During this pandemic, diagnosing concussions has turned into a Catch-22 for many physicians.
While early intervention is essential for any brain injury, concussions rely heavily on in-person assessments — assessments that may now be difficult to complete.
“At the height of the pandemic, we were left with sending people to emergency, not able to offer them care,” said Dr. Sharon Johnston, a family physician and associate professor at the University of Ottawa.
According to the Ontario Neurotrauma Foundation, about 150,000 people in Ontario experience a concussion every year.
Frustrated by her lack of options for evidence-based virtual exams and the ongoing need for virtual care, Dr. Johnston began designing, with a team of concussion experts, a video-based concussion exam for use by primary care physicians.
The CMA Foundation contributed $5 million to the Foundation for Advancing Family Medicine (FAFM) COVID-19 Pandemic Response and Impact Grant Program. This program is helping family physicians innovate to provide care during the pandemic.
With $55,000 in funding through the COVID-19 Pandemic Response and Impact Grant Program, Dr. Johnston is on track to introduce this virtual tool in early 2021.
The tool amalgamates a novel virtual concussion exam framework developed by team member Dr. John Leddy (a Buffalo-based sports medicine physician who specializes in treating concussions) with the key elements for concussion evaluation recommended in the Ontario Neurotrauma Foundation Concussion Guidelines (co-led by team members Dr. Nick Reed and Dr. Roger Zemek).
In developing the tool, Dr. Johnston has adapted for virtual use a set of assessment procedures such as tracking a patient’s eye movements and using a series of manoeuvres to examine their head, neck, cranial nerves, gait and balance.
She’s now in the process of collecting feedback from 15 family physicians in Ontario on the potential challenges associated with using the new virtual tool, such as lack of Internet access in rural areas and the need to ensure patient safety.
“The individual practitioner has to judge the conditions,” Dr. Johnston said. “You can do the exam in between seven and twelve minutes depending on how easily your patient can move and understand instructions.”
One part of the assessment, for example, requires a patient to move from a lying-down position to standing up. During an in-person assessment, physicians monitor for dizziness and can step in to catch or steady patients if they lose balance.
“That’s a riskier manoeuvre. It may not be something we can incorporate virtually,” she said.
Other issues include lighting, which may make it harder for physicians to evaluate eye movements as compared with in more ideal in-person conditions.
After receiving this feedback, Dr. Johnston hopes to produce step-by-step information for family physicians and other primary care providers on conducting virtual concussion exams by the end of January.
The CMA Foundation funded 15 projects in the first round of the COVID-19 Pandemic Response and Impact Grant Program.