Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI

Joshua P McGeown; Patria A Hume; Stephen Kara; Doug King; Alice Theadom

doi:10.1186/s40798-021-00340-8

Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI

Sports Med Open. 2021 Aug 9;7(1):56. doi: 10.1186/s40798-021-00340-8.

Authors

Joshua P McGeown^{1

2}, Patria A Hume^{3

4}, Stephen Kara⁵, Doug King^{3

4

6}, Alice Theadom⁴

Affiliations

¹ Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. josh.mcgeown@aut.ac.nz.
² Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand. josh.mcgeown@aut.ac.nz.
³ Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
⁴ Traumatic Brain Injury Network, Auckland University of Technology, Auckland, New Zealand.
⁵ Axis Sports Medicine Clinic, Auckland, New Zealand.
⁶ School of Science and Technology, University of New England, Armidale, NSW, Australia.

Abstract

Objectives: To evaluate the clinical utility of tactile somatosensory assessments to assist clinicians in diagnosing sport-related mild traumatic brain injury (SR-mTBI), classifying recovery trajectory based on performance at initial clinical assessment, and determining if neurophysiological recovery coincided with clinical recovery.

Research design: Prospective cohort study with normative controls.

Methods: At admission (n = 79) and discharge (n = 45/79), SR-mTBI patients completed the SCAT-5 symptom scale, along with the following three components from the Cortical Metrics Brain Gauge somatosensory assessment (BG-SA): temporal order judgement (TOJ), TOJ with confounding condition (TOJc), and duration discrimination (DUR). To assist SR-mTBI diagnosis on admission, BG-SA performance was used in logistic regression to discriminate cases belonging to the SR-mTBI sample or a healthy reference sample (pooled BG-SA data for healthy participants in previous studies). Decision trees evaluated how accurately BG-SA performance classified SR-mTBI recovery trajectories.

Results: BG-SA TOJ, TOJc, and DUR poorly discriminated between cases belonging to the SR-mTBI sample or a healthy reference sample (0.54-0.70 AUC, 47.46-64.71 PPV, 48.48-61.11 NPV). The BG-SA evaluated did not accurately classify SR-mTBI recovery trajectories (> 14-day resolution 48%, ≤14-day resolution 54%, lost to referral/follow-up 45%). Mann-Whitney U tests revealed differences in BG-SA TOJc performance between SR-mTBI participants and the healthy reference sample at initial clinical assessment and at clinical recovery (p < 0.05).

Conclusions: BG-SA TOJ, TOJc, and DUR appear to have limited clinical utility to assist clinicians with diagnosing SR-mTBI or predicting recovery trajectories under ecologically valid conditions. Neurophysiological abnormalities persisted beyond clinical recovery given abnormal BG-SA TOJc performance observed when SR-mTBI patients achieved clinical recovery.

Keywords: Brain Gauge; Diagnosis; Modelling; Prediction; Recovery; Somatosensory; mTBI.