Disruptive Technology Changing the Shape of Brain Health Monitoring

Concussion is the most common form of traumatic brain injury affecting over 300,000 American youth annually. Given mild and overlooked symptoms among many experiencing concussion, its incidence is likely considerably higher, upwards of 2-3 million annually. Short and long-term impacts include impaired cognition and lost productivity; long term risks are concerning given associations with depression and cognitive impairment, as well societal and economic costs associated with the burden of brain injury.

In the field of sport-related concussion (SRC), current empiric guidelines for concussion recognition and play removal decisions rely entirely upon subjective player reporting symptoms or an observer raising concern about a high impact injury with potential for concussion. After concussion occurs, it can be readily identified based on history and examination. But the critical failure in the current approach is that upwards of 2/3 of all concussions go unreported, related to vague symptoms experienced, poor recognition, and competitive disincentives compelling affected individuals not to report their symptoms which places them at a significantly increased risk for recurrent brain and musculoskeletal injuries. Clearly, there is a major need to identify concussion when and where it occurs, and this is only possible through identifying real-time physiologic changes in brain function associated with concussion.

Devices exist to estimate impact magnitude based on helmet accelerometry, out of concern for potential high velocity impacts posing the greatest risk for concussion. However, there is significant variability both within and between players of concussion risk thresholds, and accelerometry can only serve to recognize events posing risk for concussion but fails to identify changes in brain function. As a result, accelerometers have been abandoned in the space of SRC diagnostics.

An electroencephalogram (EEG) is a frequently used neurologic test used in epilepsy diagnosis and management. Conventional EEG monitoring and recording takes place for a brief period in a monitored medical setting, and ambulatory EEG has become commonplace in epilepsy management and can have a role as a confirmatory test after a concussion is clinically recognized. Ambulatory EEG has also been shown to have clear and distinctly abnormal signals of concussion when worn while playing contact sports.

Ambulatory EEG is an ideal tool to monitor contact sports athletes in addition to military service men and women, while actively participating to identify clinically apparent concussion as well as sub concussive injuries which are altogether missed in current concussion identification approaches. Previous barriers to EEG monitoring have been overcome given the advent of ambulatory EEG, dry electrodes, and automated signal processing, all of which have been innovated at NoMo Diagnostics which is developing the first helmet embedded bio-sensor for real-time automated concussion identification.

It is on this background that NoMo Diagnostics has been built. The time is right for our real-time, objective, on-the-field concussion diagnostic to change the shape of brain health monitoring as we know it. NoMo Diagnostics will present at the 2018 Michigan Growth Capital Symposium. NoMo Diagnostics is like having a neurologist on your team: a real game changer.

—-By James M. Noble, MD, MS, CPH: Co-Founder and Chief Medical Office NoMo Diagnostics, Assistant Professor of Neurology at Columbia Medical Center

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