For all the attention paid to them, it’s still difficult for coaches, athletic trainers, parents and doctors to know when an athlete has a concussion, not to mention when it’s appropriate for them to return to play or school. However, a Cleveland Clinic team led by Jay Alberts, Ph.D., Director of the Cleveland Clinic Concussion Center and Lerner Research Institute Department of Biomedical Engineering researcher, has developed an innovative iPad app that is helping to answer those questions.

Visualizing the results

Cleveland Clinic is a national leader in concussion research and clinical care, and the app, called the Cleveland Clinic Concussion (C3) App is the newest innovation to help determine appropriate care for athletes who sustain concussions or are suspected of having a concussion. Using the iPad’s touch screen and built-in accelerometer and gyroscope, the C3 App measures five key areas – information processing, attention/working memory, processing speed, balance and visual acuity, along with symptoms. The results are presented in the form of a polygon (see diagram).

Polygon in practice

Concussion symptoms are often varied and may include headache, neck pain, balance disturbances, dizziness, fogginess, sleep disruption, mood alterations, light or noise sensitivity, nausea, difficulty concentrating and visual problems. In this athlete’s case, had the medical team relied only on symptoms, the athlete would be deemed ready to return to play, based on his Day 10 score. The C3-generated polygon, however, shows that the athlete’s vision and balance may have not sufficiently recovered to return to the field.

“It provides a global view of concussion recovery, instead of looking from a single perspective or subjective assessment of one type of function."

“Our approach offers health care providers quantifiable, objective data characterizing the major symptoms associated with concussion.  This information can be used to confirm the provider’s clinical decision to return to play; or in some cases, demonstrate that while some athletes may be ready to return to play based on select criteria or self-reported symptoms, they may still have balance or dynamic visual acuity symptoms,” Dr. Alberts says. “It provides a global view of concussion recovery, instead of looking from a single perspective or subjective assessment of one type of function. No two concussions will affect two athletes in an identical manner, therefore it is critical to develop a more patient-specific method of assessment and treatment.” 

The C3 App is in clinical use, with over 10,000 baselines gathered for athletes at several colleges and 56 northeast Ohio high schools.

In addition to the iPad app, Cleveland Clinic researchers are developing an intelligent MEMS mouthguard, a concussion blood test and youth helmet testing. They are also currently researching the brain health of boxers at the Lou Ruvo Center for Brain Health in Las Vegas, and were recently chosen by the NFLPA as one of three medical sites to help assess the neurological health of former players and manage their neurological health.

 In the graphic above:

The black outline -- the athlete’s healthy baseline, before injury.

The red line -- 24 hours after sustaining a concussion, showing deficiencies in all five areas of function and exhibiting symptoms.
 
The yellow line -- three days after the concussion, showing that the athlete is still deficient in all five areas, though improving.


The blue line -- 10 days after the concussion the athlete is showing signs of improvement in information processing, memory and processing speed and their self-reported symptoms are improving. However, their balance remains deficient.

Infograph Credit: Cleveland Clinic