Diagnosing and treating concussions is an inaccurate science at best. There is presently no evidence-based definition for concussion that is uniformly applied in clinical and research settings. And there is extreme variability among clinicians on how concussion is diagnosed and managed. The Stanford Concussion and Brain Performance Center, a specialized center to diagnose and treat patients who experienced a recent concussion, is hoping to bring clarity to this concussion conundrum.
With no standard test or procedure to verify whether a patient has had a concussion, its diagnosis is based on a doctor's examination, observation of symptoms, testing a patient's reaction time and memory and understanding the incident that led to the injury. But according to Jamshid Ghajar, MD, PhD, Clinical Professor of Neurosurgery and Director of the Stanford Concussion and Brain Performance Center, clinicians are not looking at the right predictors for concussion when they rely on symptoms or memory and reaction tests. Predictive movement, he says, is a more accurate sign of concussion.
"When the brain's timer, the cerebellum, is rattled, it affects both motor and thinking pathways," says Ghajar, who is also president of the Brain Trauma Foundation. "That's why patients who've suffered a concussion feel out of sync. When somebody gets out of sync in their thinking, they also get out of sync in their movements."
When a patient is evaluated at the Stanford Concussion Center, physicians have them walk on a treadmill and can pick up jitteriness and instability by looking at patients' step-to-step variability and balance. They also measure their attention or cognitive focus using a new neuro-technology device developed by Ghajar, which tracks a patient's eye motion for 30 seconds. Patients place their face in the eye-tracking device and are then asked to follow a dot as it rotates around a circle. The patient's gaze is measured against his or her baseline movement or against a normative database. Eye-tracking has been shown to correlate strongly with the integrity of the attention network, which is commonly impaired in concussion.
"We can actually measure the problem, compare data to normal and try to improve upon it," says Ghajar. "This differentiates us from any other concussion clinic in the world because of the diagnostics we're doing and the therapeutics we offer that really give patients a solution."
Because people who have suffered one concussion are three times more likely to get another concussion, usually because they resume activity when still suffering from attention and motor issues, it is critical to be able to measure recovery, says Ghajar. Using eye-tracking technology, he and his colleagues can regularly retest patients post concussion to track their recovery as a more accurate way of determining when it's safe for them to resume activity.