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Published in CenterView on November 05, 2012
Dr. Denise Pouncey with son, Carson
Dr. Denise Pouncey with son, Carson

Repurposed device helps UMMC audiologists measure impact of traumatic brain injuries

By Gary Pettus

Carson Pouncey of Brandon was “trapped” inside an earthquake-in-a-box.

Dr. Ed Manning, left, clinical psychologist/neuropsychology, with audiologists, Dr. Denise Pouncey, center and Dr. William Mustain
Dr. Ed Manning, left, clinical psychologist/neuropsychology, with audiologists, Dr. Denise Pouncey, center and Dr. William Mustain

Harnessed within a rectangular frame resembling a gutted refrigerator, Carson clung to his equilibrium as he felt the walls around him move and the floor shift beneath him.

“Perfect,” said audiologist Dr. Denise Pouncey, voicing the relief of a medical professional, but most of all, of a mom confirming that her child is well-balanced – in every sense of the word.

Carson, an 11-year-old soccer player, had passed the rigors of the Computerized Dynamic Posturography device, an old piece of equipment with a new use he helped demonstrate: concussion testing, which UMMC’s Vestibular Laboratory is poised to administer.

“Concussions are a hot topic,” said Dr. William Mustain, the lab’s director, “and this test will not only help determine if a concussion has occurred, but it can also provide objective data which can help answer the vital question: ‘When is it safe for the athlete to play again?’”

In light of this newfound career for posturography (“balance testing”), the lab has added it to ImPACT, the established piece of its concussion testing program, which measures memory, attention span, reaction time and more.

But it’s important to get young athletes and other concussion candidates to the lab and verify a baseline, said Mustain, a doctoral-level audiologist. This information would disclose what normal balance is for each individual, instead of relying on a standard range of normal – a critical distinction, particularly for athletes, whose sense of balance is likely to be above average.

“If the same patient should suffer a blow to the head later, new tests would be compared to the baseline,” said Dr. Ian Windmill, an audiologist and chief of the Division of Communicative Sciences.

The lab already was using posturography to evaluate people who complain of dizziness, vertigo, imbalance, etc., because of disease, trauma, aging or other conditions.

Word of its new potential arrived at UMMC through an e-mail to Pouncey, a doctorate-level audiologist with an Au.D. The message, from the manufacturer, NeuroCom, declared that the National Collegiate Athletic Association endorsed its use for concussion testing.

Mustain researched the claim, contacted Dr. Ed Manning, clinical psychologist/neuropsychology, and together they and others formed a plan to swell posturography’s repertoire.

The test is based on the knowledge that the body maintains balance through touch, vision and inner ear balance. The muscles receive signals from those three systems; but for people with, say, vertigo, at least one of the systems is out of whack, Windmill said.

“Take people who get car sick,” said Windmill, who has a doctorate. “Usually this happens when they’re passengers in the back seat. Their eyes see the seat in front of them, which doesn’t move or change, so their vision says, ‘You’re not moving.’“

But the inner ear, which acts as a motion sensor, begs to differ. In some cases, the brain chooses one sense to believe, but “some brains don’t make the right choice,” Windmill said.

“So you throw up.”

Because a concussion affects either the brain functions or the inner ear, causing imbalance, posturography is helpful in ferreting out the injury. Research shows that, for exposing inner ear disorders, it’s more accurate than clinical exams.

And some other, conventional tests, including CT scans, aren’t always reliable, Manning said. Nor are they as lively.

Inside the posturography compartment, patients stand on a platform that gauges stability of stance and posture. They’re asked to close or open their eyes while the platform is either stable or moving.

Some lose their balance, but the harness keeps them from falling.

“All the patient has to do is try to maintain balance,” Windmill said.

The cost of the test is $120 per person. Insurance doesn’t cover it, but there’s a 20 percent group discount.

The staff of the Vestibular Lab wants to enlist parents, coaches, schools, booster clubs, physicians and others in the baseline-testing endeavor, especially in light of some disturbing studies.

“Research is raising concerns about the long-term lingering effects of a concussion on children – changes in behavior, decreased academic performance,” said Manning, who has a doctorate.

Another study, presented in October at the American Academy of Pediatrics National Conference and Exhibition, revealed that, during the past two years, 32 percent of high school football players surveyed did not report concussion-like symptoms, such as vomiting and headaches.

Released by Dr. Michael Israel of the University of Arkansas for Medical Sciences, the report showed that more than half of those athletes kept mum because they wanted to keep playing.

That attitude endures in spite of such recent high-profile concussion dramas involving National Football League quarterback Robert Griffin III and NASCAR driver Dale Earnhardt Jr. It endures in the face of awareness campaigns created by the NFL and other pro sports organizations.

That awareness extends now to the entire Southeastern Conference, which is scrutinizing its own sports-related concussions through a committee that includes Mustain and University of Mississippi Chancellor Dr. Dan Jones, who chairs it.

Also close to home, during the upcoming legislative session, the Brain Injury Association of Mississippi again will push for passage of an awareness bill – this one requiring the annual distribution of information about concussions to athletes, coaches, parents and officials in all sports for children ages 7 to 18.

Similar laws have passed in at least 40 other states, said the organization’s executive director, Lee Jenkins, who was intrigued by the Vestibular Lab’s announcement.

“We meet with coaches and athletic trainers all over the state,” she said. “I’d like to offer to get the word out about the new concussion test.”

A BLOW AGAINST CONCUSSIONS

CONCUSSION SYMPTOMS
    • Acting confused, feeling “spacey” or not thinking straight
    • Being drowsy, hard to wake up or similar changes
    • Headache
    • Loss of consciousness
    • Loss of memory
    • Nausea and vomiting
    • Seeing flashing lights
    • Feeling like you have “lost time”

EMERGENCY SYMPTOMS
    • Changes in alertness and consciousness
    • Seizures
    • Muscle weakness on one or both sides
    • Persistent confusion
    • Remaining unconscious (coma)
    • Repeated vomiting
    • Unequal pupils
    • Unusual eye movements
    • Walking problems

Source: The National Institutes of Health