Ever wonder why being on a surf board is so destabilizing—especially with your eyes closed?
Part of the answer is obvious: Water is an unstable surface compared to the flat ground. But why does shutting your eyes make it worse? University of North Carolina Wilmington psychology professor Len Lecci explains: “With your eyes open, the brain is collecting information that helps you. When your eyes are closed, you don’t have that information.”
Add that challenge to that of standing on an unstable surface, and you’ve got the equivalent of a stress test for the heart—only it tests balance. Ultimately, it’s tests whether or not you’ve had a concussion.
Lecci has been helping to develop a battery of concussion tests, together with LifeGait, which is housed at UNCW’s Center for Innovation and Entrepreneurship (CIE). LifeGait helps develop and commercialize technologies in the health arena, and “SportGait,” is their concussion management system.
The idea was to improve the diagnosis and management of concussions, and the impetus came from LifeGait CEO and President Chris Newton. “I’m a father of two kid athletes,” Newton said. His 11-year-old son who plays lacrosse, and his 13-year-old daughter plays soccer.
Newton wanted to know, “How can we provide safety, not only to my children, but to the 36 million youth athletes [in the U.S.]?”
According to recent data from the High School Reporting Information Online Injury Surveillance System, there were 40,843 youth athlete injuries between 2005 and 2015, with 6,399 concussions.
Overall attention to youth concussion has increased, since the implementation of youth sports’ traumatic brain injury laws in 2010. Certain sports regulating bodies, such as the U.S. Soccer Federation, have also implemented guidelines, like rules limiting heading, to help prevent concussions.
Lack of standardized testing
But what is still missing is a standardized way to measure and monitor concussions, said Kelly Rawers, who does marketing and public relations for SportGait. Because of this lack of uniformity in testing, Rawers said, many concussions go undiagnosed.
“In mild cases, you might not even recognize the symptoms,” like moodiness or headache, she said. “Typically an athlete would go to the ER, and they’d do a CT scan. Unless you have a brain bleed, a CT scan might not pick up a concussion.”
Many concussions tests are unreliable, and as a result, children have been sent back to school too soon, she said. Some tests are expensive, and others, like those involving running on a treadmill, only exacerbate symptoms.
Given this framework, Lecci and his colleagues at UNCW had their work cut out for them. First, they surveyed existing tests, only what worked from them.
Then they created three types of concussion tests: a balance test, a cognitive test, and the four-meter gait speed test, which is a gold standard test for functional assessment.
A sustained attention test—where people are judged on their speed in answering, as well as errors of omission and commission—tests cognition, Lecci said.
The balance test involves doing three poses—both on the flat ground—and on a foam pad, which is designed to create instability—much like the aforementioned surfing analogy. People do the tests in both settings once with their eyes open, and once with their eyes closed.
People are timed in the four-meter gait test, and the company is working on creating wrist and ankle sensors to provide information about discrepancies in the left or right foot, Lecci said.
All this information is then funneled into a free app that SportGait created. “The data are processed internally in a machine, and then presented to [providers] visually, so they have a very quick read,” Lecci said.
On the app, the results of each test show up somewhere along a multi-colored bar, indicating whether or not the results are clinically concerning. The results are measured against the gender and age norms of the person being tested, Rawers said.
But since most kids aren’t average, ideally they would get a baseline test to then use to measure any changes, Rawers added. “We try to encourage athletes to get a brain physical that would include this data.”
Free app for athletes, parents, doctors
The app includes several step-by-step components, starting with where the concussion occurred, whether or not the athlete was removed from play, and what the athlete’s symptoms were.
“The app helps parents determine whether their kids need to go to the doctor, and points out doctors in the area,” Rawers said. Those factors could be important for athletes on traveling teams.
It also allows parents to track sub-concussive hits, so that a provider has a solid history on the athlete. Finally, the app guides the athlete through the concussion recovery process.
The app is already being used in some of Wilmington’s Medac Urgent Care Clinics.
“We’re trying to generate awareness that urgent care is an option,” Rawers said—especially in place of unnecessary ER visits.
“Urgent care [clinics] are open at night and on the weekends, when our youth athletes are playing their sport,” she said.
There are signs that SportGait is starting to reach its target audience, of Wilmington’s youth athletes. “A number of concussed patients have already used it,” she added.
In September, SportGait plans to give baseline brain physicals to the Wilmington Icehawks hockey team members.
The word about SportGait is spreading beyond Wilmington, too. A few weeks ago, SportGait put the app on the app store, and they had over 100 downloads in the first week.
“We are excited about getting the word out and protecting our youth athletes,” Newton said, adding, “Our system works for any type of concussion.”
Car accidents are the leading cause of concussions, followed by falls, he said.
The app also generated a lot of interest at a national urgent care conference in Washington D.C. earlier this month.
“By the end of it, we were known as the concussion people,” Rawers said. “A number of providers instantly picked up on the need to upgrade their system.”
