Podcast 17 – Naomi Deakin and Research in Motorsport Medicine

Naomi Deakin is a trauma fellow pursuing a PhD in England. No strange thing amongst doctors who are trying to carve out a place and career for themselves. Except that few choose motorsport medicine as an area to chase down that higher qualification. And yet why not? It's a fertile area full of possible aspects to explore.

Yet if you go looking for clinical advancement topics in motorsport your search will not take too long. There's just not that much too be found. This is odd for a profession who have clung to the tenets of evidence based medicine for their daily practice.

So, is no one doing any research in motorsport medicine and if not why not? Or is it out there somewhere sobbing gently in a dark and dusty basement craving the sunlight of publication?

Naomi and I discuss research in motorsport medicine (as opposed to motorsport in general) and try to unpick why there is such an apparent lack of it, the barriers to generating and disseminating it and spot some of the research hot spots coming in the near future.

The podcast was recorded using Skype with me in a back room at my parents house in Dublin and Naomi in her house in England. There are a few jumps and gaps throughout the recording and early into it my father decided to crack open his favourite movie score tracklist on Spotify in the room next door; but think of it as ambience.

Here's the podcast:

If you are interested in getting started in research in this field or have material that you want to get published somewhere, here are some starting points:

Motorcycle rescue sim from SMACC Dublin 2016

Training as a team is really important. Technical skills are honed, communication becomes targeted and succinct and deficits are identified and can be troubleshot. Organising and running team training sessions takes a lot of work and commitment on everyone's part, but it pays dividends.

The Social Media And Critical Care (SMACC) conference does its best to evolve each year and seeks to explore some of the outer edge areas of acute care medicine. Last year's conference was held in Dublin and amongst many of the well run prehospital workshops was a session on motorsport medicine. It consisted of a motorcycle road race scenario played out by the MCI Medical Team (with whom Dr John Hinds formerly worked), followed by an expert panel discussion that covered topics such as the differences and similarities between civilian and motorsport prehospital medicine, impact brain apnoea and managing celebrity patients in the age of social media.

There is a lot of good stuff in here, so it is a well spent 36 minutes.

Here is the video:

If you just want the audio (but really, watch at least the simulated scenario), here it is:

These media were originally released via the SMACC website here: Motorcycle simulation - https://www.smacc.net.au/2017/02/motorcycle-simulation/

Podcast 16 – Michael Hoffer and Virtual Reality for concussion

(Image from Dr S. Olvey's presentation slides at the ICMS 2016 AGM)

More concussion. We can't get enough of it. It has mushroomed over the past few years and is firmly in the public awareness, especially amongst sports competitors.

Until recently, there have been two levels of diagnosis; point of care and clinic-based. Point of care testing occurs on the sidelines or in the event medical centre and needs to be:
  • rapid,
  • easily applied,
  • cheap,
  • easily accessible
  • and have good test characteristics (sensitivity, specificity, PPV, NPV, repeatability, reliability and validity).
For this, in addition to clinical assessment we have test like the ImPACT, SCAT and King-Devick which we've discussed previously.

Clinic testing, while more accurate, tends to:
  • require specialised training to conduct and interpret
  • need a specific appointment to attend which take a reasonable amount of time
  • be conducted only at specific centres
  • be expensive

If only there was something to bridge the gap.

Luckily, some plucky researchers and engineers have taken a simple concept that uses bulky equipment and applied virtual reality style technology to try and develop a portable, easy to use and interpret diagnostic modality for concussion called the IPAS Goggles. And they sound great.

Prof. Michael Hoffer is one of the lead researchers on this project and I met him briefly at the recent ICMS meeting in Indianapolis where he showed me how the goggles work. He agreed to come on the podcast and discuss the background to the goggles and the evidence that his team has produced to date. He also talks about issues such as the potential to game some of the current sideline assessment tools that use a baseline, the potential for young, fit athletes to outperform tests even when impaired (similar to how they may outrun a treadmill ECG during assessment for chest pain) and a little bit about the potential for placing commercial gain over test validity for conditions such as concussion that may be hard to diagnose and yet have significant possible consequences and popular and media attention.

The IPAS set up at the ICMS conference.

An example of the real-time data display

Here's the podcast

Here are three papers that link vestibulo-occular deficit to concussion:

And an overview of occular defects in concussion in general:

Sports-Related Concussion: The Eyes Have It. Leonard V Messner. Department of Optometry, The Illinois College of Optometry, USA.

Here are the two published papers mentioned by Michael in the podcast:

Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury. Balaban C, Hoffer ME, Szczupak M, Snapp H, Crawford J, et al. PLoS ONE 11(9)(2016): e0162168. doi: 10.1371/journal.pone.0162168. PubMed PMID:27654131
Clinical trials in mild traumatic braininjury. Hoffer ME, Szczupak M, Balaban C. J Neurosci Methods. 2016 Apr 30. pii: S0165-0270(16)30073-5. doi: 0.1016/j.jneumeth.2016.04.021. [Epub ahead of print] PubMed PMID: 27141855.

One concern regarding these goggles is that they rely on the concept of occulovestibular dysfunction (measured via reaction time; hence OVRT) reflecting the presence of concussion through disturbance of vestibulo-occular reflexes such as the optokinetic relex, cervico-occlar reflex and the vestibulocolic (not what you think that is) reflex. Reports suggest that anywhere between 10-80% of concussed patients with have an occulovestibular defect (either of version or vergence). So while the sensitivity of the goggles might be excellent in patients with an occulovestibular defect following concussion, what is it for a concussed patient with no OV deficit and therefore should test candidates be pre-screened for dizziness, vertigo, balance and visual impairment first?
(Version = saccadic movement, gaze fixation and smooth pursuit. Vergence = diplopia, accomodation, strabisumus)

If you want to know more, you can email Michael Hoffer directly or go and have a look at the NKI website.

What do you think? Possible game-changer?