Wearable sensing and mobile devices: the future of post-concussion monitoring?

Abstract

In the past decade, concussion has received large amounts of attention in public, medical and research circles. While our understanding of the nature and management of concussion has greatly improved, there are still major limitations which need to be addressed surrounding the identification of the injury, determining when an individual is safe to return to normal activity, and what factors may contribute to the development of post-concussion syndrome (PCS). The current model of concussion management involves a triage evaluation in the acute stage of injury, focusing on the classic signs and symptoms of concussion. Next, the clinician attempts to evaluate key components of cerebral function through clinical symptom evaluation, and traditional assessments of motor and neurocognitive function [1]. The development of the sports concussion assessment tool saw a massive leap forward in the strategies employed in the management of concussion, as it acknowledged the multifactorial nature of concussion, and provided a standardized means for clinicians to assess the many domains of cerebral function [2]. While these methods have demonstrated some promise in the acute stage, they are not designed for serial monitoring (particularly in instances where PCS develops) [3], and provide us with very little clinically relevant information that can assist clinicians in the return to learn/sport/performance process. The traditional model of concussion assessment coincides with a graduated return-to-play protocol. This protocol is simply dictated by the length of time since the injury, and symptom resolution with physiological exertion [4]; it does not reflect the athlete’s true readiness to return to sport, as determined by a multi-modal objective assessment of the variety of impairments that manifest following concussion or during PCS. Indeed, this methodology is fraught with a number of key limitations: these assessments represent the individual’s status at discrete points in time, are focused on quantifying parameters that are subject to a level of hourly and daily variability independent of the concussive injury, and do not acknowledge the heterogeneous and evolving nature of the injury. In addition, while we know that concussion affects short-term physical (such as balance and gait) and cognitive (such as memory and concentration) competencies, the evolving nature of PCS for these competencies is not well understood. There is a dearth of evidence quantifying exactly how an injury such as concussion, with widespread symptomatology, disturbs an individual’s capacity for physical activity. Improving the evidence base in these areas is vital considering recent evidence which has suggested that concussion has long term effects on physical competencies, with increased musculoskeletal injury rates being observed for 3/12 months’ post injury [5–7]. Furthermore, concern has been raised as to the long term effects of repeated concussions on cognitive Wearable sensing and mobile devices: the future of post-concussion monitoring?