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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
Speaker 1 (00:00):
Today we'll be diving into an important and timely topic, concussions. Whether you're an athlete, a parent, or just curious about brain health, understanding concussions is critical. Our guest today, Dr. Melissa Womble, is an expert in the field of neuropsychology specializing in the complex and often misunderstood topic of concussions.
Speaker 2 (00:22):
you're a clinical sports neuropsychologist, which sounds like a very cool field, um, at Inova, and you specialize in the management and treatment of sport related concussions. Clinical interests include the assessment and treatment of youth, professional level athletes and adults who have sustained a sport related concussion or non-sport related concussion.
Speaker 3 (00:53):
Thank you for having me. I'm excited to be here and help everyone understand concussions a little bit more. As Tracy said, they often are misunderstood and there is a lot of outdated information out there. I am a neuropsychologist. Um, and for those who are not familiar with this field, um, what that means is I have a doctorate in psychology and then specialized training in neuropsychology. Um, neuropsychologists are trained in how brain conditions, for example, concussion, um, affect behavior, mood, and cognitive functioning. Um, so we usually complete a pretty extensive battery of tests to be able to offer the best guidance for patients. I grew up here and wanted to come back and serve the community, um, at the Inova Sports Medicine Concussion Program. We have a multidisciplinary team led by neuropsychologists, but also including physical therapists, athletic trainers, and primary care sports medicine physicians, all caring for patients age five and older, um, uh, for any mechanism of concussion sport or non-sport related concussion.
Speaker 2 (02:22):
How did you get into this field? Was there anything in particular that kind of motivated you to go into this or were you always interested in it?
Speaker 3 (02:28):
Um, so I was, uh, division one, um, college athlete. I ran track and cross country at University of South Alabama. So I always had a passion, um, for sports, you know, involved high school level, um, college level. Um, and when I was, um, engaged in my master's and doctoral program, I worked with the athletic department at my university. The athletic department offered me an assistantship to run a concussion management program, and I thought, wow, this really combines a lot of my interests, neuropsychology, um, sports psychology and health psychology. So it kind of fell in my lap in terms of combining everything that I was passionate about and, um, still passionate about today.
Speaker 2 (03:34):
Wow, that's really cool. Can you just tell us just off the bat, what is a concussion exactly, like what's actually happening physically inside your head right to the brain during a concussion and how does it occur?
Speaker 3 (04:01):
Right. So there's a lot of, you know, again, misinformation about what a concussion is, but you know, technically a concussion is a mild traumatic brain injury. Um, a concussion is caused, um, via a direct hit to the head. So head, head-to-head collision, um, is, you know, one example of that, an elbow to the head could be another example of that, or, um, an indirect hit to the body that then translates force to the head. So I see this often in our motor vehicle accidents with the whiplash type injury. Um, the brain is made up of many cells also called neurons, and when it shakes hard enough, it negatively impacts those neurons. Um, a chemical exchange occurs during this process and leads to a toxic environment in the brain, um, which causes the cells, um, to not be able to communicate as well as they normally do, and results in construction of blood flow.
Speaker 3 (04:48):
So there's a decrease in blood flow, um, at a time when the energy supply is also reduced. So it's kind of a mismatch. Um, the brain quickly starts to heal itself. Um, but this takes time at a time when energy is also reduced. Um, and so what we know is within a few weeks, usually the brain is back to normal. Um, what I see patients often coming into clinic thinking is happening in the, in their brain is that there's swelling, bl bruising or bleeding. Um, and so that's often a conversation that we have to have is that there's not structural damage inside. Um, it's really a metabolic injury is the best way to think about it. I often give, um, you know, kind of layman's terms for, it's kind of an energy crisis is the best way to think about it. If you think about your gas tank, you're running more on empty than you are on full.
Speaker 2 (05:34):
That's a really great way of explaining it. What would you say are the most common misconceptions about concussion?
Speaker 3 (05:50):
So there's a few there, ,
Speaker 2 (05:51):
And you mentioned one, right? Like thinking that there's bleeding or bruising. So you already did mention one,
Speaker 3 (05:55):
Right? Yeah. So I would, I'd say another one is what I had also mentioned as far as a direct or an indirect mechanism. A lot of patients are under the assumption that you can only get a concussion via direct mechanism, but what we know is it can be a direct or an indirect mechanism. Another common misconception is that a concussion only occurs with loss of consciousness. And what we know is most injuries actually do not involve loss of consciousness. It's about 90% do not have loss of consciousness. Um, a lot of parents that I see and patients that I see are very concerned when a loss of consciousness happens. Um, but actually, generally I see better outcomes when loss of consciousness occurs. Kind of some of the thinking is the brain's shutting down to prevent further injury. Um, so usually I see the patients that, you know, have had a loss of consciousness, they actually get better quicker.
Speaker 1 (06:45):
Oh, that's really interesting. That's not something you would've thought of, right? That's probably more scary. Mm-Hmm, .
Speaker 3 (06:50):
Um, interestingly though, research has shown that on field dizziness. So if, uh, you know, a patient ha or I, I guess in this example, you know, a kid is playing soccer, gets an injury, has on field dizziness, that's seven times more predictive than any other symptom in terms of predicting a prolonged recovery. Um, so you know, if a if you're listening and you have a child who gets a concussion and they tell you they're dizzy right away, pull 'em out and get them to specialty care. Um, because that's usually when we are seeing more prolonged recovery.
Speaker 1 (07:20):
Is there a time period in which you need to see a patient after a concussion to get the best outcome? That's
Speaker 3 (07:25):
A good question. So what we know is usually the first 72 hours is where the biggest symptom burden is. Um, so it's actually very difficult for me to see patients too early, right? Mm-Hmm, . Um, I usually like to see them around the 72 hour mark because that's when there's just some normal recovery with the injury and we have a better look at what symptoms are actually there versus the initial symptom burden that can be a little muddy to Yeah. To kind of navigate. So
Speaker 1 (07:49):
It's like these are the symptoms that are persistent.
Speaker 3 (07:51):
Right. Exactly.
Speaker 1 (07:52):
And then, so help us understand what symptoms to look for?
Speaker 3 (08:11):
Yeah, so headache is the most common symptom following concussion. Um, and then other symptoms that are common is nausea. Usually that co-occur with a headache, light noise sensitivity, tiredness or fatigue. Um, sometimes you can have visual changes, you can have some blurry or double vision. You can have difficulty tolerating busy environments. Um, and then there's cognitive symptoms feeling a little foggy, kind of one step behind, not all there. Um, difficulty concentrating, difficulty remembering emotional symptoms are common following the injury, usually feeling kind of more anxious on edge. Um, patients also report kind of rumination or having a lot of thoughts that are hard to turn off. Um, and then sleep challenges can be pretty normal after the injury to difficulty either initiating or maintaining sleep.
Speaker 1 (08:59):
So tell us, you know, when you're seeing a patient that has clearly been concussed, how are you looking in evaluating what treatment is appropriate?
Speaker 3 (09:19):
Yeah, so there's been a lot of advances in how we look at this and, uh, I, you know, I think that's one of the reasons neuropsychology is the field that, you know, is, is leading the way in terms of evaluating this injury because we have the toolbox to be able to do so. Um, but there is not a gold standard test for concussion, and that's what makes it difficult. So I have to use a battery of tests. Typically, an initial evaluation in our office takes at least 45 minutes to an hour. Um, and that's involves, um, cognitive testing. So we usually use neurocognitive, um, components that are done on the computer, looking at verbal memory, visual memory, processing, speed and reaction time. Those are all the cognitive areas that are known to be affected post-concussion. Um, in some cases patients may have a baseline that they've completed via their youth league or their school, and so we'll have a comparison, kind of a snapshot of how they were before the injury that we can look at, um, in, in reference to how they're doing after the injury.
Speaker 3 (10:18):
Um, we can also use academic history or occupational history to try to figure out where they should be falling. But in addition to cognitive testing, we know that not every take every case is gonna have cognitive dysfunction. Um, there can be vestibular related difficulties, so that's dizziness. Um, and so we do a vestibular and ocular motor screening assessment. Um, there can be ocular motor challenges, so difficulty coordinating the muscles of your eyes as well. Um, so again, we have to use a very kind of comprehensive battery of tests to really figure out which profile or profiles an individual is fitting. Um, so I think historically concussion was really viewed more as a one size fits all injury and kind of you were given blanket recommendations. That's not really the state of concussion today, which is exciting, right? It's kind of like an ankle injury. There's different types of ankle injuries, there's different types of concussion, and that's what we're, you know, specialized with at Inova is really individualizing that treatment for the patient and really meeting them where they need to be and not over-treating the injury
Speaker 2 (11:18):
When, so you mentioned, you know, you like to see folks who have a concussion about 72 hours after, is kind of maybe the ideal time period. Tell us a little bit about this concussion protocol.
Speaker 3 (12:02):
I think the, the biggest thing is has there been a mechanism of injury? Um, and are there symptoms? If there's been a mechanism in their symptoms, really the best thing you can do is pull that player out of play. Um, now there are tools that can be used on the sidelines, just like in the office. There's not a gold standard standard test, which makes it really difficult. Um, concussions also kind of that invisible injury, right? And I think that's where a lot of patients struggle, but it's also makes it hard for, um, people, you know, athletic trainers on the sidelines or even the everyday parent in a youth league game, right? . Um, but there, just like we do use in the office, the most common kind of sideline assessment, um, looks at cognitive functioning, looks at balance, looks at symptoms that are occurring, um, kind of going through each of the areas that can be affected.
Speaker 3 (12:51):
Um, you know, I really, research that has been done has shown, again, if there are symptoms and there's a mechanism, pull them out. Um, because we know that there's a lot of symptoms of concussions. Some don't show up right away. Sometimes they can take a few days to show up. Usually within three days you're gonna see everything you're gonna see. But, um, you know, what I see sometimes is a kid might have a tournament over the weekend, they have a mechanism, maybe they had a headache for 10 minutes, um, they feel better, they go back into play, but then come Monday they walk down the hallways at school and all their symptoms come back. Hmm. Um, and so that's, you know, the risk that you have in terms of putting them back into play is do they go back into play and you know that now they're kind of set up for a more prolonged recovery versus holding out a one game and maybe we've kind of eliminated that risk and they're actually able to go back a lot sooner. So
Speaker 1 (13:45):
Going back could actually not only prolong the tr the the recovery, but it actually exacerbates the
Speaker 3 (13:50):
Injury. Yeah. So our research director at enova, Dr. RJ Elon, who, um, is, you know, very well known in the concussion research space, um, we're lucky to have him. He actually published a study a few years ago, um, looking at this. So patients that were removed immediately or continued to play, and what, um, he found in his, his research, and I think this is a good point for parents, you know, that are being kind of coerced by their child to maybe go back in, is there's actually an 8.8 times greater likelihood for prolonged recovery by continuing to play. And that,
Speaker 1 (14:23):
Wow, that's a, that's a big factor, ,
Speaker 3 (14:26):
Right? It, you know, don't quote me on the numbers, but it was about 21 days for recovery for those that were removed immediately versus 43 days for those that wow continued to play. So it's a pretty big difference. Mm-Hmm. . And, you know, that can make a big impact in terms of a season if you miss two games versus missing multiple weeks. Um, and they did a follow up study, um, to that initial study that actually looked at minutes of play, right? So if you continue to play, you know, for fif under 15 minutes or greater than 15 minutes, and the risk increased as you continue to play. So even, you know, adding an extra minute or two, it can continue to, to increase that risk.
Speaker 1 (15:02):
So does that mean, you know, anytime there's a bumped head on the field, you know, parents should pull their kid out of play just as a precaution?
Speaker 3 (15:10):
You know, I, I think that's, that's a hard thing, right? Kids bump their head all the time. , um, yes, I have
Speaker 1 (15:15):
Three kids, ,
Speaker 3 (15:17):
Um, and you know, I, I can't count the number of times they bump their head, right? But I, I think it's, it's a viable mechanism. Something that, you know, looks pretty significant. And then immediate symptoms is where you have to be, you have to be cautious. Um, you know, again, we can all bump our heads. I always give the example of like the kitchen cabinet. You know, it's, oh, it's open and you bump your head. That's not gonna necessarily give you a concussion. But if there's some type of mechanism that looks pretty significant and there's immediate symptoms after, the best thing you can do is pull them out at play.
Speaker 1 (15:46):
So what are some of the components of a treatment plan? You know, I'm in your office, I'm concussed mm-Hmm. , you know, you've talked about my symptoms. What might I expect you to tell me to do in the weeks to follow?
Speaker 3 (15:56):
You know, when they come to my office, they, they've been resting in a dark room. Um, I mean, this happens in 2024, which is surprising, right? People have been sitting in a dark room for two weeks sometimes. Um, but we really moved away from rest as a treatment model for concussion. And I think if that's one of the biggest messages that gets out with this podcast, that's the most important thing, is we've really, you know, moved away from rest as a treatment model. And what I mean by that is, you know, after that initial 24 hours, you have to reengage in normal life activities. Concussion is similar to a knee injury where you have to feel some symptoms to get better. Um, and so we kind of, you know, talk to patients about how to tolerate those symptoms just like you would if you're rehabbing your knee. You have to feel a little bit of pain. Same thing with concussion. You have to feel a little bit of headache. You have to feel a little bit of dizziness to get better.
Speaker 2 (16:54):
And is the idea behind that, that you just like part of the healing, is it you're actually re-engaging your brain? I mean, is that exactly, is that the analogy? Yep. Okay. Yep.
Speaker 3 (17:02):
Yeah. And so, you know, we instruct patients to start to, you know, it's very rare for me to hold kids outta school that long anymore. Um, we're trying to get them back, you know, maybe we'll start with a modified day or two where maybe they're doing a partial day, but then they're getting back to school pretty quickly. Same thing for, you know, our adult patients getting back into work, um, but utilizing breaks to manage the symptoms. So I, I kind of always say, you know, I wish the, the word rest would kind of go away and more breaks. Yeah. Is, you know, I, I think we all are under the assumption if somebody tells us to rest more must be better. So we've gotta rest to the extreme. And that's not how it is with concussion.
Speaker 1 (17:37):
Rest normally rest as you would before this . Exactly.
Speaker 3 (17:40):
Um, but I think, you know, back to your question, Tracy, we're trying to get people on a good schedule and routine right away. Um, you know, I always say kind of our grandma models at the core of this, but we want patients to be eating consistently throughout the day. Breakfast, lunch, and dinner. Obviously for our teenagers, they're not usually eating breakfast before this, but they need that fuel right now. Again, we talked about this being an energy crisis. Mm-Hmm. . So we need to give them that fuel to get better. They need to stay hydrated, drinking a lot of fluid, um, getting some physical activity each day. There is no reason anyone after concussion can't go for a walk, um, as a starting place. But normally we're actually trying to get our, our athletes back to even practice activities at a non-contact level. Hmm. Um, and then getting them on a good sleep schedule. So we don't wanna be adding in naps that they wouldn't normally not have taken. Um, we want that good sleep at night, that kind of restorative sleep that, you know, the brain's able to shut down and heal. Um, and then keeping stress as low as we can. You know, we find that stress is a big thing with this injury. You know, kind of being asked how you feel all the time. Do you have a headache? Do you have a headache now? Do you have a headache ? Um, it
Speaker 1 (18:42):
Kind
Speaker 3 (18:42):
Of gives me a headache thinking about it. Right. . So, um, it's not like
Speaker 1 (18:45):
Stop annoying me . It's not
Speaker 3 (18:47):
Totally uncommon for me to also talk with parents about reducing the focus on the injuries too. And I, you know, again, it's hard, you know, as a mom, I, I know, you know, you wanna know how your kid is feeling, but
Speaker 1 (18:57):
Everyone knows teenagers love questions . Yeah. But,
Speaker 3 (19:00):
You know, normalizing it and providing reassurance goes a long way with concussion as
Speaker 1 (19:05):
Well. So what about just, you know, there's no screen limitation. Go to school, go to work, you can be looking at a computer, you can look at your phone. That's all fine, right? Normal
Speaker 3 (19:13):
Activities. Yeah. That's actually another myth, you know, is that you have to stay away from screens. And, um, what we recommend is generally after that first 24 hours, starting to reengage in use of screens, but just utilizing breaks to help manage the symptoms. If something's kind of reaching more of a five out of 10 level, then you take a break. Mm-Hmm. if it's more like a zero to four, keep going. Okay. Um, and, you know, in addition to kind of our regulation techniques, then we're really trying to figure out which profile or profiles the patient is fitting. So again, which type of concussion are they have? And that's where we can match more, um, targeted treatments if we need to. Not everyone needs it, but some cases may need vestibular therapy. So that's a physical therapy to help with dizziness. Um, some may need, um, vestibular therapy to help with, um, some of the ocular motor difficulties that we see after injury.
Speaker 3 (19:59):
So patients may have difficulty focusing their eyes, um, and so they may have to retrain kind of the muscles of their eyes. Sometimes they have cervical involvement so their neck could be, um, hurting. And so they may need some physical therapy for their neck. Um, in some cases we do have to use medication management, but I would actually say that's pretty rare, you know, for trying to break a migraine cycle or if we are, um, struggling to, to manage the emotional aspects after the injury. Um, but we're really, again, trying to individualize the treatments for the patient so that they're not getting overtreated over focus on the injury is a problem.
Speaker 1 (20:32):
If this happens to your child, but there's actually, you know, really good science and protocol and they can recover and get better with a, you know, proper care. One of the things I found really interesting is something you did actually, um, was start a partnership with a local school district to create baseline, if I remember correctly, baseline screening. So that if somebody, you know, an athlete was concussed, you knew any of those measures, cognitive, et cetera, you knew where they started and what changed. Can you talk a little bit more about that?
Speaker 3 (21:21):
Yeah, so baseline testing is pretty common. Um, especially once you get to high school in this area. Um, it's completed by the athletic trainers, um, through the schools. It can be done in person or um, remotely. You can be sent test codes that you complete at home. Um, but again, it's looking at the same things we look at post-injury. It's looking at your verbal memory, your visual memory, your processing speed and reaction time. Um, and it gives that snap snapshot of cognitive functioning before an injury happens. So then we can put two tests side by side your baseline and your post-injury test and see if there are differences, um, from how you were pre-injury to post-injury. And we know how much a person can vary change day to day without a concussion. So we call that reliable change. So if it's exceeding reliable change, then we know there's been a difference.
Speaker 1 (22:20):
Are you seeing other places in the country do this as well?
Speaker 3 (22:24):
Yes. This is pretty commonly done across the country. Um, and you know what, what I think is important is that we can certainly look at a test without a baseline, but we know, especially for those kids that generally fall above average, um, if we're using normative data, it could under represent where they should be also kids, um, in particular that have like a DHD or learning disability at baseline. Um, we really need to know how they are before an injury because we can use their academic history, but they may struggle with consistency on testing or things like that. Um, and so it does make it really hard on the backend to, um, evaluate where they ultimately should
Speaker 1 (23:05):
Fall. So if somebody is listening to this and says, okay, I wanna get my child a baseline. Mm-Hmm, , do they go to their pediatrician? Do they go to their primary care? Do they come directly to you and your team?
Speaker 3 (23:15):
Yeah, we offer baseline testing through the Innova Sports Medicine concussion program. Um, they can either email or call us. Um, most of the pediatricians do not offer this service. It's usually done through specialized concussion programs are, again, once your child's in high school, a lot of the local high schools do offer it.
Speaker 2 (23:43):
This is really informative. And kind of along those lines how we can continue on our journey of myth dispelling. Um, you know, we've talked about this a little bit before we got on the podcast, but um, you know, we who read the news know that sensationalism is one of the best things a news organization can do to get readers to read their stuff or watch their stuff. And, you know, recently, it was a heartbreaking story of a teenage football player who had a contact injury on the field and I think died 24 hours later.
Speaker 2 (24:33):
So I don't know if you know the story I'm referencing, it was in Alabama, but if you could help us understand a little bit of maybe about that.
Speaker 3 (25:21):
Right. I know a little bit about what you're referencing. Um, and really that's, you know, bringing up the topic of second impact syndrome, which I think, you know, for listeners this is very rare. Um, it does happen, but it, it's rare, but it is one of the things that you have to take a concussion seriously. Um, it is not worth the risk of letting your kid play one more game, um, to get through, you know, a season, um, versus just holding them out and getting them proper care for the concussion. So what we know with second impact syndrome is when you're recovering from a concussion, you can be more at risk for having another injury. And in some cases, if you do sustain a second injury while you're still recovering, there can be what we call second impact syndrome, which causes really catastrophic brain swelling.
Speaker 3 (26:09):
Um, and it can in, uh, result in death. And that's the biggest risk for, you know, continuing to play and not getting proper care following an injury. Um, again, it is rare, you know, I had a patient the other day in my office saying she had second impact syndrome 'cause she had two hits to her head and I said, you wouldn't be sitting here if you had second Impact syndrome. So I think there, you know, as Sam alluded to, there are some misconceptions about what that looks like. Um, but it is, you know, again, one of the things I think that can be helpful when you're talking to a teenager who's desperate to go back in, continue with contact when we're managing an injury. Um, and sometimes I do have to bring that up in conversation, um, when we're kind of in a disagreement about where they are in the recovery process too.
Speaker 2 (26:55):
Any other kind of high level tips you generally give, uh, parents or kids who play contact sports?
Speaker 3 (27:07):
Yeah, I think, you know, one of my biggest messages to put out there is we've come a long way with concussion management. And I think historically there's been underreporting of the injury because, you know, I think kids are fearful that they're gonna be taken out of their sport, that their love, their outlet, you know, all of that. Um, but as I had mentioned, we actually get kids back to activity very quickly. Um, and yes, you may be restricted to non-contact activity, more your individual skills, drills, conditioning, but that keeps you in shape. So when I say you're ready to go, you're ready to go . Yeah. Um, and that's, you know, I I think if we can get more of that message out that they're not gonna be in a dark room, they're not gonna not have their cell phone, they're not gonna not be able to be with their friends. We'd have more honest reporting and more better conversations about the, about the injury, um, reducing some of the hysteria that is out there. Um, and I think we'd all be more successful in, in, um, moving things forward for a concussion.
Speaker 2 (29:16):
I know you guys are doing a lot of research right now at Innovo with concussion. Anything kind of you wanna share about that or sort of what is the frontier of concussion research at this point? Right.
Speaker 3 (30:16):
Yeah, we're doing some really exciting, um, research, um, through a Nova sports medicine concussion program. As I mentioned, Dr. RJ bin is a leader in the field, um, for concussion research. And we're lucky to have him as part of our team. Our research is really focused on advancing clinical care. Um, that's, you know, the basis behind our research and, uh, among the many studies that we have, um, ongoing, there are two that I'm really excited about. There's a, a huge de debate in the literature and also in the media whether or not people can fully recover from concussion. Hmm. Um, but much of the research that has been done has been looking at, um, the long-term effects from this injury, mostly in professional athletes or, you know, our military personnel.
Speaker 3 (31:08):
And I've observed, you know, some of my patients come in and they're really fearful they're gonna end up like the pro athletes. Um, and so we have to have a lot of difficult conversations about how that group is different from, you know, kind of you and I right. , right? Yeah. . Um, they're having, you know, repeated hits year after year. Um, they also have a lot of other conditions that can cause, you know, similar things to what may, you know, for example, you know, untreated mental health issues Right. Or ongoing pain from playing at that level for an extended period of time. So, you know, essentially what we wanted to do, um, was look at health related quality of life, um, in patients, um, that had been cleared from our concussion program. And so we asked them upon discharge or clearance if we could contact them down the road.
Speaker 3 (31:56):
And this was all approved, you know, via IRB and everything. Um, so these are everyday patients just like you and me. Um, and what we did is we sent out a standardized scale published by the National Institute of Health that assessed health related quality of life, um, in the domains of physical, emotional sleep and cognitive functioning. Um, and we had patients that had been cleared by our clinic, um, from six months to four years ago. So there was quite a range, which was kind of nice too. And what we found in approximately 200 patients that are, um, was that our, our former patients, physical, emotional sleep and cognitive related functioning was normal. Um, in fact, the majority of the sample was above normal. Um, and so, you know, this study, which we're writing up for publication right now, and you know, I I expect to be a very prominent study, um, is points out that getting appropriate clinical care works and that patients can make a full recovery from the injury.
Speaker 3 (32:50):
And I'm really excited that innova's behind that. Um, you know, the second, um, kind of line of research that we've been focusing on is implementation of digital health. Um, and so, you know, with concussion, I'm often, you know, relying on patient report of how they've been doing, um, for a week, two weeks, you know, patient recall of symptoms. If you're in the healthcare field, you know, sometimes we, we can't really recall our symptoms that well Yeah. Or what we've been experiencing. It's like, when did I have the flu? Mm-Hmm. , oh, maybe two weeks ago, maybe three weeks ago. You know, uh, that's just an example, right? Yeah. But I'm asking patients, when's the last time you had a headache? How often is the headache? You know, what does that dizziness feel like? Um, and so it relies on a lot of symptom reports. So we really, you know, have figured out there might be a lot of use for digital health. Um, so you
Speaker 2 (33:38):
Mean like logging your symptoms and what's happening kind of as you're going along? Yes. Like in an app
Speaker 3 (33:42):
Or something like that? Yeah. So smartphones. Mm-Hmm. , um, there's a lot of use here, right? Yeah. Um, and, you know, our, our goals with this, we're collaborating with Penn State University on this, um, and we've done a pilot study and actually our, our patients have reported to us, we kind of did a pilot study in terms of how they liked it. Right. And so they're, you know, for a week they were using their smartphones to track their symptoms, do momentary cognitive assessments, kind of different time periods during the day. Um, and patients actually enjoyed it. You know, they, they had fun doing it. They thought it, you know, helped them kind of stay a little more accountable. Um, but where we're going with this is actually to leverage treatments. So, you know, if I tell a patient you need to go out to more busy environments, we, and we see, you know, that they're not doing that as much, we can nudge them.
Speaker 3 (34:28):
Right. Ah, send like, you know how your phone or your watch tells you to stand up. Yeah. , we can tell you, Hey, in the next 20 minutes, you need to go out to a busy place, or you need to go for a walk. Um, so that's where we're, we're using this, um, and hoping, really cool, hoping to move this forward, but, you know, we really see the use potentially for remote patient care. Um, that would be a great use of it. Yeah. Um, I also, you know, I, again, we haven't touched too much on this today, but there's a lot of anxiety following concussion. Um, and you know, again, I need patients to get active. I need them to exercise, I need them to get back to work. And so if we can be kind of in their pocket helping to coach them along the way, um, it could be really cool.
Speaker 1 (35:10):
So we also, those things help with anxiety . Yeah, exactly.
Speaker 3 (35:13):
Yep. So behavioral activation, you know, is a big premise in the depression kind of world. Hmm. Um, and that's where some of this is coming from. So, um, a lot, a lot ahead in that, um, in that arena. And I'm excited that, again, Innova's, um, leading the way here.
Speaker 1 (35:28):
Well, Dr. Rumble, thank you so much for being with us. I feel like if there's one thing I took away is seek treatment and this is, this can, you can recover exactly. Anything you'd like to leave us with.
Speaker 3 (35:39):
You know, give us a call if you need help . Um, again, 72 hours after injury is kind of that ideal point to, to initiate care. And in those first 72 hours, just get yourself on a really good schedule and routine where you're sleeping a normal amount, eating regularly, staying hydrated, that's gonna help set you up for success.
Speaker 1 (35:59):
That's great. Thank you for being with us. This
Speaker 2 (36:01):
Is awesome. Thank you so much Dr. Womble. I learned a lot today. All right. Appreciate
Speaker 3 (36:05):
You. Thanks for having me.