Case Study: Getting back on your feet

Disclaimer: This article was adapted from a paper orginally published in the Journal of Physiotherapy Research (King et al. 2018). For privacy concerns the name of the patient has been changed.

Sacha didn’t feel so good.

A few days earlier, she had fallen off her stationary bike and clipped the side of her head on an unfortunately placed ceramic planter, opening a neat cut above her right ear. But after a quick trip to the emergency room and a handful of stitches, her wound seemed to be taken care of. However, Sacha was shaken up by the incident, and she decided to take a few days off from her job as an ER nurse. Two days later she seemed to be doing much better and felt ready to get back to the hospital.

But now, even though she felt ready to work - even though she wanted to work - her mind wouldn’t cooperate. Staring at the computer screen made her nauseated, and she was unable to focus on the pages and images that seemed to flash across with a blinding intensity. After a few hours of struggling to read through her mounting stack of emails, she decided that something still wasn’t right. She called her doctor, who referred her to a head injury clinic where she was given the Sports Concussion Assessment Tool (SCAT3). Sure enough, results from the SCAT3 indicated that Sacha had sustained a concussion during her fall. She was instructed to take 7 more days off from work, during which she would gradually increase her activity level based on how she felt each day.

One week later, Sacha was still feeling sick. A week after that - now 18 days since her initial injury - she reported feeling spacey and disoreinted; her dyslexia was worse than ever, and she had trouble reading. It was clear to both Sacha and her doctors that they needed a way to track Sacha’s recovery, a way to verify that her cognitive function was improving slowly but steadily, so that they could plan her gradual return to work.

Sacha’s doctor recommended a new product called the Brain Gauge.

Testing with Brain Gauge
On her first day of testing, Sacha had a reaction time (the measure that contributes to the Speed score) of 450 milliseconds - more than twice the average for someone her age. Her reaction time variability (which we call Focus) was even worse; at 65 milliseconds, the variability in her scores was more than three times the healthy average. Both Speed and Focus depend on the frontal lobe, an area of the brain behind the forehead that controls movement and motivation. Sacha’s low scores for these metrics reflect her difficulty to stay focused on her work.


Sacha's scores on Day 18, Day 25, and Day 45 after her injury.

Sacha also had temporal order judgment (or Sequencing) and duration discrimination (Timing Perception) scores that were far outside the normal range. Finally, her low Accuracy score in particular correponded well with her reported ‘spacey’ feeling; this metric reflects the function of the parietal lobe, which controls sensory perceptions.

Overall, Sacha recorded a corticalmetric of 37. Remember, this was 18 days after her injury, and more than two weeks since she was orginally cleared to return to work. Sacha was still healing; her brain needed more time to rest.

One week after her initial Brain Gauge tests, Sacha returned to the clinic for another assessment. She still suffered from bouts of nausea and a general ‘foggy’ feeling, but had been able to follow the recovery plan outlined by her doctors. She could now watch television and read on her computer for extended periods of time, and was able to drive herself home after work. Sacha’s employer had also been extremely accomodating to her injury, partnering her with a ‘buddy-nurse’ who could document her work when she was feeling less than 100%. She was also allowed to take frequent ‘quiet time’ breaks during the work day whenever her symptoms returned.

The recovery plan was an undeniable success. Sacha had improved her Speed by 25%, and her Timing Perception and Accuracy scores were now well within the normal range. Most importantly, she felt better; her dyslexia was improving and she was comfortable returning to a full work load with the knowledge that she could take mental breaks as needed. Her corticalmetric was up to 75, an incredible 101% improvement since only a week before.

Back to work
On her final Brain Gage testing session, 48 days after her run-in (bike-in?) with that dastardly potted plant, Sacha scored within the normal range on nearly all of her metrics. She had the Speed of a collegiate sprinter, the Accuracy of a sharpshooter, and the Timing Perception of a rockstar. The visual display in the Brain Gauge app showed Sacha clear evidence that her recovery plan was working, and she was excited to watch her scores improve with each testing session. The diversity of metrics provided by the app also allowed the physicians and Sacha to monitor her wide range of initial symptoms.

We love hearing stories about how the Brain Gauge has helped people recover from their injuries. Sacha was fortunate to have an understanding employer that worked with her to gradually return to work, and it's important for all employers to realize that coming back from a brain injury can take a long time. Sacha’s scores continued to improve over the next few weeks until leveling out into the normal range. She is now back to full-time shifts in the ER, caring for her patients and keeping a watchful eye out for those spacey, foggy-headed symptoms that she’s all too familiar with.

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