The Concussion Health Summit Sponsor Showcase: Science and Technology Move Concussion Assessment into the Modern Era
underlying structural changes that occurred after the injury.
Most recently the conception that concussion is a structural injury has been refuted. Research on what actually transpires in the brain when there is a traumatic injury has found that a concussion is not a structural injury but rather a pathophysiological event (Giza and Hovda, 2014). Because a concussion is not a structural injury, scans (including CT, XRAY, MRI, and PET) are generally not useful in identifying this type of injury leading clinicians to consider a variety of alternatives when diagnosing a concussion.
While there currently are many ways to assess a patient for a concussion, not all methods are equally accurate, provide useful data to the clinician, or are practical from a cost or efficiency standpoint. By far, the most popular approach is clinical judgment. The more experienced the clinician is in diagnosing and treating the injury the more likely they are to eschew other methods in favor of trusting their judgement. While widely utilized, this approach tends to have a high degree of subjectivity and the accuracy of this approach is highly dependent on the skill and experience of the healthcare provider. Further, this approach is frequently criticized for lack of standardized procedures.
Similar to clinical judgment in terms of its widespread use is symptom evaluation as a way to diagnose a concussion. A patient exhibiting one or more symptoms may cause a clinician to diagnose that patient with a concussion. Symptom evaluation has been the focus of a number of research studies (e.g. Lau, Collins, and Lovell, 2011; Collins, Iverson, and Lovell, 2003). When focusing only on symptoms, the clinician is relying on the patient to be truthful about the nature and severity of the symptoms he or she is experiencing. More importantly, there is no universally accepted set of symptoms or threshold for the number of symptoms the patient must exhibit for the clinician to diagnose a concussion.
Because of the subjectivity of the previously described methods, many healthcare providers have endeavored to utilize a more objective approach to diagnosing a concussion. Neuropsychologists have for many years utilized paper and pencil testing to assess essential functions such as memory, processing speed, and visuospatial skills (Randolph, McCrea, and Barr, 2005). Though these tests tend to be well normed and accurate, and provide the clinician with valuable data when diagnosing and treating a concussed patient, they tend to take a significant amount of time and involve significant expense to administer and interpret. Most recently, Computerized Neurocognitive Testing (CNT) has been widely endorsed as an economical, efficient alternative that can be used by clinicians to gather the data needed to make an accurate diagnosis (McCrory, Meeuwisse, Dvorak, et al, 2017).
Computerized Neurocognitive Testing (CNT) allows the healthcare provider to quickly and cost effectively diagnose and treat a concussed patient. Commonly used by psychologists, physicians, and other trained healthcare providers involved in diagnosing and treating patients CNT was recently endorsed as a cornerstone of concussion diagnosis in the 2016 Consensus Statement on Sports Concussions (McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., et. al., 2017). Within this category of tests, ImPACT (Lovell, 2016) is the most widely used and the most widely researched and supported for clinical evaluation. It is also the only tool approved by the FDA for aiding clinicians in the diagnostic process.
Utilizing a test such as ImPACT, enables the clinician to identify the focal treatment best suited for the particular patient based upon the nature of his or her injury. A study by Collins, Kontos, et al (2014) demonstrated that ImPACT provides the clinician with data that can be used to categorize concussions into six recovery trajectories. Matching the appropriate therapy to the particular trajectory involved (i.e. cognitive, anxiety/mood, vestibular, etc.) enabled patients to return to normal activity more quickly.
Diagnosing and treating a concussion is a complicated endeavor. Patients depend on the clinician to accurately identify their concussion and devise a treatment approach that will enable them to return to their daily activities quickly and safely. For clinicians, the best approach to this problem is to utilize a CNT such as ImPACT which can provide valuable information in an efficient and cost-effective manner. Used in a multidisciplinary approach along with clinical, behavioral, and medical information, ImPACT is an important part of the diagnostic process.
Thank you to ImPACT Applications, Inc. for contributing to our Summit Sponsor Showcase! We look forward to future blogs from our sponsors leading up to The Concussion Health Summit. Register today to attend the Summit and join the conversation discussing the latest knowledge and technology regarding concussion management.
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