The Future Of Telehealth In Sports Related Brain Injuries
Recent study shows promise for remote TBI diagnosis
Sports took a hard hit during the COVID-19 pandemic. But telehealth began to flourish with the sudden need for remote care. As athletes and sporting events of all levels resumed regular activity; providers, athletic trainers and coaches have shown interest in how telemedicine can be used on and off the field.
Telemedicine is particularly well suited for sports medicine, assisting the diagnosis, treatment and prevention of sports related injuries, including but not limited to sports related brain injuries. According to The Centers for Disease Control (CDC) approximately 1.6 to 3.8 million sports related traumatic brain injuries (TBIs) occur every year.
While the issue is being recognized at the professional level; collegiate, high school and youth athletic programs across the U.S. lack the adequate medical personnel. Specifically concussion specialists to handle these injuries on the sidelines in real time.
Telemedicine is the answer we need to reduce the delay in adequate diagnosis and treatment.
What is a traumatic brain injury (TBI)?
TBI has multiple definitions but can generally be defined as a brain dysfunction caused by a violent outside force. This can be a blow or jolt to the head that causes the brain to move rapidly back and forth inside the skull. Thus, disrupting the normal function of the brain.
TBI symptoms can be mild, moderate or severe, depending on the extent of damage to the brain. The most common in sports being cerebral contusions, second-impact syndrome (SIS), chronic traumatic encephalopathy (CTE) and hematomas— aka a goose egg.
Second Impact Syndrome (SIS)
Is a severe, sometimes fatal, swelling of the brain that is the result of a second concussion sustained before complete recovery. The repeated injury causes obstruction of normal blood flow and increased swelling, which may be difficult or impossible to maintain.
Chronic Traumatic Encephalopathy (CTE)
Is a progressive degenerative disease mostly found in individuals who have sustained repeated head injuries, including concussions during sports. The symptoms of CTE typically develop over several years to decades after repeated injuries and consist of cognitive deficiencies such as:
Mental illnesses such as
As the disease progresses, some may experience progressive dementia and motor symptoms such as balance instability.
Sports related concussions
Concussions are traumatic brain injuries that can occur in a wide range of sports or recreational activities. From youth teams to the pros, athletes at all levels can be affected. Not all sport related concussion are caused by impacts to the head. They may be caused by a direct blow to the neck or elsewhere on the body with an “impulsive” force transmitted to the head.
Most sports related concussions result in the rapid onset of short-lived impairment of brain function that settles shortly after. But in some cases, symptoms may occur from minutes to even hours after the initial impact.
In rare cases, a concussion can lead to swelling and bleeding in the brain and can even turn fatal. Post-concussion syndrome can take place when symptoms last longer than the expected recovery period. The usual recovery period is weeks to months.
Faster concussion diagnosis
Concussions are typically managed by their severity. Immediately after a concussion, medical attention is needed to determine an athlete's vital signs, level of consciousness and to rule out any other injuries, such as to the spine. This is where telemedicine can come in handy.
High school and collegiate sports are seeing a shortage in athletic trainers versed in concussion protocols. Especially those schools located in more rural areas with less funding. Putting these student athletes at risk for a potential misdiagnosis or delayed diagnosis.
Telemedicine allows medical professionals and athletic trainers to be at games and practices virtually. But does the lack of in-person care affect a medical professional's ability to diagnose properly? Studies are finding that not to be the case.
Study of telemedicine and sports related brain injuries
The Feasibility and Accuracy of Teleconcussion for Acute Evaluation of Suspected Concussion study focused on the use of telemedicine technology with concussion specialists in order to determine if a player needed to be removed from the game in real time. The findings would determine whether or not telemedicine technology was an effective solution.
Both physicians (in-person and remote) had 100% agreement with the evaluation scoring and the most important decision — removal from play (RFP). This suggests neurologists may be able to use telemedicine to manage concussions and make removal from play decisions. Thus, closing the gap in medical care by providing all collegiate and youth athletes similar concussion care as professional athletes.
Types of SRC evaluation
The study involved three SRC evaluations:
Standardized Assessment of Concussion (SAC) - Commonly used among team physicians and trainers to evaluate an athlete's mental status. It involves a five-minute series of questions and physical exercises.
modified Balance Error Scoring System (mBESS) - Consists of three stances: double-leg stance, single-leg stance and a tandem stance. The stances are performed with the eyes closed and hands on the hips, first on a firm surface and then on a soft surface.
King-Devick test (K-D) - A two-minute rapid number naming test. An individual quickly reads aloud single digit numbers while the test evaluates impairments of eye movements, attention and language function.
The remote neurologist assessed each athlete in real-time using a telemedicine robot with 2-way audiovisual communication. The in-person provider performed the same methods simultaneously. Both providers were blinded to the others examination findings and RFP decisions until the assessment was completed.
Note: There is no single, standardized test for an initial diagnosis.
Best practice for providers, athletic trainers and coaches
We’ve talked about how telemedicine can help diagnose sports related concussions, but what can we do to prevent traumatic brain injuries in athletes for the future? Here are a couple best practices to keep in mind when working with athletes.
Encourage the use of:
Properly fitted equipment, if required
Reporting concussions and taking time to recover
Follow rules of the sport and guidance for safety
Good sportsmanship at all times
When in doubt, sit them out
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