Rollcage Medic Podcast

Feast your ears and eyes on podcast and vodcast goodness, as I pick the brains of the leading lights of the motor sport medicine and rescue community.

Some will be well known, others working in the background, but all are experts in their field with acres of experience that they are willing to share.

So tune in, turn on and absorb the goodness.

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Podcast 16 - Michael Hoffer and Virtual Reality for concussion

February 10, 2017
(Image from Dr S. Olvey's presentation slides at the ICMS 2016 AGM)

More concussion. We can't get enough of it. It has mushroomed over the past few years and is firmly in the public awareness, especially amongst sports competitors.

Until recently, there have been two levels of diagnosis; point of care and clinic-based. Point of care testing occurs on the sidelines or in the event medical centre and needs to be:
  • rapid,
  • easily applied,
  • cheap,
  • easily accessible
  • and have good test characteristics (sensitivity, specificity, PPV, NPV, repeatability, reliability and validity).
For this, in addition to clinical assessment we have test like the ImPACT, SCAT and King-Devick which we've discussed previously.

Clinic testing, while more accurate, tends to:
  • require specialised training to conduct and interpret
  • need a specific appointment to attend which take a reasonable amount of time
  • be conducted only at specific centres
  • be expensive

If only there was something to bridge the gap.

Luckily, some plucky researchers and engineers have taken a simple concept that uses bulky equipment and applied virtual reality style technology to try and develop a portable, easy to use and interpret diagnostic modality for concussion called the IPAS Goggles. And they sound great.

Prof. Michael Hoffer is one of the lead researchers on this project and I met him briefly at the recent ICMS meeting in Indianapolis where he showed me how the goggles work. He agreed to come on the podcast and discuss the background to the goggles and the evidence that his team has produced to date. He also talks about issues such as the potential to game some of the current sideline assessment tools that use a baseline, the potential for young, fit athletes to outperform tests even when impaired (similar to how they may outrun a treadmill ECG during assessment for chest pain) and a little bit about the potential for placing commercial gain over test validity for conditions such as concussion that may be hard to diagnose and yet have significant possible consequences and popular and media attention.

The IPAS set up at the ICMS conference.

An example of the real-time data display

Here's the podcast

Here are three papers that link vestibulo-occular deficit to concussion:

And an overview of occular defects in concussion in general:

Sports-Related Concussion: The Eyes Have It. Leonard V Messner. Department of Optometry, The Illinois College of Optometry, USA.

Here are the two published papers mentioned by Michael in the podcast:

Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury. Balaban C, Hoffer ME, Szczupak M, Snapp H, Crawford J, et al. PLoS ONE 11(9)(2016): e0162168. doi: 10.1371/journal.pone.0162168. PubMed PMID:27654131
Clinical trials in mild traumatic braininjury. Hoffer ME, Szczupak M, Balaban C. J Neurosci Methods. 2016 Apr 30. pii: S0165-0270(16)30073-5. doi: 0.1016/j.jneumeth.2016.04.021. [Epub ahead of print] PubMed PMID: 27141855.

One concern regarding these goggles is that they rely on the concept of occulovestibular dysfunction (measured via reaction time; hence OVRT) reflecting the presence of concussion through disturbance of vestibulo-occular reflexes such as the optokinetic relex, cervico-occlar reflex and the vestibulocolic (not what you think that is) reflex. Reports suggest that anywhere between 10-80% of concussed patients with have an occulovestibular defect (either of version or vergence). So while the sensitivity of the goggles might be excellent in patients with an occulovestibular defect following concussion, what is it for a concussed patient with no OV deficit and therefore should test candidates be pre-screened for dizziness, vertigo, balance and visual impairment first?
(Version = saccadic movement, gaze fixation and smooth pursuit. Vergence = diplopia, accomodation, strabisumus)

If you want to know more, you can email Michael Hoffer directly or go and have a look at the NKI website.

What do you think? Possible game-changer?

Podcast 15 - Fabian Berger, tornado jets and human factors training

December 3, 2016

Fabian Berger is a tornado pilot with the German air force and amateur race car driver. He is also an aircraft accident investigator.

He was inspired to take his aviation experience of simulator based training, crew resource management (Fabian calls it Race Resource Management to better contextualise it) and human factors education to race officials and motorsport medics, so that's what he did through the DMSB in Germany.

I caught up with him after his talk at the FIA Institute's chief medica...
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Podcast 14 - Dan Marin, the ICMS and PRI_2015

December 1, 2015
Motorsport medicine is a lot of fun. There are fast cars, (mostly) good drivers and you get to work with a small group of similarly aligned individuals in a fairly challenging environment. Often it's the social aspect and the things that you learn along the way that keeps you coming back.

And medical conferences play on that socialising/networking/learing framework. So thankfully there are a handful of motorsport medicine conferences at various times of the year. Last year I went to my second ...
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Podcast 13 - The medical communicator role with Don DiGiglio

September 18, 2015
I've been chasing this podcast for a while now. My guest for this one is Mr Don DiGiglio, who has been the medical communications operator for the Formula 1 GP since it started in Adelaide. At the recent WRC Rally Australia in Coff's harbour I finally managed to convince Don to sit down over a cup of tea and a choccy bickie and chat about this often under appreciated role.

It can be a tricky job, balancing the communication demands of the medical and rescue teams as well as what is going on in...

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Podcast 12 - Impact Brain Apnoea with Mark Wilson

May 1, 2015

Impact brain apnoea is a topic I've wanted to cover for a little while now. It's something that I became aware of about eighteen months ago and I've been planning to put something on the Rollcage Medic site for the last couple of months. Chatting to a motorsport medical provider recently gave me the spark to get on with it and track down someone who I could tease out the topic with.

And through the myriad corridors that make up the online world of FOAMed (Free Open Access Medical education, #F...
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Podcast 11 - Hugh Scully and Rob Seal - Part 2

April 2, 2015

This podcast continues on from Podcast 10 and was recorded at the end of the FIA Medical Summit in Doha in December last year. Profs Hugh Scully and Rob Seal and I talk about motorsport medicine as a pre-hospital entity, the importance of data, audit and research in the evolution of motorsport medicine rescue and safety and the roles that motorsport competitors have in their own rescue.

For more information on the content of the FIA Summit, go here: FIA Institute Medicine in Motorsport Summ...
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Podcast 10 - Hugh Scully and Rob Seal - Part I - History, Track craft and Crew Retention

March 9, 2015

Doha was fun! Not as much fun as Istanbul two years ago, but still fun. Hopefully you've had a chance to skim through the overviews of the two day Medicine in Motorsport conference, held as part of the FIA AGM last December which I posted a while ago, so you know roughly what was discussed. Certainly the social program at Istanbul was a lot better, but this time I met a lot more people and really interesting people. It's really clear that there are a bunch of really smart individuals who work...
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Podcast 9 - Dr Ian Roberts and lessons learned in motorsport

January 2, 2015
I hope you all had a good Christmas and sent 2014 out with a bang. It's probably why I haven't gotten much work done over the past ten days.

However, it's time to get 2015 up and running and to do that here is the podcast that I recorded with Ian Roberts while we were at the FIA Medicine in Motorsport Summit in Doha. If you want to know more about what was discussed at the Summit itself, I've posted a summary here.

Ian and I sat down in a side room of the ASPETAR Orthopedic and Sports Medicine...
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Podcast 8 - Decision making in high stakes environments with Mike Lauria

August 28, 2014

So last week I wrote a post about a presentation by a guy named Mike Lauria (@ResusPadawan)on the topic of "Making the call" that I found on Scott Weingart's EM Crit site.

Mike's presentation covers all of the key areas relevant to current thinking on critical decision making in high stakes environments, drawing on his experience as a U.S. military pararescueman and a civilian paramedic. (He is also now studying to be doc.)

This is an area I've been following for a little while now, through...

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Podcast 7 - Irish road racing and Australian circuits with John Hinds and Brent May

March 26, 2014
I spent last week in the Gold Coast at possibly the best critical care conference in the world ... smaccGOLD (You can find out the details in my blog post smaccGOLD ... All the hype and more). Amongst the greats like Scott Weingart, Cliff Reid, Victoria Brazil, Karim Brohi, Simon Carly, John Myburgh and Rich Levitan and the rising stars such as Louise Cullen, Grace Leo, Liz Crowe and Lauren Westafer, there was an Irish anesthetist and pre-hospital physician from Belfast who spends his weekend...
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