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Name of the mobile application
HHITT (Handheld Head Injury Treatment Tool).
Category of the mobile application
Sports medicine, Health and Fitness.
Requires iOS 6.0 or later or Android 4.1 and later. Compatible with iPhone, iPad and iPod touch.
About the app
Concussion stories are now endemic in mainstream media. Multimillion dollar class action lawsuits have been filed against sport governing bodies such as the National Football League and the National Hockey League, to name but two. Young athletes are retiring from sport because of persistent postconcussion symptoms, while some retired athletes are dying prematurely from neurodegenerative diseases or suicide.1 ,2 It is no surprise, therefore, that concussion evaluation and management standards have been raised in recent years. Although concussion protocols have been implemented in some sports, in particular at the elite levels, there is good reason to believe that there is considerable variation in the standard of care of many concussed athletes. Younger athletes and amateur athletes are at risk of receiving suboptimal or inadequate care.
It is hoped that new technologies such as smartphone apps will help to improve the standard of care delivered to these vulnerable populations. HHITT is a mobile neurocognitive assessment tool aiding in the diagnosis and treatment of concussions. It is comprised of a battery of nine interactive tests covering; short-term memory, balance, coordination, visual memory, impulse control, long-term memory, reaction time, problem solving and colour recognition (see screen shots). HHITT promises to allow non-healthcare professionals (eg, athletic trainers and coaches) to collect reliable on-site concussion data in a fast and easy manner, and subsequently allow healthcare professionals to evaluate the data remotely. As such HHITT is not designed to be a concussion education tool, but rather to document the cognitive performance of athletes. The most unique feature of this app is arguably its potential for telemedicine, that is, the neurocognitive performance data that is collected on-site can be evaluated remotely by healthcare professionals with experience with concussion assessment and management.
Use in clinical practice
Although HHITT was originally targeted at coaches and athletic trainers in youth sports to enable them to share on-site concussion data without medical supervision, it has a potential role in the clinical practice of sports medicine professionals too. The app is useful for healthcare professionals who specialise in concussion management or work with sports where concussion is relatively common (eg, rugby, ice hockey and full-contact combat sports). It can enable them to quickly and objectively report or monitor cognitive deterioration following head trauma. Moreover, because test results can be shared online via the cloud to registered users in a particular team, the app is suited for use in multipractitioner clinical settings. Alongside a detailed patient history and other crucial assessments such as the SCAT3,3 HHITT can help the clinical decision-making process pertaining to emergency management, cognitive rehabilitation and return-to-sport (figures 1⇓–3).
Free: Unrestricted use at no cost will increase the uptake among potential users.
Fast: Testing can be administered immediately after a suspected concussion, and the full battery of tests can be completed in <7 min.
Simple: The layout is simple and clear, which makes the app easy to use without any particular training. Moreover, the app also contains a practice test functionality that will allow any user to get familiar with the app and its test battery before starting actual testing.
Multiple team member access: Each team can include multiple users such as administrators, clinicians, and athletic trainers. All results are shared via cloud and can be reviewed in real time for clinical decision-making.
Registration: Simply downloading and installing the app to a mobile device is not enough to get started. Users are required to register on a website, receive a confirmation email and verify that email before any test data can be logged. Unfortunately, this process of registering as a user is cumbersome and it cannot be completed within the app itself, thereby making it a considerable barrier for some potential users.
Baseline testing: The utility of this app depends on the compliance with and quality of baseline testing. Following a suspected concussion, a postinjury test is administered. The evaluation of postinjury test scores is dependent on preinjury baseline measurements to determine if any changes in brain function have occurred.
Incomplete: Comprehensiveness is traded off for simplicity. No concussion examination is complete without a detailed history and the range of tests normally performed by a qualified healthcare professional, including the use of SCAT3,3 which includes the Glasgow coma scale, Maddocks score and Standardized Assessment of Concussion. Given that this app may be used by non-professionals, it would be have been useful to include clear notes on concussion warning signs and symptoms to watch out for (eg, the Pocket Concussion Recognition Tool).4
Mobile data coverage dependent: Although a strength of this app is its option of telemedicine, an online connection is required to log data. As sports fields for youth sports may not always have mobile data coverage this could be a decrease the utility of this app.