MEDTRAK DIAGNOSTICS

TRAUMATIC BRAIN INJURY (TBI)

OBJECTIVE TESTING & REPORTING

MEDTRAK DIAGNOSTICS

TECHNOLOGY CATCHES UP TO

OBJECTIVELY ASSESSING CONCUSSIONS

MEDTRAK DIAGNOSTICS

VNG – BALANCE - NEUROCOGNITIVE

A WINDOW TO THE BRAIN

MEDTRAK DIAGNOSTICS

TBI – CONCUSSIONS

THE SILENT EPIDEMIC

TRAUMATIC BRAIN INJURY (TBI) – THE SILENT EPIDEMIC

DOWNLOAD Case Manager Brain Injury Check List

For decades concussions were erroneously described as a transient loss of consciousness without radiologic confirmation of structural injury or long-term deficits. However, clinicians have known that patients with head injury (even without loss of consciousness) can endure long-term symptoms even when imaging studies like CT / MRI are normal. These studies are good for identifying fractures and vascular injuries, but do not assess brain function. Hence, medical providers rely on clinical evaluation to determine if a worker with an industrial accident, a victim of a car crash / assault or a football player after a rough tackle have permanent injury to their neural system. Of course, these evaluations can be highly subjective, resulting in a need for an unbiased test.

A new frontier has arrived. Testing is now available, via MedTrak Diagnostics, for objectively assessing a TBI. The “battery of tests” is performed on some of the brain’s most heavily used pathways and the objective results assist clinicians with determining performance impairment and diagnosing injury.  The objective testing paradigm is non-invasive and non-pharmaceutical and consists of the following evaluations:

  • Videonystagmography (VNG): Vestibular testing
  • Posturography – FallTrak II: Balance and coordination testing
  • BrainCheck: Neurocognitive testing

Together, these tests allow clinicians to measure critical areas of central (brain) and peripheral vestibular function to provide an objective diagnosis of the cause of some of the post-traumatic symptoms of TBI such as dizziness, vertigo, fatigue, problems with balance, coordination and unsteadiness, blurred vision, memory problems, anxiety, depression and personality changes. This allows proper diagnosis and the development of a core plan for patient improvement and ongoing compensatory recovery.

Testing is performed at MedTrak Diagnostics testing centers nationwide.

TESTING – HOW IT WORKS

MEDTRAKVNG

VNG

Goggles with an infrared light and camera measure nystagmus and other eye movement during different types of stimulation (visual, positional and caloric). From the pattern of eye movements, measured in rotational velocity (micro-rotations), practitioners can make an objective diagnosis of central (brain) or peripheral (inner ear) injury / pathology..
FALLTRAK

Posturography

A physical performance test measured by electronic sensors and a force monitoring balance plate system provides the clinician with an objective assessment of the patient’s balance disorder by analyzing the three systems of balance and equilibrium (visual, vestibular and somatosensory) as well as measuring the patient’s ability to move around their center of gravity. The patient’s responses are measured and compared to age-matched normative data and the clinician receives an objective balance assessment differentiating between visual, vestibular and somatosensory pathology as well as simple movement dysfunctions.
BRAINCHECK

Neurocognitive Testing

BrainCheck performs neurocog-nitive testing using small tasks to directly and objectively measure cognitive functions such as reaction time, attention, visual processing and memory. Using these quantita-tive measurements, researchers and clinicians gain powerful insight into how the brain has been damaged. 

Yang, S., et al., 2017, Diagnostic accuracy of tablet based software for the detection of concussion. PLOS One 12(7).

Bridgett Wallace, et al., 2016, Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. Eye and Brain, 8:153-164.

WHAT YOU NEED TO KNOW ABOUT TBI

Physics, Forces & Pathophysiology of TBI

The pathology of concussion can be demonstrated as an impairment to neural function. Dynamic forces of acceleration or deceleration and rotation are understood to be causes of concussion and diffuse axonal injury. The inertia of the head with an acute deceleration to the brain parenchyma results in this type of injury. The brain sustains an intracranial collision causing a disruption of cranial neural pathways. This is commonly seen in a whiplash situation when the head does not collide with any object.

Radiologic Studies used in TBI?

A concussion is a metabolic brain injury which can be present without detectable structural brain injury. A patient who has suffered a TBI may have a normal  CT scan / MRI or specialized imaging, especially when the diffuse axonal injury is microscopic. 

Neuropsychology

Neuropsychological testing for TBI has historically consisted of a battery of tests known as the MMPI-2 performed over a couple of hours by a psychologist. This testing is primarily used to evaluate personality traits and psychopathology. Braincheck, Inc. is an effective, purely objective, computerized test developed by Texas Medical Center which takes about 10 minutes to assess the presence of cognitive impairment. 

Alexander MP, 1995, Mild traumatic brain injury: Pathophysiology, natural history, and clinical management. Neurology 45:1253-1260.

Glascow Coma Scale (GSC)

Standardized Assessment of Concussion (SAC)

GCS & SAC were developed and used by medical personnel directly after a traumatic event to evaluate the degree of brain injury. Patients with normal GCS or SAC scores can still have a TBI.

Clinical Presentation

The post-concussion patient presents with a multi-symptom syndrome which can include specific vestibular changes, cognitive changes and/or psychological changes which can manifest as complaints of vertigo, dizziness and balance disturbances, diminished concentration, attention span and memory abilities, fatigue, sleep disorders, anxiety, depression and mood swings.

Peripheral Vestibular Injury

The peripheral vestibular or “balance organ” in the inner ear senses information about head position, motion, and acceleration. It can be damaged by direct or rapid linear or rotational acceleration-deceleration forces. The vestibular nerve (carrying such information to the brain) can be damaged by similar processes and also shearing forces. Inaccurate or zero information then reaches the brain, resulting in loss of balance and coordination and can also result in dizziness and vertigo.

Central Vestibular Injury

Similar forces can damage widespread areas in the upper brain and brainstem, interfering in the flow of information, leading to a variety of symptoms including loss of balance and equilibrium and vertigo.

Benign Paroxysmal Positional Vertigo (BPPV)

There are crystals in the semicircular canals of the inner ear which sense motion and position of the head in 3-dimension. Trauma can displace them and change the way the motion stimulates the nerve fibers resulting in a debilitating illusionary sensation of spinning or vertigo.

O’Neil, B., et al., 2014, CT positive brain injury in mild TBI patient presenting with normal SAC scores. Mil Med; 179: 1250-1253. Curley, K., et al., Intracranial pathology (CT+) in emergency department patients with high GCS and high SAC scores. J. Head Trauma Rehabil. 2018. Vol. 33. No 3 p E61-66.

Q & A

QUESTIONS AND ANSWERS

Who may need MedTrak Diagnostics testing?

A person who presents after a traumatic even and may have sustained a TBI/concussion based on the biomechanics of the injury and their complaints. The symptoms typically start with the patient “not feeling right” or “not themselves.” This manifests into a myriad of symptoms which vary greatly, but some of the most common are:

✜ Cognitive - Confusion, decreased attention span, and concentration, memory problems and difficulty reading, problem solving deficits, and inability to perform multiple commands

✜ Motor - Weakness, poor balance, fear of falling, difficulty changing position, unsteadiness, and poor coordination

✜ Perceptual / Sensory - Loss of sensation as well as changes in hearing, vision, taste and smell, sensitivity to light and sound, ringing in ears and blurred vision

✜ Communication - Difficulty with speaking or understanding and vocabulary

✜ Functional Deficit - Problems with normal activities of daily living like dressing, bathing and organization

✜ Social Difficulties - Difficulties with interpersonal relationships

✜ Vertigo - Dizziness, headaches, change in sleep patterns, nausea and fatigue

✜ Personality / Psychiatric - Apathy, anxiety / depression, mood swings, frustration and restlessness

✜ Diminished Quality of Life - Decreased life satisfaction and diminished perception of their position in life

✜ Diminished Work Abilities - Inability to work at the same level as they did prior to the injury

Who analyzes the data and writes the assessment and plan?

The test results are assessed by a board certified Medical Doctor, typically a neurologist or physiatrist who specializes in traumatic brain injury. The plans for rehabilitation are constructed by a rehabilitation expert.

Is vestibular injury a brain injury?

Yes. Any damage to the peripheral or central vestibular nervous systems is considered a traumatic balance injury. The brain is the coordinator and correlator of balance and coordination and, therefore, any traumatic balance injury is a traumatic brain injury.

How is a traumatic brain injury treated?

Depending on the severity of the brain injury, the patient may need treatments as intense as in-patient rehabilitation with daily treatments including occupational and physical therapy. TBI with a vestibular component is treated with specific vestibular, balance and neurocognitive therapy as needed. 

Abstracts

Alhilali, M., et al., 2014, Detection of central white matter injury underlying vestibulopathy after mild traumatic brain injury. Radiology, 272:224-232.

Akin, F., et al., 2017, Guideline for concussion / mild TBI and persistent symptoms. Brain Injury, 31:9,1188-1194.

Chandrasekhar, S., 2013, The assessment of balance and dizziness in the TBI patient, Neurorehabilitation, 32:445-454.

Lei-Rivera, L., et al., 2013, Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury, NeuroRehabilitation, 32:463-472.

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