KU researchers aim to improve concussion symptoms in a new way

It isn’t every day that the sound of a cowbell is part of medical research, but that clang features prominently in a new study on a novel way to help patients with concussion led by Lauren Mann, Ph.D., assistant professor of hearing and speech at the University of Kansas School of Health Professions.

In this pilot study, a computer-based interactive metronome makes the ringing sound of a cowbell at regular intervals. Study participants, meanwhile, clap along, aiming to time each clap precisely with each cowbell beat.

Interactive metronomes such as the one employed in this study often are used clinically as a rehabilitation tool for children with autism, motor disorders and attention-deficit hyperactivity disorder, to help them improve their sound processing and learn to coordinate their movements.

Mann is interested in the sound processing deficits in adults who have suffered a concussion, and how this tool might help them recover. The brain uses the timing of sound to help with motor coordination. “So what we're looking at is, how can we tap back into that timing? How can we train it, even, and use that as a therapeutic tool?” said Mann, who also co-directs of the Auditory Research Alliance (AURA) Lab at KU Medical Center.

More than a million concussions are reported annually in the United States, and roughly half of patients experience persistent symptoms. In addition to headache and cognitive impairments, patients with concussion often report auditory and balance symptoms, including tinnitus (ringing in the ears) and dizziness. Nevertheless, most of the standard questionnaires used to evaluate concussion do not address any of these problems, noted Mann, who was a neuro-audiologist at the Center for Concussion Management at The University of Kansas Health System before earning her doctorate and focusing on research.

Recent research at Northwestern University using an interactive metronome has shown that concussion alters auditory timing and disrupts rhythmic skills (the ability to synchronize with a beat) in children. Mann wanted to know if the same was true in adults. She and KU Medical Center co-investigators Michael Rippee, M.D., associate professor of neurology, and Linda D’Silva, Ph.D., assistant professor of physical therapy, launched the study with a grant from the KU Center for Community Access, Rehabilitation Research, Education and Service (KU CARES).

This preliminary study is focused on getting a baseline measurement of how well adults who have at least one post-concussion symptom, including tinnitus, dizziness or difficulty with auditory processing, are able to clap along with the cowbell beat.

“Most people are surprised that it's harder than they anticipate,” said Mann. “Once you get off the beat, it's very difficult for some people to correct it, especially after a concussion.”

The study will also measure how well patients respond to the feedback from the metronome, which includes sounds or visual displays that tell the user if their clap is too early, too late or on time. In addition, the researchers want to correlate concussion severity and types of symptoms with how well patients perform on the interactive metronome.

In the future, Mann would like to do a larger study and use imaging techniques to consider other motor tasks people with post-concussion symptoms could do besides clapping (e.g., foot tapping) and isolate which are most therapeutic for specific patient types.

“Rhythm is something that we can train, and you don't have to be born with it,” said Mann. “You don't have to be good or proficient at an instrument to engage with music and get some therapeutic effect from it. I think that's really exciting.”