Concussion analysis focuses on eye test

PITTSBURGH – In studies relevant to the gridiron and other kinds of battlefields, researchers hope to use a new test based on eye movements to bring increased accuracy to the diagnosis of concussions.

The research, by Allegheny Health Network and corporate partner Neuro Kinetics Inc., involves the use of high-speed digital photography and other technology to analyze a patient’s tracking of dots of light or other visual stimuli, which are projected against a light or dark background.

In an initial study of high school football players, those with concussions had more difficulty tracking the images than a control group without brain injury. Results of the study will be among the promising developments in orthopedic medicine to be highlighted this month on the website of the American Academy of Orthopaedic Surgeons.

With the Allegheny Health Network’s involvement, O’Hara-based Neuro Kinetics now is exploring a potential military application with trials at Naval Medical Center San Diego and Madigan Army Medical Center in Tacoma.

Mounting concern about the long-term effects of concussions has spawned a flurry of new studies – including other research at Allegheny Health and at the University of Pittsburgh and its medical center – on how to better detect and manage concussions.

There is no single “confirmatory diagnostic test for concussion,” said Dr. Jeff Kutcher, director of Michigan Neuro-Sport at the University of Michigan, who helped to write the American Academy of Neurology’s sports concussion guideline.

Unlike broken bones, which show up on X-rays, or other conditions that can be detected through imaging, concussions are not readily observable. While doctors, athletic trainers and professionals have balance and cognition tests to guide them, diagnosis of concussions still relies partly on the self-reporting of athletes who may just want to return to the game.

To some degree, “you are relying on patients telling you how they feel,” said Sam Akhavan, a sports medicine specialist at Allegheny General Hospital who’s involved in the research of the Neuro Kinetics technology, called I-Portal.

J. Howison Schroeder, Neuro Kinetics president and CEO, said he hopes I-Portal will be more clinically precise than methods now used to detect concussions, including the well-established King-Devick Test, a 2-minute eye-movement test that measures the speed and accuracy with which a person reads a sequence of numbers. Eye-movement tests, including King-Devick, also are used to assess people for multiple sclerosis, Parkinson’s disease, dyslexia and other disorders.

Concussions are a major concern for the military, whose soldiers can sustain the injury in combat, and for sports at the scholastic, college and professional levels. The National Football League faces a lawsuit from more than 4,000 former players who claim they weren’t properly warned about, or treated for, concussions. A judge last year rejected a proposed $765 million settlement, saying she didn’t believe the sum was sufficient.

In the I-Portal trial, researchers administered the eye-tracking test to 292 high school football players with no record of brain injury. Ten of those players later sustained concussions that were diagnosed by the standard methods. When they were given the eye-tracking test again, the 10 performed at a significantly lower level than they or their peers had before.

“They fell well outside what the normal fit was,” Dr. Akhavan said.

Kutcher and Steven Broglio, director of the University of Michigan’s NeuroSport Research Laboratory and lead author of the National Athletic Trainers’ Association policy on concussions, said I-Portal is less likely to be the magic bullet for diagnosing concussions than another tool health professionals will have available to them. To increase the accuracy of concussion detection, he said, some professionals use multiple tests on a patient.

The companies owning the King-Devick Test and Pittsburgh-based ImPACT – which measures attention span, memory, reaction time and problem-solving ability – do joint marketing. Both products have a list of studies backing up their reliability, but neither considers itself a stand-alone diagnostic test. James S. Gyurke, chief marketing and sales officer for ImPACT, said his team is among those searching for improved measures of concussion detection.

Besides the I-Portal research, Allegheny Health Network is helping to evaluate a test, developed by a Cleveland Clinic Innovations spinoff, that incorporates a patient’s vision, balance and motor function into concussion detection.

Awarded one of 16 NFL-General Electric grants in January, UPMC is working on the development of a new imaging technique that would show concussion damage. Other grant recipients are working on other imaging techniques and blood tests.