DAAP and Nursing Students Collaborate to Address Concussion

Doctors, nurses and emergency personnel have long understood the perils of concussion—but the impact of this traumatic brain injury is getting renewed attention because of recent tragedies in college and high school sports.

The topic has sparked innovation and collaboration at the University of Cincinnati with students and faculty in the College of Nursing and the College of Design, Architecture, Art and Planning (DAAP) developing a host of products and services to address concussion. Fifteen student-led projects dealing with concussion were on display at a Dec. 4, 2014, exhibit in the Dorothy W. and C. Lawson Reed, Jr. Gallery.

The projects were part of a UC effort dating back to April 2013 to address sports-related concussion through cross-campus initiatives.

Fourth-year DAAP students and accelerated nursing students were divided into teams who looked at various populations affected by concussion including student athletes, parents of children with autism or cerebral palsy, senior residents, cyclists and other high risk populations, explains Jean Anthony, PhD, associate professor of nursing. The projects attempted to address ways to prevent, ease or recover from injury related to concussion in primary, secondary and tertiary stages. 

"There has been a lot of work done on the different senses and pressure points around the head and neck,” says Steven Doehler, an associate professor of industrial design. "One of our students worked closely with Greg Myer of Cincinnati Children’s Hospital to build a device that places slight pressure on a blood vessel in the neck, which causes an increase in intracranial pressure and helps hold the brain in place when the head experiences a jarring blow.”

"That idea was developed from research that suggests in higher altitudes athletes experience a much lower rate of concussion,” says Doehler. "We thought, how can we raise pressure in the skull and not disrupt the athletes’ motion and performance.”

"Another project is an awareness campaign designed to help athletes understand when an injury is serious and is a health concern versus simply shaking it off and getting back in the game,” says Doehler.

Recently, sports enthusiasts and others are questioning the role concussion may have played in the tragic death of former Ohio State University football player and wrestler Kosta Karageorge, who was found dead on Nov. 30, 2014, four days after he reportedly went missing from his apartment. The death of the Karageorge has resonated nationally and heighten discussions about the role of concussion in college sports.

Jeanine Goodin, associate professor in the College of Nursing, says students also worked on a couple of projects focused on bike safety—a helmet that has attachable parts that can be used for different situations and a pack worn by bikers that has an air bag that inflates during an accident and protects the head and neck.

Students developed a secondary concussion prevention project which looks similar to an otoscope, but it can be inserted into the ear and detect inner cranial pressure and determine if concussion is present, explained Goodin.

"There are concussions that are undetected and often untreated because of one reason or another,” says Goodin.

The main objective for students and faculty was to prevent concussion from occurring in the first place, explains Roberta Lee, an associate professor in the College of Nursing.

But once it has occurred, individuals who have suffered a concussion can be protected from further injury if bystanders and first responders are properly trained and equipped with devices to limit further complications. During the tertiary stage of concussion, individuals need treatment and rehabilitation, says Lee.

Fourth-year DAAP students Hailey Cook, Eliot Reshetar-Jost and Maddie Huey and College of Nursing accelerated student Sam Newman developed a wristband device that interacts with a mobile phone application to track key biometrics that relay information about a concussion patient’s physical condition.

"Basically, you start using the app to plan your recovery while at the doctor’s office,” explains Huey. "There are features that allow the patient to rank the symptoms they are experiencing. When the patient goes to the doctor, a baseline test is performed to see how well the patient is completing certain activities.”

Everything after this point is building on the level of the health the patient registered during the baseline test, explains Reshetar-Jost. The patient is now ready to try and improve his or her condition through therapy activities.

"The wearable has a heart rate and blood pressure sensor along with an accelerometer which tracts movement and is useful to determine whether a patient is having sleep disturbances at night,” says Reshetar-Jost.

Blood pressure and heart rate work well to provide an accurate measure of the patient’s condition during exercise and everyday activities.

Cook says the physician can prescribe therapy based on the information collected by the app.

The traditional way to recover from concussion is bed rest, but some experts, including a researcher at Cincinnati Children’s Hospital Medical Center, are starting to work on techniques that are more active, explains Newman.

The researcher from Children’s has expressed interest in what Newman and his fellow students have developed.

"Researchers have found that when people do receive extended bed rest they get depressed and are socially isolated,” says Newman. "Even though they recover from the concussion, they have regressed in other ways. Sensory deprivation is the result and the recovery process is not very good.

"The new idea is to create an active recovery where you try to exercise and do activities up to a point where you don’t exacerbate your symptoms,” says Newman. "We have a wide range of rehab activities.  There are balance, memory and coordination exercises along with neck massage and other therapies.

"You can tailor someone’s rehab to the symptoms they are having. If someone is having balance problems we will do balance exercises with them,” says Newman. "If they are having memory problems we will do memory exercises. That’s an important thing from a nursing perspective. When you assess a problem you have to intervene and fix it.”

Huey says the team had an important goal in mind in developing the wearable and app.

"We have heard from our nursing students that giving the patient control and empowerment in their own recovery is really important for modern-day health care and that was our general goal,” explains Huey.

Kim Hasselfeld, a researcher from UC’s Sports Medicine Division, says the app developed by nursing and design students would definitely be a plus for an athlete recovering from concussion. "It would allow an athlete to work recovery at his or her own pace and it the app could be used by coaches to monitor an athlete’s recovery,” explains Hasselfeld.

Joseph Clark, PhD, a professor of neurology, says permitting active recovery for athletes is essential.

"With competitive athletes extended rest is also associate with loss of conditioning, which can impact their mental health and quality of life,” says Clark. "Thus safe methods for permitting physical activity and escalating that physical activity are especially important for athletes with concussions.”