Over the past two years, many of the world’s foremost researchers and leading clinical experts from across the United States have collaborated to develop more useful ways to classify the most common clinical trajectories seen in concussion. Authored by top neurosurgery, neuropsychology, emergency medicine, family medicine, and sports medicine experts, this week’s publication represents the first ever evidence-based characterization of concussion into the most prevalent subtypes and associated conditions. The systematic review identifies evidence for each of the subtypes within the first three days of injury, having classified them as headache/migraine, ocular-motor, cognitive, vestibular, and anxiety/mood with sleep disturbance and cervical strain identified as common associated conditions.
This publication is certain to be a defining moment in our understanding of concussion today, further evolving what constitutes standard of care for all clinicians, and simultaneously offering millions of patients hope for more specific diagnostic criteria and individualized recovery plans. It is the authors’ hope that by establishing the supporting evidence, more clinicians will utilize subtyping as a preferred strategy for the evaluation and management of concussion.
The importance of proper classification
The primary goal of classifying concussion into subtypes is to provide timely intervention through targeted treatment. Each subtype and subtype cluster require a specific and progressive treatment approach. In the initial days after head injury, the most prevalent, significant neurological cognitive functions impaired are attention based, which manifest through the ocular-motor and oculo-vestibular systems. Therefore, accurately identifying people with ocular-motor and oculo-vestibular conditions is critical. If the identification of subtypes is reserved only for specialists who see cases of prolonged recovery, targeted treatment is delayed and the likelihood of co-morbid subtype development increases, most likely with associated anxiety, depression, and sleep disturbance.
By using the EYE-SYNC technology, a logical and algorithmic approach to the measurement of these conditions can be established and utilized from the initial moment a suspected injury occurs. A subtyping workflow provides the guidance to rule in or rule out, allowing the clinician to properly classify the impairments involved and those in need of remediation. Once a treatment plan has been developed, recovery strategies can be started using EYE-SYNC therapy paradigms, allowing patient progress to be monitored and progressed objectively through clear visuals and data-driven comparisons. This ultimately creates a systematic approach to timely and thorough evaluation, objective based progression, and clear indications of impairment resolution.
EYE-SYNC or VOMS – does it matter?
In recent years, VOMS (Vestibular Ocular Motor Screening) has gained popularity as a novel screening tool to evaluate ocular and vestibular function in concussion patients. Physicians, Neuropsychologists, Physical Therapists and Athletic Trainers have begun implementing this into their clinical practice to identify dysfunction that can be remedied with targeted therapy. Using a five minute process of recording patient symptoms post injury, performing a visual and vestibular screening, and then asking the patient to determine if symptoms have increased has shown to be a sensitive tool for further evaluation and classification of subtypes. So, why then does objectively measuring these conditions matter? In the same manner we have progressed from relying on patient reports and subjective information to objective metrics, we need to add objective metrics to VOMS. It is fantastic at capturing the progression of the patient from their perspective. However, in many cases, the patient is impaired and unable to provide a reliable perspective – a sentiment many athletes themselves have questioned. As clinicians, how do we know that by relying solely on patient input, that they are truly ready to resume life’s activities? The answer is we don’t – and that is why EYE-SYNC is so valuable.
As I routinely saw in my clinical practice, EYE-SYNC delivers what the patient cannot – a true objective measure of impairment and a progression of its associated resolution. During the same timeframe it takes to conduct the VOMS, EYE-SYNC captures 120 data points relative to ocular-motor and oculo-vestibular function, in addition to relevant symptom inventories. By using data visuals and key precision metrics, clinicians can identify specific deficits of the visual field and abnormal function of the vestibular system. Uncovering more complex functional signs of impairment allows the clinician to clearly identify the cause of reported symptoms and guides them through the process of creating a specific rehabilitation plan – or a timely referral to someone who can.
Scott Anderson, CCO, SyncThink
Scott joined SyncThink in 2017 after 10 years of distinguished leadership of the Sports Medicine program at Stanford University. It was there he met and subsequently worked alongside Dr. Ghajar as part of a multidisciplinary research collaborative studying the natural history of head injuries. Over a three-year period, Scott worked closely with Dr. Ghajar to roll out investigational studies into the EYE-SYNC technology, integrate the technology into the clinical care of athletes, and develop a comprehensive treatment algorithm for concussion emphasizing the key role of eye tracking as a clinical subtype.
In addition to deep product knowledge of the EYE-SYNC technology, Scott also brings market expertise in domestic and international sports organizations. He holds numerous clinical specialty certifications and is an internationally recognized speaker on the topic of head injury management. Scott currently serves as a consultant to the National Football League, and prior to joining the team at SyncThink, he served as Chair of the Pac 12 Sports Medicine Committee.