A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow‐up?

Abstract

Objectives Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. Methods All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of <100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. Results A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. Conclusions The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.

Quantitative measurement of post-concussion syndrome Using Electrovestibulography

“…Accurate diagnosis and prognosis of the TBI consequence are essential for patient care and long-term rehabilitation. In a recent study 24 , using a robotic-assisted assessment of neurological function, they investigated if PCS following mTBI can be predicted during the initial presentation to an emergency department. However, they only validated their prediction accuracy over a short (3 weeks post-injury) duration.…”

“…Thus, having an objective and reliable assessment technique for PCS, such as the one investigated in this study, would be of great interest. There have been some quantitative approaches, such as quantitative EEG (qEEG) 21 – 23 and robotic-assisted test battery 24 , investigating PCS and its recovery with some very positive outcomes including, when studying different post-concussion times using qEEG, a reported 77.8–92.3% accuracy in detecting short-term and long-term TBI 23 . However, there are also some studies that question qEEG’s clinical usefulness 12 , 25 but recent publications do continue to support its utility 26 , 27 .…”

The feasibility of using robotic technology to quantify sensory, motor, and cognitive impairments associated with ALS

“…KINARM Standard Tests were initially developed and tested on individuals with stroke to quantify impairments in upper limb sensory, motor and cognitive functions [7][8][9][10][11][12][13][14][15]. These tasks have also been used to quantify impairments associated with concussion [16], traumatic brain injury [17], cerebral palsy [18,19] and transient ischemic attack [14]. In the present study, participants performed a battery of 9 behavioral tasks that assess upper limb motor and proprioceptive performance, as well as aspects of cognitive function.…”

Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function?

“…This could be dealt with by baseline testing all athletes and having individuals return when they sustain a concussion. In general children and adolescents have been shown to take longer to recover following concussion than their adult counterpart’s [ 15 , 17 ].…”

“…In general, the majority (80–90 %) of concussions resolve in a short (7–10 days) period [ 5 , 6 ]. Our understanding of the impact of concussion(s) on the brain is limited, however neuropsychological deficits have been observed in adults over a time span ranging from 24 h to 3 years [ 7 – 15 ]. Within the last decade research related to concussion in children and adolescents has rapidly expanded [ 16 – 18 ].…”