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Got concussion? There’s an app for that: Saint Francis teams with Cleveland Clinic to combat concussion

October 16, 2012

The Center for Rehabilitation at Saint Francis' DiSepio Institute for Rural Health and Wellness is piloting a new way of managing concussions.

This approach, known as “C3”, is an iPad-based system developed by the Cleveland Clinic. C3 carries the potential of more efficiently managing concussions in athletes through multiple screening protocols and research driven methodologies.

This pilot study sprung from a brief conversation between researchers at the Cleveland Clinic and Dr. Ivan Mulligan, the Director of Saint Francis University’s Physical Therapy Program and a practicing Physical Therapist at the DiSepio Center For Rehabilitation, at the annual American Physical Therapy Association (APTA) conference.

“This application had Saint Francis written all over it,” said Mulligan. “As soon as I saw Cleveland Clinic’s approach, I immediately thought of the work we’re doing at DiSepio and the Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA). It’s all about rapid rollout of technology to increase access to care.”

Following initial conversations in August 2012, Saint Francis University became a test site for C3 in a number of days.

“The level of enthusiasm by the Cleveland Clinic folks is outstanding,” said Mulligan. “We worked together to make it happen.”

The C3 system uses a detailed series of graphical, touch-screen prompts to guide a therapist or coach to perform a pre-screen of each athlete in order to establish a “baseline” of cognitive, balance, and visual abilities. The purpose of a pre-screen is to document the individual’s neurophysical and neuropsychological status; in essence, their physical and mental acuity to stimuli such as light, changing scenarios, and movement. These variables can then be later compared to scores following a suspected concussion to determine what course of treatment may be required and if the individual is ready to return to athletic competition.

Unlike currently recognized concussion diagnostic systems, which heavily rely on subjective evaluations, and are expensive with limited portability, the C3 approach employs objective, interactive approaches within a completely digital system. From the initial point of enrollment, all athlete information is kept in an internet-based database, making it secure and rapidly accessible. Using this approach, the athlete is directly involved in his/her pre-screen, unlike existing systems, in which individuals are only observed. Many of the screening mechanisms require the individual to directly interact with the iPad via engaging applications. For visual acuity and balance tests, the individual has to trace their finger on the screen and even wear the iPad on a belt; using the built-in touch tracking and gyroscope, the iPad can automatically evaluate the user’s performance.

According to Saint Francis Sports Physical Therapy Resident, Stacy Trice PT, ATC, it takes about 20 minutes to enroll each athlete into the study and the process is simplified due to the iPad interface. Trice also praised the simplicity and thoroughness of the C3 interface.

“This technology will be pretty easy to learn,” said Trice. “It has built in corrective measures. If you’re not doing something right, it will let you know.”

Physical therapists at the Center for Rehabilitation, in conjunction with professionals from the Cleveland Clinic, began this research by pre-screening Saint Francis University athletes during summer training camp, including volunteers from men’s football, women’s soccer, and women’s volleyball.

According to Mulligan, the eventual goal will to be pre-screen as many student athlete volunteers as possible while putting safety first.

“At this point, we’re examining the viability of the C3 as a diagnostic tool,” said Mulligan. “We will continue conducting traditionally accepted pre- and post-assessments, which are based on recognized standards, to ensure that our athletes are getting the absolute best care we can provide.”

Trice also emphasized that the C3 system offers a number of other advantages over existing, concussion assessment tools, particularly in cases where athletes are encouraged to falsify test scores.

“Whether at their own urging or someone else’s, some athletes will try to rate low on pre-screens,” she said. “That way, when they’re injured, the amount of change is likely to be less, meaning they’re more likely to be put back into play, potentially at their own peril. The C3 tool’s level of detail doesn’t give players the same opportunities to ‘stack the deck’.”

Mark Boland, Director of Physical Therapy at the Center for Rehabilitation, also pointed out that the level of detail present in the C3 screening system far exceeds the current standards.

“The C3 offers 10 modules of assessment,” he said, “which provide far more detail than we’ve ever gathered for student athletes. I think we have the potential of knowing these individuals in a way we’d never have dreamed of five years ago.”

Trice also cited the general enthusiasm of the athletes to participate in the study, both from a safety and technology interest.

“It’s more functional and engages the student athlete a bit more,” she said. “This test is on a new piece of technology and has a wow factor. It’s more appealing to today’s generation.”

The C3 initial study is expected to run from Fall 2012 through Spring 2013. Research results will be tallied and compared to data from the current system to determine the efficacy of C3 as compared to established protocols. Jay Roberts, Director of DiSepio and CERMUSA, emphasized the value of bringing technology and applied research to the community.

“These kinds of activities encapsulate what DiSepio and CERMUSA are all about,” he said. “Connections with groups like the Cleveland Clinic bring new ideas and possibilities to the populations we serve, on and off the campus. We are excited to see where this research will lead us!”

For more information about this study or the DiSepio Institute/CERMUSA, please call (814)472-3389 or e-mail jroberts@cermusa.francis.edu.