Authors: Ryan D'Arcy (Simon Fraser University, Burnaby, Canada)
Take a look behind the scenes of a recent study published in Brain, entitled ‘Brain vital signs detect concussion-related neurophysiological impairments in ice hockey’, as we ask co-author Dr Ryan D’Arcy about the main challenges surrounding objective evaluations of concussion, including how extracting brain vital signs could help to overcome them.
What inspired you to write this report?
We have been working on ways to extract more clinically valuable data from electroencephalography for 25 years. With the rising urgent need for an objective, physiological measure that is deployable at point-of-care, this effort crystalized into the concept of developing a brain vital sign framework a few years back. We have amazing collaborators, including the Mayo Clinic (MN, USA), so validation work in sports concussion was a natural step. This has developed into a long-standing collaborative program that is growing and expanding very quickly.
What challenges are there surrounding objective evaluations of concussion, and how does extracting ‘brain vital signs’ using EEG help to overcome them?
The major challenge relates to the fact that current assessments for brain function are indirect, subjective and consequently error prone. Objective options, such as diagnostic imaging, are simply not accessible, practical and easy-to-use at the front lines quickly. This was the driving motivation behind developing a brain vital sign framework. The science behind EEG is well established; what was needed, quite literally, was to reverse engineer the appropriate technology solution using prior vital signs like blood pressure for heart health. Timing has been fortunate too, as portable EEG devices, signal processing and artificial intelligence advances have made a huge impact in terms of translating the complex EEG signals into simple vital sign information.
How has the field progressed since the publication of your review?
There was an interesting published commentary that followed, in which the authors were surprised by some of our reported results showing increased rather than decreased neural response amplitudes following concussion. We were excited to receive this perspective because it further highlighted the current blind spot around what actually happens to brain function in the immediate minutes following concussion. Prior to this study, no such insights were possible – and really, not even considered – in terms of the complex cascade of physiological events that transpire in the minutes, hours, days, weeks and months following concussion. We were really pleased to see the impacts of the study begin so quickly.
In your opinion, what more needs to be done in this area of research? What work will you focus on?
With the brain vital sign framework beginning to become established, the next step is to ensure that others adopt this approach globally. Widespread uptake is critical in order to spread the potential impacts across the diverse field of neuroscience. If we continue our comparison to blood pressure and heart health, the importance of vitals signs is underscored in terms of evaluating effective treatments, identifying risk factors and effectively managing our brain health. This is our go-forward vision.
Where do you hope the field will be in 5–10 years’ time?
There’s a gap between what is available at the clinical frontline today and what is possible in terms of advanced neuroimaging of brain function. You can’t treat what you can’t measure. Thus, accessible functional imaging is essential to identify new disruptive treatment options. In 5–10 years, we hope that the concept and application of brain vital signs will be an important link that bridges that gap. Whether concussion, dementia, stroke, neurodegenerative diseases, mental health and the many other brain conditions, the plan is to demonstrate the vital role that a simple, objective and accessible measurement system can play in brain health.
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