Noreen Khan, Content Manager, Neurovine
As we near the end of this Brain Injury Awareness Month, we’re examining the complex nature of brain injuries; with regard to diagnosis and recovery guidelines. According to the Brain Injury Association of America, acquired brain injury (ABI) is a brain injury that is not hereditary, congenital, degenerative or induced by birth trauma, and TBI or traumatic brain injury is a type of ABI caused by an external force, resulting in trauma to the brain. Currently, it is estimated that 69 million people sustain a TBI each year worldwide. Falls are reported as one of the leading causes of TBI.
The Brain Injury Association also reports that approximately 5.3 million Americans or 1 in every 60 people live with a TBI related disability. Although brain injury or disorder can be caused by many different mechanisms, including concussion or stroke, the recovery process shares many of the same traits. First of all, brain injury and the recovery process are invisible for patients, caregivers and clinicians. There's no clear road map or set of directions for the patient or for the loved ones to follow. Patient data is scattered between general practitioners, specialists, and therapists. And finally therapeutic intervention is very expensive and difficult to access and often it's not targeted to that individual's journey.
CONCUSSION AS AN INVISIBLE INJURY
Concussions or mild traumatic brain injury can be difficult to diagnose. While moderate to severe TBI may be visible on MRI or CAT scans, concussions are currently diagnosed relatively subjectively. Concussion is an invisible injury as it can not be seen like a broken arm or bruise. Many may not even realize they've sustained a concussion until a few days after, when symptoms persist. Those who do seek help are often faced with subjective diagnoses and vague or confusing recovery guidelines. I myself was diagnosed with a mild concussion in December 2018. When I went to the ER, they asked me a few questions, checked my vision and balance, and told me to go home, avoid screens and rest in a dark room. These guidelines didn't help much as I had an exam in a few weeks and noticed the symptoms persisted.
The total addressable market for concussions is 8.6 billion dollars a year, and currently this recovery process is very poorly managed. It's expensive for the patient and the payer. Once a patient is diagnosed with a concussion, they experience a snakes and ladders type recovery process where they slowly make progress but often regress in their recovery because of overexertion or exposure to triggers. This snakes and ladders progression may lead to post concussive syndrome, which indicates that the patient is still suffering from symptoms 3 months after their injury. In addition to the cost of extended medical care, these patients also have a difficult time returning to work, resulting in high short-term disability payments.
While many who experience a concussion may recover relatively quickly, vague recovery guidelines can put patients at risk of post concussion syndrome. Post concussion syndrome or PCS, occurs when concussion symptoms last beyond the expected recovery period. However, with current advancements in research and technology, we are understanding how to better support the recovery process for those living with mTBI.
SUBTHRESHOLD PHYSICAL AND COGNITIVE ACTIVITY
The current standard of care for concussion has been rest until symptoms gradually decrease. Patients are generally asked to avoid screens, rest in a dark room, and don't push themselves. But these guidelines are relatively vague and subjective. The amount of physical and cognitive activity one can manage before it's considered "overexerting" is subjective. That being said, as research continues to grow and develop, we are learning more about how to effectively manage recovery for concussion patients.
A study by Dr. John Leddy et al, found that early subthreshold aerobic exercise appeared to be an effective treatment for adolescents after a sports-related concussion or SRC. The objective of this study was to assess the effectiveness of aerobic exercise versus placebo-like stretching, in recovery from sports-related concussion. The aerobic exercise group was instructed to perform aerobic exercise via bike or treadmill, under supervision, at the prescribed target heart rate. The placebo-like stretching group was instructed to follow a prescribed stretching program. They found that aerobic exercise improved recovery in adolescents with SRC compared to the placebo-like stretching. The Neurovine solution is designed to get patients physically active but warns them before they overexert. This physical activity is essential to a healthy recovery post concussion but within parameters. And so, the clinician is involved in setting the parameters and we provide alerts to the patient to get them active but prevent overexertion.
Similarly, a certain amount of cognitive activity is important to the brain injury recovery process but overexertion is associated with regression. This study shows that you can actually use EEG technology to measure how hard the brain is working. The Neurovine app provides a gamified AI-driven therapeutic intervention. Working in conjunction with the EEG Sensorband, patients can receive brain break alerts to warn them before they overexert and clinicians can set appropriate thresholds to improve cognitive pacing.
#MORETHANMYBRAININJURY
Brain injury patients can often experience stigma or gaslighting, due to the invisible nature of the injury. Though it can't be seen, it is a very real injury. Thanks to brain injury awareness month and other such campaigns, more information is becoming easily accessible. The more information we have, the better able we are to understand it and decrease stigma surrounding the injury. If you or someone you know has been affected by brain injury, we encourage you to look into the #MoreThanMyBrainInjury campaign run by the Brain Injury Association of America.
At Neurovine, we're combining state-of-the-art EEG technology with advanced data analytics that provide an end-to-end experience to navigate, connect and provide actual insights for patients, their caregivers, and clinicians, throughout the recovery process. Our real-time data analytics provide personalized gamified therapeutic intervention for patients and these insights help clinicians make medically informed decisions for their patients. To learn more about what we do and how you can get involved, contact us today.
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