Thursday, August 25, 2022

HEALTH TECH REPORT: BRAIN HEALTH (PART 1)

INNOVATORS SPOTLIGHT: Concussion Monitoring Headband

July 19, 2022- IPHA NEWS conducted a private interview with the co-developers of NEUROVINE® - a portable headband using EEG (electroencephalogram) technology designed to measure brain waves.  Meet CEO Ashleigh Kennedy, Ph.D., and CMO Matthew Kennedy, MD, MSc (co-founders of Neurovine Inc.) from Ottawa, Ontario, CA. who share their objectives in support of concussion monitoring by measuring brain health as part of optimizing their recovery process. Neurovine is marketed to offer "interactive monitoring program for athletes, students, professionals and anyone undergoing mentally strenuous work by alerting them to take brain breaks before an activity becomes too strenuous”.

IMPROVING CARE OF CONCUSSION VICTIMS   By: Dr. Matthew Kennedy

Seeing a lot of patients come through my family practice in Ottawa, I see numerous patients with disjointed care with concussion, either not having access to missing pieces or just a disjointed lack of communication between practitioners. And then probably the biggest thing that stood out was the cognitive pacing component. We use our brains all the time. You can be in the cognitive rest part of your concussion recovery, and trying to not overdo it. You can even be sitting in a dark room and your mind can be going‐‐ thinking about your taxes or other stressors.  It's really hard to turn the mind off because it's where we live our life and where we experience the world. And so I would see time and time again, patients going back to work, even with half days or we'd have time regulated limitations on how much they'd be able to work and then they would overdo it and have setbacks and they'd be back three weeks, four weeks in the recovery.

We have developed a comfortable, portable EEG guided cognitive pacing tool which monitors how hard the brain is working in real time and gives alerts to patients before they overexert themselves. This allows for data driven cognitive pacing which can be used at home, in the office, or in the classroom. We also have the heart monitor as well as heart rate variability. So that helps to guide subthreshold exercise, which has been shown to speed recovery, as well as giving metrics on concussion status with the heart rate variability. And then on top of that, we have accelerometer, gyroscope, magnetometer --sensors in the head band that allow for measuring head movement. The amazing thing about that is it gives biofeedback for balance retraining, vestibular retraining, as well as even some ocular motor and eye tracking exercises- making for a fairly thorough package of information.


ORIGINS AND CONCEPT EVOLUTION    By: Dr. Ashleigh Kennedy 

My father had played professional football in Canada and he had a lot of friends that were really experiencing some cognitive decline. I also lost a friend to suicide when I was quite young- and that really is what got me interested in how the brain recovers after an injury. This all inspired my studies and has been my mission in life to learn more about how the brain works and how it recovers. I was a postdoctoral fellow at the Toronto Rehab Institute and I found them to be amazing at putting technology in patient's hands and sending them home with it. This idea offered continuous and more intense care as an inpatient- allowing patients to thrive both mentally, as well as physically through the recovery, because they were part of the process. 

I made my first EEG headband during my undergrad at Stanford.  That model was designed for kids with cerebral palsy- to help their understanding of how they're moving through space and also what's going on cognitively. Matt and I actually met in our master's program during a research project to explore and build this type of technology. 15 years later, Matt and I started talking about how we can do this for patients who have sustained a brain injury. The intention of Neurovine was to create a kind of small technology that could support them in the recovery journey. Over the past three years, that's evolved into more of a platform solution where patients take our technology home, and our data analytics really supports them right from the time of their concussion until they've returned back to work or school or sport. 

We're actually launching as a wellness technology in September… we are working with sports teams, delivering the technology to them on a yearly license. We are exploring the opportunity to work with military organizations and employers. We also aim to target post-concussion cases both in the US and Canada, where employees are not getting care for these concussions (and it's keeping them out of work for months- longer than it really should). If they had the proper care after the injury, that's our starting point and that's how we are entering the market. 


*This spotlight segment is part of IPHA MedTech News' innovators feature series.



CONCUSSION 101: "The Phantom Menace"
By: Joshua Schueller, PT

In the spirit of public awareness and technical education, the clinical team at IPHA (The Integrative Pain Healers Alliance) recognizes the need to bring resources and information about the latest innovations in diagnostic and therapeutic solutions to the general public.  In addition, IPHA’s support of this public awareness offers the same awareness to the patient-care community with the hopes of adding new options to their expanding possibilities in search of bringing wellness to their patients.  

Whether a vicious hit during a football game or an elderly man falling while getting out of the shower, concussions can occur at any time any place to anyone.  Concussions do not discriminate based on age, activity, or location. Nearly a quarter of the population has suffered a concussion. A traumatic brain injury sustained to the head is a concussion.  This number is probably higher due to unreported concussions. [5] Symptoms of concussion can range from mild to severe. 


THREE CLASSIFICATIONS OF CONCUSSION:
Grade 1 Mild - headache, difficulty focusing, memory loss, dizziness, and nausea. No loss of consciousness
Grade 2 Moderate - similar symptoms as Grade 1 but loss of consciousness up to 5 minutes
Grade 3 Severe - risk of permanent brain damage and loss of consciousness more than 5 minutes. Symptoms include speech difficulty, amnesia vomiting [6]

Currently, concussions are diagnosed by symptoms and mechanism of injury. In severe cases a CT or MRI is used. [7]  The difficulty in concussions is that there is not a universally accepted diagnosis test to determine a concussion or its severity.  Also adding to the challenge with concussions is treatment protocols are symptom reliant. Current treatments include rest, abstain from physical activities, and medications for headaches.  [8].  The complexity of the brain has made diagnosing concussions accurately difficult.  If someone returns too quickly, before the brain is fully healed another more serious concussion can occur.  Repeated concussion especially in short time frames can lead to permanent severe brain damage. 

Chronic traumatic encephalopathy (CTE) is brain degeneration caused by repeated head trauma (concussions).  There currently is no treatment and can only be diagnosed through an autopsy.  CTE has been found in athletes such as football players and boxers, but also in military personnel who have been exposed to repeated explosive blast.  Experts do not have a clear understanding of concussions and CTE.  [9]


People who suffer from head trauma can display cognitive, behavioral (impulsiveness and aggression), mood disorders (depression, apathy, suicide) and motor symptoms (motor neuron disease and Parkinson’s). (5).

Due to the complexity with dealing with brain injury, diagnosis and treatment have fallen significantly behind.  Concussions often go unreported or misdiagnosed as “getting your bell rung”.  Many sufferers will hide their symptoms and keep going on with normal activities despite suffering from symptoms.  Until an accurate test or device is available to accurate classify a concussion and a universally accepted treatment, concussion will continue to grow, and the side effects will be debilitating for the suffers.




2022 TRENDING INTEREST IN BRAIN HEALTH
By: David Dachinger

Within the recent decade, a higher level of focus on brain health has been a trending topic in headlines throughout medical community news.  Public concerns about Alzheimer’s, Dementia, MS, ALS and other neurodegenerative diseases has driven advanced research in their diagnostics, therapeutics and prevention. According to Dr. Jay Lombard, “One of the most exciting opportunities in neuroscience research today is the use of strategies that protect the brain which may potentially prevent, delay or inhibit the progression of neurodegenerative diseases… this opportunity rests on our ability for early diagnosis. Research has shown that the likelihood of success for a given treatment-whether lifestyle changes or pharmacological approaches- is highly dependent upon early intervention, before the disease process has become too severe and potentially irreversible.” [1]

In addition, growing reports on Chronic Traumatic Encephalopathy/CTE (identified from head concussions) has prompted significant attention to this progressive brain condition.  According to the National Health Service (UK), this disorder “is thought to be caused by repeated blows to the head and repeated episodes of concussion. It's particularly associated with contact sports, such as boxing or American football. Most of the available studies are based on ex-athletes”. [2]

More concerns of brain function and performance is widely seen in the current pandemic and post-covid infection sequelae cases, where over 50 prevailing symptoms and disorders (known as LONG HAUL) are now under global review. Clinical researchers state post-acute COVID—affects a multitude of organ systems- including neuropsychiatric issues like BRAIN FOG, a form of cognitive impairment. This may be linked to a wide range of pathologies such as anxiety and depression, post-traumatic stress disorder (PTSD) and recurring headaches and migraines. [3] In a recent meta-analysis study on long term effects of covid-19, Dr. Sonia Villapol (Assistant Professor of Neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute & Asst. Professor at Weill Cornell Medicine) recorded significant long haul cases pertaining to brain health and functions including 44% headaches, 27% attention disorders, 13% anxiety, 12% depression. [4]





JOSH T. SCHUELLER is a licensed Physical Therapist who dedicated his life's work to supporting and treating chronic pain and disorders with non-invasive, safe and effective treatment solutions. He is the current VP of Clinical Operations and Business Development at AxioBionics LLC. and is formerly the Clinical Director for Orthopedic Physical Therapy Clinics (Rockford, MI).  As an active member of APTA, he holds advanced certification in Physical Therapy treatment techniques including the McKenzie method of patient empowerment.  He has over 20+ years experience in the treatment of neurological conditions such as Spinal Cord Injury, Traumatic Brain Injury, CVA, Cerebral Palsy etc.  In 2021, Josh is elected a clinical advisory role and educational advocacy for IPHA (Integrated Pain Healers Alliance) and has published research articles in pain management for the MedTech Reviews program of therapeutic devices.   Today, Josh continues to support patient suffering from disabilities and has expanded his focus to contribute his expertise in treatment programs for Veterans and first responders. 


Lt. DAVID DACHINGER (Ret) - Northeast F.A.C.E.S. Ambassador /Cancer Advocate
David Dachinger is a retired Fire Lieutenant with over 21 years as a leader in emergency services. He is also a Stage IV cancer survivor. He wrote cancer prevention policies for the Ridgefield CT Fire Department, and introduced physical fitness wellness initiatives. David hosts the video podcast “Responder Resilience”, which is dedicated to improving the mental and physical well-being of police, fire, EMS, and dispatch personnel. In addition to being a Grammy®-nominated engineer, David combined his expertise in multimedia, crisis leadership and major medical challenges to produce calming programs (alongside his wife Tamara) that enhance the lives of first responders & cancer patients though a state of the art APP called "Loving Meditations Mindfulness".

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GENETIC RESEARCH & CONCUSSION RECOVERY  By: Roberta Kline, MD
Studies in professional athletes have shown that about 80–90% are sufficiently recovered to return to playing within 7–10 days. But that means that 10-20% are not, and their recovery can take up to 3 times longer. Even taking into account variations in initial injury, this variation is difficult to explain or predict.  DNA is the genetic code that is the blueprint for everything that goes on in our bodies. Genomics is the study of how small changes in our DNA affect how our bodies function. [link to genomics article] Research, primarily focused on combat veterans and athletes so far, has shown that these small variations in our DNA may account for at least some of why some people respond to and recover from traumatic brain injury better than others. While the APOE gene is the most widely studied, there are now over a dozen others that have been identified. Because there are hundreds of genes impacting all of these biological systems, it is likely that there are many to still be evaluated, and outcomes are the result of the interaction of multiple genes. (more)



REFERENCES

1) Research Review: Neurodegenerative Diseases and the Vascular System/ Health Resource Digest:  https://healthresourcedigest.blogspot.com/2022/06/neurodegenerative-diseases-and-vascular.html
2) Chronic traumatic encephalopathy: https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/#:~:text=Chronic%20traumatic%20encephalopathy%20(CTE)%20is,are%20based%20on%20ex%2Dathletes.
3) COVID long-haulers: Questions patients have about symptoms | AMA:  https://www.ama-assn.org/delivering-care/public-health/covid-long-haulers-questions-patients-have-about-symptoms
4) https://cancerresourcealliance.blogspot.com/2021/06/long-haul-syndrome-post-covid-dilemma.html
5) https://www.npr.org/sections/health-shots/2016/05/31/479750268/poll-nearly-1-in-4-americans-report-having-had-a-concussion
6) https://www.carrushealth.com/2020/02/07/signs-and-symptoms-of-the-3-different-grades-of-concussion/
7) https://www.hopkinsmedicine.org/health/conditions-and-diseases/concussion
8) https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
9) https://concussionfoundation.org/CTE-resources/what-is-CTE


Disclaimer: HealthTech Reporter / Med-Tech Reviews* is a non-commercial user review of health-related technologies and is not intended as a marketing program for any device(s) featured in this video for evaluation. This presentation is for informational use only does not offer any direct medical claims whatsoever. Statements from all speakers herein are expressing their own unscripted views that do not reflect those of our producers.  Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment.


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