As an athletic trainer – an opinionated one at that – I struggle with all the “bells-and-whistles” in this conundrum that is the concussion issue. If you have visited here or heard me speak you undoubtedly know that mismanagement of concussions is the true issue of this complex paradigm. Yes, we need to know when a concussion occurs to begin the process in the right direction; however, this can be accomplished by simply making sure you have a trained medical professional on hand when the need arises. Getting an athletic trainer to cover the most at risk sports at the most at risk times is a great start (and in the authors opinion is the only choice if you want to have collision sports). Short of that,
education over-education is necessary for everyone: players, coaches, parents, officials, teacher etc. to properly identify and accept the nature of concussion in sport – it is a risk.
Even having an allied medical professional, like an athletic trainer (AT) at practices and games does not stop the injury from occurring. In fact, many products that may claim reduction in concussions or “possible concussions” are toying with fraud; at the very least they are practicing deceptive marketing. The point being, once we identify a concussion how do we and who do we send the injury to, to avoid the rest of the iceberg lurking under the surface of the water? Moreover, what tools do we have that can help get the right prognosis, treatment and recovery for the injured (and there are many out there)?
I feel there is a new product (I am not a paid endorser, nor have I been given compensation for this article/opinion) now hitting the market that may get us closer to the panacea that we are all hoping for (note I said “closer”). Although it may have been presented as some big secret; the C3 Logix: Comprehensive Concussion Care system is not a secret rather it is something I feel is a “game changer” for concussion care. It is not the be-all-end-all and DOES NOT replace an athletic trainer (rather enhance the AT) but, in my humble opinion it is a system that has the potential to address the areas where we are lagging. C3 Logix is the next level. C3 Logix was invented at the Cleveland Clinic and is being sold by Just Go Products.
Currently we encourage baseline testing of the brain and its systems to have some form of objective data to compare to after an injury, the most widely used are computer based neurocognitive test batterys – ImPACT being the most known and used. These type of tests are tools used to help with return to play decisions; by looking at the baseline results compared to the post-injury tests. However these applications have limitations, namely they only look at brain processing function (including reaction time). There are other tests that can be delivered in conjunction with these computer based platforms to assess other, as important, portions of the complex that is the brain and its functioning such as: balance, vestibular functioning, motor function and vision. This is where C3 Logix trumps what we currently have at our finger tips – it has what we currently have PLUS all of the above.
Certainly the gold standard for concussion assessment and management delivers on all portions, but until now it has been a piecemeal process (recently ImPACT has partnered with another company to encompass the balance portion). Unless, of course you have been using the SCAT3 as your baseline and post test instrument; this paper and pencil test envelopes all the process and was developed in a collaborative effort during the International Concussion Symposiums. This still presents a problem as different testers may observe and score differently on the portion of the SCAT3 that deals with balance; the BESS Test. Furthermore, there is not a portion of SCAT3 that deals with vestibular functioning or vision other than subjective questions and answers.
Having as much comprehensive information for a doctor to make return to play decisions, that is as standard and objective as possible is a win-win situation for everyone: players, parents, athletic trainers and doctors to name a few. C3 Logix I feel can and will deliver on this.
Take a quick look at the C3 Logix Overview and tell me it does not have what we all have been looking for in a single testing battery. Now, remember that passing a test like the C3 Logix or other testing platforms does not automatically mean return to play; these are not “clearance devices”, they are tools used to make the most informed decision about the management of concussion – the true problem of the concussion crisis.
A quick analogy would be talking to a mechanic over the phone about a weird noise your car is making and giving them a ton of subjective data, even letting them listen over the phone. A good mechanic can probably drill down to a preliminary diagnosis, but would you just let them service your car based on that alone? Probably not, you would feel much more comfortable with them (and hoping they don’t up sell you with made up problems) getting in the vehicle and taking it for a test drive and getting a true feel, along with hooking it up to a diagnostic machine. That is how C3 Logix can be viewed.
Other benefits of this next level thinking is that the baselines provide three important components to me – as well should most of you;
- The test is about 20 minutes, max – this beats ImPACT by about 15-20 minutes, but behind Axon Sports. Remember there are added components to the other platforms.
- Although it may add to the time of the test, this platform provides a one-on-one testing environment with the tester (most cases the athletic trainer for baseline and doctor in follow-ups). Not only does this eliminate the distractions of mass testing in a computer lab it allows for trust to be built.
- Sandbagging or deliberate non-performance on the test (in the hopes of getting back quicker – a real and present danger in all testing) is dealt with immediately. Trials on each component of the test where this can happen will not count and must be redone if this is detected by the software. This is similar to Axon Sports software that rejects baselines that have not met minimum requirements. Currently with ImPACT the tester has to look at results to make this determination – labor intensive.
Here are some screen shots:
The “polygon” view of recovery is very nice to see and simple to explain, it also pinpoints exact areas that need addressed. This can be extremely valuable when looking for the right rehabilitation professional (vestibular, balance, etc.) for treatment.Being so new, there is not normative data quite yet, but I have been assured it is on its way soon – allowing for assessment of injured athletes/people who did not take a baseline. There are other aspects to also highlight;
- Being cloud based, a test can be performed elsewhere and then reviewed by whomever is within the patients care.
- The application works offline, so in areas of horrible or no up-link availability you can perform the test then the info is stored until it can be sent to the cloud, then its off the device, making it HIPAA compliant.
Certainly there will be research done on this application by independent groups that will find faults and problems with it, as has been done with other applications. However internal research, particularly with the most exciting aspect – in my opinion – the balance assessment (because of its objective nature) has been very strong, comparing it against the gold standard of the Neurocom (SOT Test). Here is the C3 NATA 2013 Cleveland Clinic Concussion Poster for your viewing.
I freely admit that I have not had hands on with this product quite yet, still working up the funding to get it, but it is indeed on my short list. I honestly feel the C3 Logix brings us forward in concussion care and is above and beyond what is currently available. I am interested in hearing your thoughts on this.