Whether or not to send a soldier or football player back to the battlefield or playing field following a suspected concussion is a decision that many military field leaders and coaches face. And it can be a life-or-death decision.
Two persons who are looking at brain injuries in different ways at two educational institutions in Atlanta have put their heads together in an effort to develop a device that can detect concussion in about 10 minutes – important in high-pressure, time-sensitive situations.
The effort involves Michelle LaPlaca, a biomedical engineering assistant professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology, and David Wright, MD, director of the Emergency Medicine Research Center at Emory University.
“The Coulter Foundation has contributed to the development of the Department of Biomedical Engineering at Georgia Tech and Emory, and they are very interested in promoting clinical translation projects,” LaPlaca told Diagnostics & Imaging Week. “In other words, getting projects out of the lab and into clinical situations on a rapid time-frame.”
The foundation had a funding announcement, and Wright and LaPlaca, who came to know each other through their focus on traumatic brain injuries – she on the research side and he on the clinical side – decided to submit a proposal after “basically brainstorming” to see how they could address the problem.
“We’re interested in mild traumatic brain injury [mTBI], and it’s very difficult to diagnose in a short amount of time,” LaPlaca said.
More than 750,000 mTBIs occur in the U.S. alone each year, and a standard mTBI test requires a quiet room and one to two hours of testing.
What the duo has developed is a device, called DETECT (Display Enhanced Testing for Concussions and mTBI system), that fits on the head of the person suspected of having suffered a concussion.
LaPlaca explained, “Basically, what the subject sees when they put that on ... is an LCD screen.”
The device is connected to a laptop computer, and the subject sees whatever is on the computer, wearing the head-mounted device “like a projector screen,” LaPlaca said. The device also includes earmuffs, which block “some of the outside noise.” The earpieces muffle noise to the point that the subject can concentrate on what is on the screen. That’s important because there also are audio instructions for the test, so the subject not only sees the instruction for the test, but hears them as well.
The person holds an “input device that is basically like a large [computer] mouse,” she said. “It almost looks like a PlayStation input device, where there’s a right and left button.”
Questions are sent from the computer, and the answers are sent back to the computer for analysis and for storage. The person then goes through a series of three tests, the first of which is a simple reaction time test, for example, remembering whether a shape he or she is shown is a yellow square or red triangle.
“One of the common features in concussion early on is reaction time,” LaPlaca said.
The second test is a “selective reminder’ test in which the person is shown a list of words one after another and asked to remember the list. If they fail the first time, they are given another chance, she said. That one tests “working memory,” LaPlaca said, which also is reduced after mild brain injuries.
The third test is more difficult – a pattern recognition test. The person is shown different shapes and can only select each shape one time.
“It’s designed to be sensitive to even minor changes in cognitive function, because even minor changes can have a large impact in performance that can affect the safety of the athlete,” she said. “Or in a life-and-death situation on the battlefield, [it] may affect target accuracy or decision-making that could” result in death.
LaPlaca said that most of those functional disturbances would appear mild to the general observer.
The device generates a score. Ideally in using the device, the operator would be able to get a baseline score for the test, such as when an athlete or soldier first gets a physical allowing them to enter the military or as part of sports team participation. That way, a baseline for each soldier or athlete would be stored on the computer. If that person was suspected of having a concussion, the test could be administered and his or her results compared to the baseline score.
The device also could be used in first-responder emergency situations, as well as in the actual emergency room.
The DETECT device is now in clinical validation trials, and LaPlaca said she is “optimistic” about its potential for commercialization.
“We have a patent application that’s been filed, and we are designing our studies such that they would be valid for all of the regulatory hurdles that we have to go through in order to commercialize the product,” she said.