Baylor University Researcher Shares Development of Concussion-Detecting Sideline Screener on National Concussion Awareness Day®

Quick, what is today’s date? It is Sept. 15, 2023. Today marks the seventh annual National Concussion Awareness Day®, which is recognized by the United States Congress and helps stir public dialog of the issue.

Chances are, many of you reading this may have experienced a concussion at some point in your life. According to a 2023 study, the Center for Disease Control (CDC) estimates between 1.4 to 3.8 million concussions happen per year. The wide range in numbers is because many people do not seek medical care while experiencing symptoms.

A concussion, which is a mild traumatic brain injury (TBI), is most often caused by a bump or blow directly to the head. It can also be triggered by a hit to a person’s body that is strong enough to cause their head to jolt back and forth. This rapid movement can cause the brain to bounce around in a person’s skull, bruise and stretch nerves and blood vessels, and initiate chemical changes in the brain. Research shows that multiple concussions over a lifetime may result in structural changes in a person’s brain. Because of this, the “invisible injury” is receiving growing attention.

“Concussions, whether caused by sports-related injuries or not, are often underestimated due to the subtlety of their symptoms,” Jungjun Park, PhD, CCC-SLP, Associate Professor for the Department of Communication Sciences and Disorders, said. “Especially in young athletes with robust neural plasticity and spontaneous recovery abilities, impairments in brain function may not be immediately apparent. However, when injuries are repeated or individuals fail to adhere to the everyday protocols provided after the initial diagnosis, unnecessary cognitive impairments can occur.”

The Robbins College of Health and Human Sciences researcher is collaborating with researchers from other universities to develop a highly accurate concussion-detecting test. Their “sideline screener” will help to improve accessibility, is designed to be intuitive, and will quickly provide on-site test results.

The sideline screener is a modified version of the Rapid Naming Test (RAN), which is commonly used in research on child language disorders and dyslexia. RAN assesses how quickly and accurately a person can access the familiar words stored in their brain when seeing an image of an item, for example, a specific piece of fruit.

“We have adapted the typical procedure for this test to be slightly more complex than the commonly known method,” Park said. “This allows us to simultaneously assess various cognitive functions commonly observed in concussion patients, including visuospatial processing, saccade controlling, task switching, and sustained attention. Performing this test requires high-level attention and mental flexibility. We hypothesize that individuals with cognitive deficits will struggle to achieve normal scores on this assessment.”

If an athlete experiences an impact to their head, they will be removed from the game and testing begins immediately on the sideline. To gain optimal test results, testing should be performed inside a small testing booth equipped with soundproofing. If test results provide an accuracy score that is lower than the designated cutoff score, it’s an indication the athlete may have a concussion. Depending on the suggested level of cognitive impairment, an in-depth assessment by a doctor may be useful.

“This assessment tool can be administered by coaches or trainers without the need for assistance from other professionals, given that they are familiar with very simple instructions,” Park said. “Additionally, the testing process takes only about 3-5 minutes, which is a big advantage in the field.”

Currently, the sideline screener is being tested in combination with neuromonitoring systems, such as functional near-infrared spectroscopy (fNIRS) and an eye-tracking system. The testing combinations will help the research team understand the screener’s sensitivity and accuracy in detecting changes in the brain.

“At the current stage of data collection, we are taking an approach to this screener that involves monitoring the desk-dependent changes in the cognitive attention of all participants,” Park said. “To achieve this, we utilize an fNIRS technology, which measures changes in oxygenated hemoglobin influx to the prefrontal cortex. This allows us to gauge the operational state of the brain's attentional system resulting from the administration of the screening tool. According to the current preliminary data, it appears that our screening tool dynamically alters hemodynamics in the prefrontal cortex during real-time execution with high accuracy.”

The screening tool development is a key project in Park’s lab, Baylor Adult Neurogenic Disorders and Aging (BANDA), which is affiliated with Robbins College’s Department of Communication Sciences and Disorders. BANDA’s overall research focuses on neurocognitive changes resulting from language and cognitive impairments associated with normal aging and various brain disorders, including Parkinson’s disease, concussion, TBI, dementia, and stroke.

Currently, the lab’s primary focus is compiling normative control data, following the standard approach in psychometric health science research.

“We are in the process of building a database for our Competitive Rapid Naming Test (C-RAN), using data from young adults aged 18 to 29, who have no history of concussions,” Park said. “In the latter part of this fall semester, we intend to commence the second phase, which involves assessing the validity of our screening tool in collaboration with researchers from other universities, particularly focusing on college athletes.”

Next, the lab’s efforts will shift toward adapting the sideline screener from the existing desktop version into one that is tablet friendly.

“We will gather data from college athletes and individuals diagnosed with concussions to investigate the construct validity of our screener,” Park said. “Beginning in the fall semester of 2024, our plan includes widespread distribution of the screening tool, through partnerships with local sports programs and hospitals.”

It’s important to know that while symptoms are often quick to appear, sometimes they may take hours or days to present themselves, and they may even change throughout the recovery process. Common symptoms are blurry vision, dizziness, headache, heightened emotions, memory problems, and trouble sleeping. More dangerous, are symptoms like enlarged or unequal pupils, extreme sleepiness, lingering or worsening headaches, loss of consciousness, and numbness. At least 48 hours of complete physical and mental rest is necessary to allow the brain to begin recovery – for example, no exercising, video games or texting – and most symptoms resolve with 21 days.

“Concussion symptoms can vary significantly from one person to another, and it's crucial to be vigilant about recognizing a broad range of potential signs and symptoms, as they may not always be immediately obvious,” Park said. “Regardless of the circumstances, any injury or incident that impacts the brain should prompt an immediate consultation with a medical professional for proper evaluation and diagnosis.”