Concussion, in particular, sport concussion, has become very topical in terms of public awareness over the last 15 years. Both physicians alluded to that.
Research on concussion has also risen exponentially. In doing a literature review for the 2012 adult version of “Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms”, about 18,000 abstracts were reviewed. When the third version of the guidelines was created in 2018, over 38,000 abstracts were reviewed.
There are different types of research targeting different aspects of concussion. There's research on identifying concussion conclusively and quickly. Not everyone who experiences an impact to the head develops a concussion. How do we identify those people who actually do end up with brain damage? There's research that looks at proper healing timelines, and there are guidelines for adults, children and adolescents, designed to advise people on getting back to work, school or play. A lot of research has been done looking at attempts to speed recovery during concussion, in the subacute phase, to address specific symptoms, such as headaches, cognitive issues and vestibular issues. People want to get back to their day-to-day activities as quickly as possible.
Some research on persisting symptoms has also been done. How do we identify people who might develop persisting symptoms? We know, for example, that women tend to have persisting symptoms more frequently than men do. What can we offer these people, in terms of rehabilitation? What therapies and treatments might offer optimal management for these persisting symptoms in the long run?
There's also research that looks at extrinsic and intrinsic factors that might contribute to persisting symptoms. There's a concern about the effects of multiple concussions that may translate into persistent symptoms. There's gender, age and mechanism of injury which could contribute to persisting symptoms as well.
Some athletes are working in jobs that can increase their likelihood of having concussions. It's known that people who experience a concussion are more likely to have another one, which is also a danger for athletes, especially those in contact sports.
It's generally accepted, as Shawn and Dr. Tator mentioned, that about 15% of people who experience a concussion may go on to have persisting symptoms. It's becoming a little more clear that it could actually be a higher number; maybe 20% of people end up with persisting symptoms following a concussion. Symptoms that remain beyond three months are considered persisting symptoms. People who fall into the persistent symptoms category are at a great disadvantage. Their symptoms interfere with work, return to play, social activities and family obligations.
In terms of avenues for future research, which is more where my focus is, augmented reality and virtual reality are definitely gaining interest, in terms of assessment and treatments for concussion. There are different types of goggles with analytic software emerging for use in sports. They are very portable, and may be able to assist in the diagnosis of concussions. Virtual reality that uses larger, more immersive systems can also measure range of motion and centre of balance. They have good potential, although they'd only be available at health care centres. The newer gaming platforms make simulation interfaces more visually engaging, which could improve compliance with treatment.
The advantages of the use of VR for assessment and therapy are that we can program virtual reality very specifically, to elicit responses based on increment, difficulty or intensity, and we can measure responses to stimuli. It's also a great distraction, and, obviously, the entertainment feature is high.
In terms of the disadvantages, we don't know what long-term exposure to virtual reality can do. Virtual reality is also not the real world. Human responses are not the same in virtual reality. If we want to rehabilitate people into the real world, there are some things we simply want them to do in the real world. If we want them to stack blocks in virtual reality, they might as well stack blocks in the real world.
Overall, there's a lot of research being done on concussion. At this point, the literature, in my opinion, needs to be evaluated. Studies need to be evaluated by people with clinical and research experience using reporting guidelines that will help to qualify the research. The new research that is going to be done needs to be driven by what gaps exist that we know about now.