ImPACT test, as well as the addition of the NeuroCom balance test, it’s difficult for athletes to conceal their symptoms in order to return to the field quicker. The on-field SCAT test alone leaves the possibility open for athletes to hide symptoms, according to both Cross and Ptito.

“Athletes have a tendency to minimize their symptoms,” Ptito said.

Cross and Papula agreed the fMRI is even more accurate than the ImPACT, SCAT or NeuroCom, but the cost of the fMRI is simply too high for many universities. For reference, Canadian Magnetic Imaging in Vancouver charges $1,245 for scans of mild traumatic brain injuries, while the ImPACT test provided at the PERFORM Centre costs only $25.

The PERFORM Centre’s technology and medical capabilities have drawn interest outside of the Concordia Stingers as well. The centre is currently working with French soccer powerhouse Paris St-Germain’s Canadian academy, as well as Collège Montmorency’s basketball team, to provide baseline concussion testing.

Despite the progress in concussion testing, Ptito said there are still many questions about the injury that he wonders about. “Eighty per cent of athletes recovered in three months. For 20 per cent, symptoms linger,” he said. “We’re asking ourselves now: are there genetic aspects that we haven’t found yet?”

Graphic by Alexa Hawksworth

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