Hard-hitting research: Transforming concussion diagnosis
KALAMAZOO, Mich.—From falls to fender-benders to sports injuries, concussions are common among most of the population. They can have longterm health implications, and worse yet: They’re often unreported and consequently untreated.
Researchers at Western hope to change that.
“The goal is to develop better diagnostic tools and make them available not only for the community but also for health care providers,” says Dr. Alessander Danna-dos-Santos, director of WMU’s Laboratory for Advancements in Rehabilitation Sciences.
He teamed up with Dr. Carrie Barrett, associate professor of physical therapy, to develop a series of tests to quantify concussive events—also known as mild traumatic brain injuries (MTBI)—and measure their impact over a lifespan.
“Our group at Western is on the front wave of this type of development,” Danna-dos-Santos says.
The goal is to identify physical biomarkers with MTBI that give health care professionals better data to diagnose the injury.
“We’re trying to create clinical scores that work like a blood work result, but instead of getting specifics from your blood, we’re going to get that from the central nervous system,” says Danna-dos-Santos. “Once we have that, it’s going to be much easier for us to develop interventions and track their success.”
As first-year students, this is a very unique opportunity to be involved in research like this and also make an impact on quality of life in an area of research that could potentially have a profound impact on a huge portion of the population."
Tracking the untraceable
Concussions are hidden injuries, undetectable to the naked eye and nearly impossible to capture in medical imaging.
“If you examine a patient, you’re not going to find any lesions on the central nervous system,” says Danna-dos-Santos. “However, depending on the amount of energy, the type of concussion that you have or the number of events that you have, many people—about 20% of patients do not recover after the initial 60 days. In fact, the symptoms linger, and long-term subtle symptoms start to develop including difficulties in learning and memorization. Along the years they worsen. They start developing difficulties in learning and memorization. So the first aspects of the long-term events are cognitive.”
Barrett, a board-certified neurologic clinical specialist, says the outcome is more severe for older adults.
“Research shows anywhere from 40% up to 60% of those who have a mild traumatic brain injury over the age of 65 aren’t recovering within the first six months to a year out. And some never recover,” Barrett says.
Left untreated, repeated concussions can lead to long-term neurological and cognitive issues, from learning disabilities to balance and memory problems. But the impacts of MTBI can progress at different rates over time, and conditions associated with aging can further cloud diagnoses.
“With cognition you can often attribute symptoms to maybe dementia or Alzheimer’s when it could be from a potential incident they had previously,” says Shaun Kayes, a physical therapy doctoral student. “If you are also screening for MTBI, their treatment could be different and their results would be better. So, their quality of life would improve.”
Collecting critical data
Western’s team, which includes several physical therapy doctoral students, is focusing research on patients over the age of 65. It will help fill critical gaps in data that could lead to improvement in treatment.
Exams begin with a neurological screening, checking for past brain injuries or anything that could skew testing. Then, they complete a series of assessments aimed at measuring skills linked to traumatic brain injury:
- Balance: Patients stand on a force plate and perform a series of balance tests with their eyes open and closed to measure their body’s natural sway.
- Cognition: Patients are given a series of images and asked questions related to recall, grouping and other memory- based skills.
- Eye tracking: Using technology developed by Danna-dos-Santos, patients don innovative goggles and follow a dot across a digital screen with their eyes.
“When we put these three approaches all together, we are going to have a very good understanding of the health of your central nervous system and if you have physical effects of the long-term symptoms of traumatic brain injury,” Danna-dos-Santos says. “These tests are going to be able to show even subtle changes.”
He says the hope is to make this a tool that can be used in any doctor’s office.
“The most important thing after the diagnosis is the intervention. These tests are all quantitative, so we are able to quantify our abilities. And if interventions are put in practice with these patients, we are able to check if they’re getting better or not.”
Western’s concussion clinic is currently in the research phase focused on a relatively small group of patients, but eventually Barrett and Danna-dos-Santos aim to have a much broader impact.
“One of our major intentions here at WMU is to make our laboratory one of the leaders in the development of this type of research,” says Danna-dos-Santos. “We expect to be able not only to do this work but to involve our community in the research and give them access to this type of technology.”
Students have the opportunity to gain experience at the clinic both through data collection and literature review, helping to expand knowledge that could lead to important breakthroughs in concussion treatment.
“We all feel really good about it. We got into PT and health care to take care of other people, so being able to start doing that before we even get out of school and put some research forward backed by actual work we’ve done ourselves is really cool,” adds physical therapy doctoral student Joshua Chirackal. ■