Concussions have been in the news often in recent years, particularly relating to contact sports such as football. According to the Brain Injury Research Institute , an estimated 1.6 million to 3.8 million sport- and recreation-related concussions occur in the United States each year, and, many of these involving young athletes playing contact sports at the high school or college level.
High school athletes who sustain a concussion are three times more likely to sustain a second concussion, and can see significantly longer recovery times than more mature athletes. When these athletes don’t receive a proper diagnosis and so fail to manage their concussion and associated symptoms, the result can be serious long-term consequences, including the risk of coma or death.
The Centers for Disease Control and Prevention indicates that people suffering from traumatic brain injuries (TBI) can face effects lasting anywhere from a few days to the rest of their lives. These include impaired thinking, memory, movement, sensation, vision, or hearing, as well as depression or personality change.
Putting useful, accurate diagnostic tools into the hands of healthcare providers as well as concussion patients could go a long way to ensuring that proper monitoring and care is received during the recovery process, which can significantly reduce the changes of said serious consequences.
And fortunately, like many healthcare tools these days, there’s an app for that.
Reflex: The Concussion Test in the Palm of Your Hand
In an effort to make concussion testing available quickly and easily to anyone who has or may have sustained a concussion, a start-up called Brightlamp Inc., has developed a smartphone application that lets users quickly record data and send it directly to a trainer or medical professional. The medical practitioner can then examine this data and determine whether the user has sustained some form of neurological disturbance—including whether they have a concussion—that may have the potential for serious long-term health repercussions.
Reflex is essentially a pupillometer that measures the biological response called “pupillary light reflex”—a common way to help test for concussions by measuring how a person’s pupils dilate in response to light.
While holding a ruler up beside a person’s eye has already been replaced by automatic infrared pupillometers in hospitals and critical care clinics, these are expensive and generally not available to the general public. The Reflex app puts the ability to accurately measure pupil response into the hands of the user by using smartphone cameras to record a digital video of the eye.
When the user holds their camera up to their eye and taps the screen, the camera’s light flashes to initiate a response from the pupil.
The app records video of the eye’s pupil response, measuring metrics including the latency, constriction rate and dilation rate. “We give them an objective tool to monitor, and that way they’re not second-guessing,” said Kurtis Sluss, CEO of Brightlamp. “Plus, it gives them data they can reliably look back on and track progression over time.”
The app is currently intended for use by athletic trainers, physicians, neurologists and academic researchers to monitor cognitive functionality for many neurological disturbances, diseases and abnormalities, including concussions.
The ultimate goal, according to Sluss, is for coaches and parents of young athletes to be able to use a version of the app to help them monitor for potential problems. However, that would require approval from the FDA, which is expected to take years.
In the meantime, Reflex is a Class I regulated medical device according to the U.S. Food and Drug Administration, and is available only to trained medical professionals.
Importance of Accurate Concussion Diagnosis
Medical diagnostics have long been able to correlate changes in pupil response with brain stem and hypothalamus injuries, including blast-induced and non-blast-induced traumatic brain injuries, neurodegenerative diseases and other conditions that affect brain function.
Concussions fall under this banner as a relatively mild traumatic brain injury caused by a bump, blow or jolt to the head or body that causes the brain to move rapidly inside the skull. Common in sports injuries, concussions can also result from car crashes, trip-and-fall accidents—essentially, any time a person’s head sustains an impact.
Despite how common they are, diagnosing a concussion can be tricky.
Measuring the pupillary light reflex has long been used by medical professionals to assess a patient for severe forms of brain injury. Usually this comes in the form of a penlight test, where medical personnel shine a light into a patient’s eyes and observe the pupil response.
Recent tests and research indicating that another long-time concussion test, the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), may not always be accurate.
This was the subject of a 2018 study by researchers at Butler University, which found that deliberately fooling the ImPACT test—one of the nation’s most common screening tests—was much easier than previously measured.
The Butler researchers found that half of test takers who “sandbagged” the test, meaning to purposefully underperform, were not detected. This meant that half the test takers would potentially return to physical activity sooner than would be medically appropriate.
Typically, athletes taking the ImPACT test will record a baseline score before the sports season begins. The test is computerized, and asks subjects to answer questions involving words, designs, colors and symbol matching in order to test the person’s brain function. After experiencing a traumatic brain injury incident, an athlete would be given a different version of the test that asks a similar set of questions, and their scores compared.
However, by “sandbagging” during the first baseline assessment, the athlete would only need to match the lower threshold on post-injury tests.
“Anyone who works with the concussed clinically knows there are a lot of people who purposefully sandbag the baseline test and a lot of people don’t get caught,” said Amy Peak, one of the study’s authors and director of undergraduate health science programs at Butler. “I would hear in the community and hear all these athletes tell me, ‘I sandbagged mine, everybody sandbags it.’”
Eliminating the avenues for inaccurate diagnosis as well as sandbagging is the kind of improvement Sluss hopes Reflex will bring to the field of athletic medicine. For one thing, he said, Brightlamp’s method can’t be duped.
“Our test is unbiased,” Sluss said. Rather than self-reported responses, “[Reflex] is based on a natural response, so you can’t beat it. It also gives direct insight into the brain,” he said.
In addition, a growing body of medical research has begun to determine that identifying more subtle changes in pupil response can be useful in detecting milder concussions. Sluss said Brightlamp’s app is better at identifying these milder concussions than traditional assessment tools because Reflex is more sensitive.
Brightlamp recommends that users take a baseline test before an athletic season begins, but Sluss said it isn’t necessary. “There’s a normal physiological response across the human population, so we know what normal areas are,” he said.
A smartphone app alone won’t prevent concussions for athletes, so check out these stories on other research and tech that aims to keep players safe: