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Sports Medicine Turns to Telemedicine

 |  By smace@healthleadersmedia.com  
   April 29, 2014

Advances in telehealth technology are revolutionizing how healthcare providers respond to the hard knocks and head injuries athletes sustain on the football field, soccer pitch, and ice rink.

It may be baseball season, but I've got football on my mind.

Not the game itself, but the injuries that can result from it, and specifically, how new technology can help detect concussions, those hard knocks that can do so much damage and yet be so difficult to detect.

Sensor technology and telehealth technology are revolutionizing how the healthcare system responds to the football field's hard knocks, and the same technology could apply to other sports such as hockey, soccer, and anywhere else where sharp blows to the noggin are part of the game.

In January at the International CES show in Las Vegas, I got to see technology up close from a firm called MC10, that forms the basis for Reebok's CheckLight, which collected a CES Innovations 2014 Design and Engineering Award.

The soft garment fits over the head, but underneath a player's helmet. Sensors within the garment measure direct accelerations experienced by the head, rather than to the helmet or chin strap. Earlier sensors, attached to these, could provide inaccurate readings.

When CheckLight measures a dangerous acceleration, the technology switches on a yellow or red light, depending on the severity of the acceleration. Coaches and trainers on the sidelines of the playing field can clearly see the light displayed below the bottom edge of the helmet.

Coaches and trainers then can bring the player to the sidelines and run a symptom checklist, which more and more coaches and trainers have been trained to administer.

According to officials at MC10, the sensors measure both linear and rotational acceleration to the head, which together calculate the total energy being delivered to the head.

Players with stronger necks will experience less acceleration than players with weaker necks, says Isaiah Kacyvenksi, director of MC10's sports segment.

With medical device maker Medtronic as one of its investors, MC10 is also pushing forward with even more invisible wearable sensors. At CES it also showed Biostamp, a seamless sensing sticker due out this year that can stretch, flex and move with the body. The company says Biostamp will be able to measure a variety of physiological functions: data from the brain, muscles, heart, body temperature, even hydration levels. (No pulse oxymetry – at least not yet.)

Sensors are fine, but seeking qualified medical assessment quickly is the other technological tool being deployed to treat concussions. As I was researching my story on how telemedicine is expanding for the April issue of HealthLeaders magazine I spoke with Vernon Williams MD, medical director of the Kerlan-Jobe Center for Sports Neurology in Los Angeles. Williams also works with a group called the Sports Concussion Institute. In other words, he's a concussion expert.

"I've always been interested in applying technologies that make sense to medicine and trying to improve my practice, trying to improve access for patients, improve the experience patients have, and the value of the interactions," Williams says.

A common scenario goes like this: An athlete will sustain a blow to the head during a Tuesday practice or a Friday game, but the parent who needs to take him to the doctor cannot take off work for several days, or geography is a barrier, often for the initial appointment, but especially for followup appointments.

So, either the player's symptoms go unchecked and don't get care in a timely fashion, or due to lack of care or followup, patients are told by trainers to sit out for weeks or even skip the rest of the season.

"That's when I came up with this concept of using telemedicine and videoconferencing, and as it turns out, it was great," Williams says.

By sitting the athlete in front of a video session, the neurologist on the other end can ask the athlete to answer some questions or perform some simple exercises that help the neurologist confirm the concussion diagnosis and its severity.

And because injuries from concussions sometimes evolve rapidly, the ability to schedule followup assessments via video chat is a whole lot more convenient than scheduling a succession of doctor's office visits.

Now, more and more trainers are placing telemedicine "towers" (kiosks optimized for a video session) in their training rooms, so that injured athletes, with a trainer and even parents by his side, can be evaluated by the neurologist.

"The communication is far more consistent," Williams says. "We don't have to rely on just sending pieces of paper saying yes he's cleared, or no he's not cleared."

Teams working with doctors also now have a far more consistent approach to their players being returned to play, with consistent evaluation and management, Williams says. It also helps neurologists schedule these followups more efficiently as well.

Of course, once a platform like this is in place, it has benefits that go far beyond concussion treatment. "We can clearly see benefits where an athlete may have a good trainer on the other end where they're actually competing and participating and practicing," Williams says.

"That trainer may have a question about range of motion or an ankle injury or what have you, and they can fire up that videoconference and speak directly with an expert, and say, 'hey here's what's going on, here's what his exam looks like, what do you think? Should he come in? Does he need an X-ray? Does he need an MRI? Should we advance his therapy or his activity level another step?' So it is I think a great tool for improving communication and improving consistent and efficient evaluation and management."

A big enabler of all this has been the plummeting cost of those telemedicine towers, which in the past three years have plunged from a cost of $15,000 to something equivalent to a tablet with its ever-sharper display and built-in camera, and HIPAA-compliant software to ensure privacy, Williams says.

Telemedicine towers still have their place alongside tablets, because cameras on these towers can pan, zoom and tilt. But tablets are still usable as well.

"With the iPad, then they have to either position the iPad or someone else has to be holding it and reposition it so that they can be seen, but it's still achievable, and we still do it, and it works very well," Williams says.

After two full football seasons of use with high schools and colleges, Williams' clinic has conducted hundreds of telemedicine assessments of athletes. With 49 out of 50 states requiring clearance from a licensed healthcare professional prior to returning to play, the access telemedicine affords is making a big difference in treatment.

Add the sensor data to the mix, and you have the kind of analytics that can lift a whole population of at-risk athletes and provide a much larger evidence base to look at concussion and other sports injury trends over time.

Finally, it also provides yet more scenarios where a patient's initial encounter with medical help takes place via technology. Some said it wasn't possible, or advisable. But sports medicine is yet another example of this new reality.

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Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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