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Eye-tracking can help diagnose concussion, but it’s under-utilised

By Insights

Concussion can cause serious damage if it’s not properly diagnosed and treated.

Author: Nadja Snegireva, Stellenbosch University

Sports-related concussion has been described by some experts as a “silent epidemic” because it often goes unrecognised.

It’s defined in the 2017 Berlin Consensus Statement on Concussion in Sport as a “traumatic brain injury induced by biomechanical forces”. It typically manifests in the rapid onset of short-term impairment of neurological function. Common symptoms include headaches, nausea, dizziness, confusion or feeling as if you’re in a fog.

A concussion may lead to neuropathological changes – at the level of the nervous system tissue. But it’s not a structural injury. It doesn’t change the brain in a way that can be seen with the naked eye or on traditional neuro-imaging screens. This is part of the reason that it’s not always diagnosed, and why there is still no universal tool to detect concussion. Clinicians have to rely largely on their experience and on the symptoms that injured athletes report.

The problem with self-reporting, though, is that athletes are often not too keen to be removed from the field, so they sometimes understate their symptoms. Younger athletes also struggle to properly verbalise what they feel and don’t necessarily understand the implications of the injury.

Researchers worldwide are working on solutions and methods that will help clinicians to diagnose concussion. One such method could be using eye-tracking. This is a technology for recording eye movements with a small externally mounted camera and then analysing, for example, how fast the eyes move or how accurately they can follow a certain target.

Research has already established that eye-tracking can be used successfully in diagnosing and classifying brain disorders such as schizophrenia or autism.

We believe that eye-tracking also shows promise in concussion assessment. According to research, up to 80% of concussed athletes show some eye movement dysfunction.

But do clinicians know this? We conducted a survey among sports medicine clinicians who deal with concussions to find out. A total of 171 clinicians from 32 countries shared whether they were aware that concussed athletes may have impaired eye movements, and whether they believed that eye-tracking technology has a potential to assist them in assessing concussion.

Clinicians’ feedback

Our survey revealed a few interesting facts.

On whether they knew that concussed athletes may have impaired eye movements, we found that the respondents on average saw eye movement impairments in only 30% of their concussion patients. That’s lower than what we expected.

The reason for this may be that, even though measuring the eye movements without the equipment is possible – for example, asking a patient to look side to side – it is not as accurate. On top of that, 20% of our respondents admitted that they were not checking for any eye movement deficits at all, which indicates they probably were not aware that concussion may lead to abnormal eye-tracking.

And then on the potential of eye-tracking technology to help them assess concussions, most clinicians did see benefits in using eye-tracking. These benefits include objectivity, ease of use (both for the clinician and the patient), replicability of the tests, and the fact that the results can be quantified.

But despite this, many seemed reluctant to implement this technology in their practice. Only 49% of the survey respondents explicitly said that utilising eye-tracking technology for concussion diagnostics was advisable.

There are several understandable reasons for this reluctance: they may not be familiar with this still rather novel technology at all; may lack access to the equipment; or may lack training.

Using technology

The survey happened against the backdrop of several recent developments in eye-tracking for concussion assessment.

First, there have been significant technological advancements in recent years. In 2018 two eye-tracking devices, RightEye and Oculogica’s EyeBOX, designed specifically for concussion assessment were approved by the US Food and Drug Administration. A third device, EYE-SYNC, is currently undergoing a clinical trial in the US.

The prices of the eye-tracking equipment have also dropped tremendously. For instance, EYE-SYNC cost US $6000 in 2018, but is expected to decline to between $1000 and 2000 this year. RightEye is targeting the cost of the tests at $10-$20 per patient.

It’s important to point out that eye-tracking technology isn’t perfect and certainly shouldn’t be the only approach to diagnosing concussion. These developments nevertheless suggest that eye-tracking technology has a valuable role to play in clinical settings.

The way forward

We believe that with ongoing education of clinicians on current developments in the field, and particularly with reference to continuing technological advances, eye-tracking technology could become more common in clinical settings.

Our results suggest that the level of exposure to novel diagnostic tools and clinicians’ acceptance possibly go hand in hand. That’s why we strongly recommend creating training opportunities for concussion evaluation, including the use of potential innovative technology. We also suggest facilitating close interaction between researchers and clinicians regarding the use of latest tools for concussion assessment such as eye-tracking.

All of this could lead to the technology being adopted at a higher rate. This in turn might enable the evaluation of currently somewhat neglected eye movement deficits caused by concussion – and ultimately more accurate evaluation of concussion resolution over days to weeks.

Dr Karen Welman, Stellenbosch University; Professor Wayne Derman, Stellenbosch University & International Olympic Committee (IOC) Research Centre and Professor Jon Patricios, University of the Witwatersrand, co-authored this article.The Conversation

Nadja Snegireva, PhD Researcher in Sport Sciences, Stellenbosch University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

[PODCAST] Interpreting Surface EMG

By Insights

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Andrew Vigotsky and Dr. Nick Rolnick back on to the show to discuss Andrew’s paper, Interpreting single amplitude in sports and rehab sciences.

In this episode, the team discuss

-What information can you conclude from a surface EMG study

-The limitations of surface EMG research

-What to look for in a surface EMG methods section

About Dr. Nicholas Rolnick:
Nick is a licensed physical therapist, the founder of the Human Performance Mechanic and the co-founder of Blood Flow Restriction Pros. He received his Doctor of Physical Therapy Degree with academic honors from Columbia University in New York City.

Through his work as a physical therapist his goal is to keep his patients in perfect balance, have the skills to recognize asymmetries and help patients enjoy the benefits of pain-free movement.

He teaches across the United States as a clinical instructor for SmartTools Plus and is an adjunct faculty member at Concordia University – Chicago where he teaches Kinesiology I and II in their MS Applied Exercise Science Program. He also speaks nationally and internationally on the use of blood flow restriction therapy for various diagnoses and populations.

About Andrew Vigotsky
Andrew is currently a PhD student in Biomedical Engineering at Northwestern University, where he studies neuromuscular biomechanics. He has published papers in areas ranging from rehabilitation to surface electromyography methodology and biomechanical modeling. His dissertation works aims to understand the neuromechanical implications of muscular heterogeneities.

[PODCAST] Martin Asker, MSc: Shoulder Injury in Overhead Athletes

By Insights

On this episode of the Healthy Wealthy and Smart Podcast, Dr Litzy welcomes Martin Asker on the show to discuss a handball injury case study.

Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm.

In this episode, they discuss:

-Teasing out subjective findings and when to refer for imaging

-How the acute:chronic workload ratio impacts young handball athletes risk for injury

-Essential and nonessential objective measurements that are relevant for return to sport

-The importance of strength and conditioning in end ranges of motion and return to throwing programming

The acute:chronic workload ratio is an important consideration for injury management as Martin stresses, “Being an on and off, on and off player, it won’t do anymore.”   Your clinical tests and measures need to be robust enough to translate to the sport setting because, “What we measure on the bench does not correlate to what happens when they are throwing.”   Framing your language surrounding a shoulder health maintenance program as being a performance enhancer will help improve compliance as Martin has found that, “They care, but they care more about the performance than injury prevention.”

Understanding the motivation behind why a youth athlete seeks care can help guide your patient education because, “They don’t see you when they are in pain, they see you when they can’t perform anymore.”

About Martin Asker:

Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm. The overall aim of his PhD project is to deepen the knowledge in shoulder function in elite adolescent handball players and the specific aim is to investigate risk factors for, and prevention of shoulder injuries in such population. He also has a special interest throwing biomechanics and its relationship to throwing performance and injuries. Martin is also a board member of the Medical Committee of the Swedish Handball Federation and part of the medical team of the Swedish youth-16 national handball team.



Range of Motion with Mike Israetel and Nick Tumminello

By Insights

While the science of biomechanics and Range of Motion (ROM) is important, how do we apply this in the health and fitness sector?

In this latest Revive Stronger vodcast, the team talks to Mike Israetel and Nick Tumminello about the subject of ROM.

Israetel is the head science consultant for Renaissance Periodization, where he has authored and co-authored a number for books. He has a PhD in Sports Physiology from East Tennessee State University, and on the sporting side has experience as a competitive powerlifter, grappler and bodybuilder.

Nick Tumminello is the 2016 NSCA Personal Trainer of the Year, and the Editor-in-chief of the NSCA Personal Training Quarterly journal. He’s the author of three books: Building Muscle and Performance, Strength Training for Fat Loss, and Your Workout PERFECTED. He’s been a trainer for over 20 years, is the former strength coach for team Ground Control MMA and has trained professional athletes in field, court, combat and physique sports

For ease of navigation, the below Timestamps apply:
01:29 Mike starts with explains his take on range of motion
02:51 Nick then starts talking about biomechanics and limitations in the context of range of motion
07:21 Mike responds to Nick’s points brings up common mistakes people make
11:49 Nick replies to Mike’s stance and talks about memorising and analysing concepts. Furthermore he continuous with talking about loading and specificity
16:41 Mike talks about range of motion and hypertrophy
22:54 Nick moves on with speaking about practical applications
30:20 Mike gets back with talking about his practical applications
35:25 Nick then shares his thoughts on partials, individuality and specificity
39:45 Mike adds his comments on partial range of motion
44:28 Nick ends with training different parts of a movement
47:45 Steve gives a short summary



Don’t forget that you can use our 3D Joint ROM tool to accurately measure Range of Motion (ROM) in your practice.

[TREND WATCH] This Next-Generation Exosuit Provides Enhanced Mobility Options

By Insights

We love the innovation that is taking place in the world of movement and biomechanics and we are constantly scouring the globe for innovative new technology to guide our thinking.

Check this out:

Researchers from the Wyss Institute of Harvard University have developed a wearable robot that functions to support the wearer in scenarios in which movement capabilities are severely impacted. A sophisticated system of cables, a garment, motors, and cables come together to offer a fully integrated experience. Stefano de Rossi, a postdoctoral fellow in the Wyss Institute, said of the thinking behind the invention, “When people think about traditional robotic systems, they don’t think about something that can be worn by a person. When developing this soft exosuit, we start with the analysis of human biomechanics.”

PodChatLive: Episode 45; The Physiotherapy Episode

By Insights

The PodChat Live team put together some fantastic content around the world of podiatry and biomechanics.

In this episode, Craig Payne and Ian Griffiths welcome a panel of highly-respected physiotherapists to talk about the inter-disciplinary relationship.

The panel comprises Hamish Vickerman, Tom Goom, Neil Meigh and Kevin Nordanger to talk about how Podiatry and Physiotherapy can/should work together, the overlap between professions, the preconceived notions we have about each others professions and more.

Don’t forget to check out the 3D Joint ROM tool to accurately measure Range of Motion on any joint.