Currently, a concussion 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, director of the Stanford Concussion and Brain Performance Center, clinicians are not looking at the right predictors for a concussion when they rely on symptoms or memory tests. Predictive movement, he says, is a more accurate sign of a 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 Stanford, physicians have them walk on a treadmill and look at patients' step-to-step variability and balance to identify jitteriness or instability. They also measure a patient's attention or cognitive focus using a new neuro-technology device developed by Ghajar, which tracks a patient's eye motion for 30 seconds.
"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."
Active treatment and recovery
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. Using the eye-tracking technology, Ghajar and his colleagues can retest patients post concussion to track their recovery as a more accurate way of determining when it's safe for them to resume activity.
The Stanford Concussion Center also offers an active treatment protocol that goes beyond the standard rest that physicians have prescribed in the past. Physicians work to improve patients' balance, walking and eye movement through exercise and feedback to regain executive function quicker and recover sooner. The thrust behind the clinic is that by treating movement problems, patients' timing gets better and their thinking improves.
Patients who come to the Concussion and Brain Performance Center are evaluated by one of three neurologists or neurosurgeons. At the same visit, they meet with a physical therapist for balance and movement testing and therapy, and receive a neuropsych evaluation. Patients will then get rehabilitation in the areas where they are experiencing deficits.