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Smart Phone Application for the Management of Mild Traumatic Brain Injury

Keywords: Mild traumatic brain injury, concussion, management of concussion, smartphone applications, sport-related brain injury, brain injury.


Mild traumatic brain injury (mTBI) is a common injury amongst Canadian children and adolescents; prevalence reported at 200 per 100,000 [1]. Following mTBI, inappropriately timed physical and cognitive exertion can result in delayed recovery, prolonged functional deficits, or more serious injuries [2]. Return to activity following mTBI involves gradual reintegration of progressive physical and cognitive load [1, 3]. Currently, the progression through these stages is managed by self-reporting of post-concussion symptoms, e.g., headache, dizziness [1, 3].

Project Motivation

A significant concern with the current approach to mTBI management is that it solely relies on subjective reporting. This is especially problematic in children who may really want to return to activities such as sports and may not have an accurate concept of the potential for long-term damage. There is lack of an objective parameter to determine mTBI recovery in youth. Previous research has established heart rate variability (HRV) as a useful tool for evaluating stress capacity following severe TBI. Resting HRV can be indicative of readiness for activity following mTBI.

Research Objectives

To design a smart phone application that:

  1. Accurately collects and stores resting HRV data;
  2. Accounts for movement artifacts; and
  3. Displays information in a meaningful way for the user.

Resaerch Plan

Software Development
  • A technology (e.g. the Shimmer) will be used to collect the electrocardiogram and accelerometer data.
  • We will design an application to receive, collect and analyze heart-rate to get HRV, and develop motion correction software for HRV measurements when a person is mobile
User-Interface Design
  • We will use a participatory design approach to determine the content and features of the app using a participant group made up of stakeholders, such as physicians and end users
Testing and Evaluation
  • The applications precision will be measured by comparing HRV values between two testing session.
  • The accuracy by comparing HRV measurements from a standard 3 lead ECG recording device to the smart phone HRV measurements. 
  • The acceptance, usability and meaningfulness will be measured using Likert questionnaires

Project Significance

  • Address a practical clinical need for a better solution for the management of the return to activity for mTBI, while developing an accessible and user-centered application
  • Develop a novel technology that will help bridge the major gaps in our knowledge about how to objectively manage the issues of physical and cognitive exertion associated with the return to activity following mTBI

Research Team

Harminder Sandhu (University of Toronto)

Alex Mihailidis (University of Toronto)

Michelle Keightley (University of Toronto /Holland Bloorview Kids Rehabilitation Hospital)


  1. Sahler, Christopher S., and Brian D. Greenwald. “Traumatic Brain Injury in Sports: A Review.” Rehabilitation Research and Practice 2012 (July 9, 2012): e659652. doi:10.1155/2012/659652.
  2. Guskiewicz, Kevin M., Scott L. Bruce, Robert C. Cantu, Michael S. Ferrara, James P. Kelly, Michael McCrea, Margot Putukian, and Tamara C. Valovich McLeod. “National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion.” Journal of Athletic Training 39, no. 3 (2004): 280–97.
  3. Team, Guidelines Development. Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms. [S.l.]: Ontario Neurotrauma Foundation, 2010.