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Device Technologies and Biomedical Robotics

Device Technologies and Biomedical Robotics - Poster Session A & B

N19 - Creating a quantitative, pre-hospital diagnostic tool to assess Traumatic Brain Injuries

Thursday, October 9, 2025
10:00 AM - 11:00 AM PDT
Location: Exhibit Hall F, G & H

Introduction: : Traumatic Brain Injury (TBI) can affect mobility, memory, reaction time, cognitive function, and communication and is major cause of death in the US. In 2010 alone, direct and indirect costs of traumatic brain injury in the US reached approximately 76.5 billion dollars (1, 2). Pre-hospital care, or triage, typically involves a first responder determining the patient’s stability and deciding on the appropriate level of both pre- and post-definitive care. There are few diagnostic resources to assist first responders in determining a patient’s TBI level, yet major decisions such as immediate interventions, hospital choice, and mode of transport are being made before definitive care (4). The Glasgow Coma Scale (GCS) is the primary neurological assessment used by first responders (5), yet data indicate that the GCS accurately predicted TBIs only about 40.8% of the time (6). Additionally, a systematic review of triage tools in the US and UK found that elderly patients are often under-triaged (6). Many states and municipalities have protocols related to patient transport when a TBI is suspected. For example, in Rhode Island, the state protocols dictate that every suspected TBI patient needs to go to a level one trauma center (7). This can pose a significant challenge to first responders in locations where there are few trauma resources, or in cases where TBI is difficult to assess. There is a definitive need for a simple and reliable technology, designed for both assessment and grading of suspected TBI, that is suitable for field-based use and challenging environmental conditions.

Materials and

Methods: : A device prototype was developed with a touch-sensing patient interface that incorporated color vision deficiency-informed color palettes, and accessible auditory output strategies. Particular attention was placed on simplification of the user interface to increase ease of use and assessment reliability for first-responders operating in challenging situations. The design process involved assessing the use environment; specifically determining the (1) storage constraints on a standard ambulance in use in Rhode Island, (2) typical arm reach length when first responders are initially reaching in to assess a patient in a passenger vehicle, and (3) environmental aspects of patient assessment including low light, noise, and weather. The prototype was also adapted for use by collegiate athletic trainers for immediate athlete assessment, and for potential use in field-based or remote environments. Figure 1 shows the initial map of the LED and capacitive, touch-sensing textile pad layout, colors and numbers were used to organize wiring, and an LED strip with 60 individually addressable, side-oriented LEDs, was woven through an acrylic and paperboard prototype base. Figure 2 shows the touch-sensing textile pads integrated within a moisture-resistant, blackout fabric sheet. Holes corresponding to individual LED elements were included in the fabric, and touch-sensing pads were connected to a capacitive input bus via conductive thread. An LCD with incorporated microprocessor, was programmed to illuminate a specific LED, then read an instance of tactile interaction with the nearest touch pad, turn off that LED, illuminate the next LED, and record the timing of this process for a given sequence.

Results, Conclusions, and Discussions:: The prototype was developed as described, and Figure 3 shows the current prototype device with a custom device base and rim, a two-part handle for safe use by a first responder, and clear, carbon fiber-reinforced overlay to allow for cleaning. In use, the first responder or assessment provider uses the small LCD screen (not shown) to select a particular sequence of lights to display. Lights will turn on in that sequence, and the patient will attempt to touch the associated touch-sensing element or pad nearest the illuminated light. Once the patient touches the pad, the LED goes off, and the next LED illuminates, and so on. The device records reaction time for the patient to complete to complete sequence of touches. A menu of programs is included, with increasing levels of difficulty. Initial testing returns accurate and repeatable results for the timing of a particular program, and an output display (not shown) indicates a level of possible TBI risk, based on the total elapsed time for the assessment. Future work includes (1) development of a clinical trial for the device to ensure appropriate risk categorization, (2) further development of the programming to ensure assessments that incorporate a variety of patient populations with an option for individual athlete profiles, (3) inclusion of haptic or sound feedback, and (4) completion of a carrying case designed to meet use standards for emergency equipment, including high density foam padding, reflective and chemical resistant fabric, and closures that can be manipulated with heavy duty gloves. This device could provide simple, safe, and reliable TBI assessments for various challenging and complex settings including athletic use, vehicular emergencies, and combat or conflict zones. Further development of this technology can provide vital information to first responders, so that appropriate care decisions can be made and resources can be used efficiently.

Acknowledgements and/or References (Optional): : References
1. “Get the Stats on Traumatic Brain Injury in the United States” [2018, August 9]. BrainLine. https://www.brainline.org/article/get-stats-traumatic-brain-injury-united-states. Accessed 13 October 2024.
2. Zyla, G. (n.d.). “Snapshots into Traumatic Brain Injury.” [2023, August 14]. Www.brainfacts.org. https://www.brainfacts.org/diseases-and-disorders/injury/2023/traumatic-brain-injury. Accessed 13 October 2024.
3. Powell JM, Ferraro JV, Dikmen SS, Temkin NR, Bell KR. Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil. 2008 Aug;89(8):1550-5. doi: 10.1016/j.apmr.2007.12.035. Epub 2008 Jul 2. PMID: 18597735.
4. Pélieu, I., Kull, C., & Walder, B. (2019). Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury. Medical Sciences, 7(1), 12. https://doi.org/10.3390/medsci7010012
5. Cleveland Clinic. (2023, March 26). Glasgow Coma Scale (GCS). Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/24848-glasgow-coma-scale-gcs
6. Alqurashi, N., Alotaibi, A., Bell, S., Lecky, F., & Body, R. (2022). The diagnostic accuracy of prehospital triage tools in identifying patients with traumatic brain injury: A systematic review. Injury, 53(6). https://doi.org/10.1016/j.injury.2022.02.020
7. Williams, K. (2024). Rhode Island Statewide Emergency Medical Services Protocols and Standing Orders. https://health.ri.gov/sites/g/files/xkgbur1006/files/publications/protocols/StatewideEmergencyMedicalServices-2024.pdf

Acknowledgement
Research reported in this presentation was supported in part by the Rhode Island Institutional Development Award (IDeA) Network of Biomedical Research Excellence from the National Institute of General Medical Sciences of the National Institutes of Health under grant number P20GM103430