Mild traumatic brain injury, also known as concussion, is common, with more than one million cases in the United States each year. Up to 30% of individuals with concussion continue to experience chronic symptoms long after their brain injury. These symptoms may include things like headaches, insomnia, dizziness, fatigue, irritability, and memory problems, and they can have major impacts on productivity and quality of life. Individuals with concussion often experience multiple symptoms, and this can complicate treatment planning. The presence of different combinations of fluctuating symptoms across patients, and the varying factors that may lead to the persistence of these symptoms, make it difficult to develop treatments and evaluate their effectiveness in clinical trials.
To address these barriers in the field, Amanda Rabinowitz, PhD, is conducting an innovative study that will pave the way for more individualized treatments for people with concussion. Dr. Rabinowitz is the Associate Director of Jefferson Moss Rehabilitation Research Institute, Research Associate Professor at Thomas Jefferson University, and Director of the Brain Injury Neuropsychology Laboratory. Funded by the Peer Review Committee of our Institute and Jefferson Moss-Magee Rehabilitation, this study will help better characterize and identify patterns of post-concussion symptoms as they evolve over time in individual patients. “This line of research will potentially allow us to identify clinically meaningful symptom profiles to refine concussion diagnosis and treatment planning for those with persistent symptoms. Our work characterizing symptoms in this chronic stage of concussion will also contribute to better predictions of prognosis, evaluation of potential biomarkers, and stratification of patients for clinical trials,” Dr. Rabinowitz explained.
The study will use Ecological Momentary Assessment (EMA), a method that involves repeated sampling of participants’ behaviors and experiences in real time in their usual environments. For twenty days, participants will receive smartphone notifications five times per day, cueing them to start the assessment. Each time, they will complete the assessment, which consists of reporting the presence of 22 post-concussion symptoms on a 7-point Likert scale using a smartphone application. This approach will allow the research team to examine patterns and changes in symptoms within individuals over time. It will also facilitate the identification of lynchpin symptoms within individuals. These are the symptoms that primarily drive the dysfunction an individual experiences. For example, headache may disturb sleep in one individual, but it may be a secondary consequence of insomnia in another. The decision of whether to treat the headache or the insomnia would ideally be made based on which symptom is primarily driving dysfunction.
In the ongoing study, Dr. Rabinowitz and her team aim to identify person-specific lynchpin symptoms and examine the variability in these lynchpin symptoms between individuals. They will also conduct exploratory analyses on the relationships between parameters of personalized symptom networks and participants’ performance on neuropsychological tests at baseline and three months after completing 20 days of EMA. All 40 participants have completed the EMA portion of the study, and the final two participants are on track to complete their 3 month follow-up visits this spring.
“Currently, there isn’t an objective diagnostic test for concussion, so self-reported symptoms are often the only marker that we can use to assess brain injury. Improving our ability to clinically characterize concussion symptoms, through studies like ours, is an important step towards developing better diagnostic and prognostic tools to ultimately improve patient care,” Dr. Rabinowitz remarked.