the effectiveness of testing for concussions using the stop watch method
TRANSCRIPT
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STOP WATCH TESTINGAn analysis into the use of a new testing technique to identify and treat concussions
By Peter Eggleston ConnorData provided by
Southern Oregon OrthopedicsA Graduate Thesis from
Southern Oregon University
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TERMINOLOGY
Reaction TimeHealthy / Injured / Recovering
Days Since Injury (or: Recovery Time)
Symptom Score
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HISTORY
โข Prior to 2001: Concussion detection had little empirical evidence supporting it.
โข 2001-2012: American Academy of Neurology (AAN) creates guidelines for more globally accessing concussion risks in athletes.
โข 2013: An update came out pointing towards evidence that having a concussion made future concussions more likely.
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OBJECTIVES
โข Identify changes between healthy and injured reaction times
โข Determine a concussion recovery rate based on reaction time
โข Identify significant symptom scores over course of recovery
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DATA COLLECTION โ HEALTHY AND INJURY FORM
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DATA COLLECTION โ RECOVERING FORM
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DATA ORGANIZATION
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DESCRIPTIVE ANALYSIS
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DESCRIPTIVE ANALYSIS โ RECOVERY TIME
n = 39
Mean:8.2 days
Standard Deviation:5.3 days
90th Percentile:~11 days
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DESCRIPTIVE ANALYSIS โ HEALTHY REACTION TIME
Mean:0.18 sec
Standard Deviation:0.03 sec
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DESCRIPTIVE ANALYSIS โ HEALTHY REACTION TIME IN CONCUSSED PLAYERSMean:
0.18 secStandard Deviation:
0.02 sec
Hypothesis Test All vs Concussed Healthy Reaction Timesp-value:
0.16Conclusions:
Accept Null
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DESCRIPTIVE ANALYSIS โ INJURED REACTION TIME Mean:
0.27 secStandard Deviation:
0.10 sec
Hypothesis Test Healthy vs Injured Reaction Time in Concussed Athletes p-value:
~1Conclusion:
Reject Null
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DESCRIPTIVE ANALYSIS โ REACTION TIME
DIFFERENCES
Mean:.088 sec
Standard Deviation:.098 sec
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DESCRIPTIVE ANALYSIS โ REACTION TIME RATIOS
Mean:1.49
Standard Deviation:0.52
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COMPAREDAYS TO REACTION TIME
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EXPONENTIAL MODELING:DIFFERENCE ๐ฆ=(๐โh)๐๐ฝ๐ก+hy: The reaction time at t days since injury
c: The reaction time at the time of injury
h: The healthy reaction time
ฮฒ: The rate of decay in the reaction time during recovery
t: The number of days since the concussion injury
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EXPONENTIAL MODELING
๐ฆ=(๐โh)๐๐ฝ๐ก+h
Purple:ฮฒ = .01
Red:ฮฒ = .2
Blue:ฮฒ = 1
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EXPONENTIAL MODELING: DIFFERENCES
๐ฆ ๐=(๐ ๐โh ๐ยฟ๐โ๐ฝ ๐ก+h๐
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EXPONENTIAL MODELING: DIFFERENCES
Where:i: Index for patient histories (1 to 39)ลท: The predicted reaction time at t days since injury
Objective: Find the ฮฒ that minimizes
โ๐
๐
โ๐
๐๐
( ๐ฆ ๐โ ลท๐ )2
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PREDICTIVE MODELUSINGDIFFERENCES
๐ฆ=(๐โh )๐โ0.5441 ๐ก+h
With ฮฒ selected as 0.5441 is optimized at 0.62
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PREDICTIVE MODEL USING DIFFERENCES
Can be transformed into: ๐ก ๐ฆ ,๐=ยฟยฟWhere ๐=๐ฆโh๐
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PREDICTIVE MODEL USING DIFFERENCE BETWEEN HEALTHY AND INJURY
๐ก๐ฆ ,๐=ยฟยฟOptimal k:0.0014
Mean:6.97 Days
Standard Deviation:1.52 Days
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EXPONENTIAL MODELING: RATIO
๐ฆ ๐
h ๐=(
๐ ๐
h๐โ1)๐โ๐ฝ ๐ก+1
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EXPONENTIAL MODELING: RATIO
Objective: Find the ฮฒ that minimizes
โ๐
๐
โ๐
๐๐
( ๐ฆ ๐
h๐โ^(๐ฆ ๐
h ๐))
2
Where: : Is the predicted ratio
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PREDICTIVE MODEL USING RATIOS
With ฮฒ selected as 0.5696 is optimized at 0.43
๐ฆ ๐
h ๐=(
๐ ๐
h๐โ1)๐โ 0.5696๐ก+1
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PREDICTIVE MODEL USING RATIOS
To predict days until RTP:
Where๐=
๐ฆ ๐
h๐โ1
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PREDICTIVE MODEL USING RATIOS OF HEALTHY TO INJURY
Optimal p:0.008
Mean:6.97 Days
Standard Deviation:1.50 Days
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SYMPTOMS Blurry Vision Concentration Dizziness Fatigue Headache Heightened Feelings Light Sensitivity Loss of Balance Memory Loss Nausea Noise Sensitivity Sleeping Habits
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SYMPTOMS COMPARED TO DAYS SINCE INJURYHEADACHE EXAMPLE
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SYMPTOM LINEAR MODELING: SINGLE DESCRIPTIVE VARIABLE
Where:y: Represents the response variable, days since
injury x: Represents the predictor variable, a symptom: Is the value of y when x is zero: The amount y changes when x increases by 1
๐ฆ=๐0+๐1๐ฅ
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SYMPTOM LINEAR MODELING: MULTIPLE DESCRIPTIVE VARIABLES
Where:n: Is the number of predictor variables used in the
model: Is a predictor variable value, where are
symptoms: The amount y changes when increases by 1
๐ฆ=๐0+๐1๐ฅ1+๐2 ๐ฅ2+...+๐๐๐ฅ๐
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SYMPTOMS COMPARED TO DAYS SINCE INJURY
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ANALYSIS OF VARIANCE(ANOVA)
โข Identify Predictor Variables Independently in Multivariable Experiments
โข Assess Explained and Residual Variation of Response Variable
โข Determine Significance of Predictor Variables on Response Variable
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SYMPTOMS COMPARED TO DAYS SINCE INJURYANOVA
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SYMPTOMS COMPARED TO REACTION TIMEHEADACHE EXAMPLE
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SYMPTOMS COMPARED TO REACTION TIME
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SYMPTOMS COMPARED TO REACTION TIMEANOVA
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CONCLUSIONS:DETERMINING A CONCUSSION OFF OF STOP WATCH TESTINGThe reaction times taken after injury were significantly different from those of healthy times taken at the beginning of the season.
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CONCLUSIONS:RETURN TO PLAY
๐ก๐ฆ ,๐=ยฟยฟBest Calculator:
Roughly 97.5% of cases recover in 10 Days.
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CONCLUSIONS:CONCUSSION SYMPTOMS
Headache, dizziness, fatigue, heightened feelings, and feeling nauseas showed significance when looking at reaction time.
Headache showed significance when looking at days since injury.
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FURTHER RESEARCH
Unconscious Incidents
Multiple Concussions
Correlation Coefficients in Linear Analysis
Larger Data Set