Time is Brain: The Need for Real-Time Assessment and Monitoring for Stroke and TBI | LSI USA ‘23

Transcription

Henry Peck  0:06  

And thank you all for being here for joining us at LSI. And joining us for this panel. Again, my name is Henry. I'm the VP of Strategy and Growth here at LSI. And it is my absolute pleasure to be joined by four incredible leaders, academics, clinicians, legends in their craft across the board. I'll give a quick intro on each of these individuals and the intros include so much that I am going to read a little bit of information off this just to make sure I get everything in. I'll start down at the end. Over here we have Geoffrey Klass, Geoff is the CEO of Sense Neuro Diagnostics, an innovative med tech company that is diagnosing TBI and stroke by subtype and monitoring the brain in the neuro ICU. Sense Neuro has a $2.5 million contract with the DOD and as part of the Mayo Clinic accelerator. So thank you so much for joining us, Jeff. We're going to talk about the technology and the vision that your technologies painting for the future tonight. Joining him next is Dr. Hunt Batjer. Dr. Batjer is a vascular neurologist. He's a UT Southwestern Professor Emeritus and an adjunct professor at the Mayo Clinic. He's also the co chair of the NFLs committee on head, neck and spine. Thank you so much for joining us, Dr. Batjer. Dr. Munro Cullum is a neuropsychologist. He is a professor of psychiatry, neurology and Neurological Surgery at UT Southwestern. He also serves on the NFL is research and innovation committee and as a neuro psychology consultant for the Dallas Stars hockey club. He does research and concussion, traumatic brain injury and neurodegenerative diseases of the brain. Thank you so much for joining us, Dr. Cullum. And Mr. Mike Singletary. Thank you so much for joining us inducted into the Pro Football Hall of Fame in 1998. Played with the Chicago Bears from 1981 to 92. And if any of you are football fans, and we're not Bears fans, he probably terrorized your teams like he did mind. He was a member of the famed 85 Super Bowl team and he made 10 trips to the Pro Bowl. And today, he is committed and passionate about raising the quality of life for underserved and underprivileged communities of several large cities with an emphasis on education, health care, and food insecurities through changing our perspective, his nonprofit organization. So one more time, please quick round of applause for everyone joining us on this panel. And I couldn't be happier to pass it over to Mr. Singletary to kick us off, give a little bit of the context of why we're here and open this discussion up.

Mike Singletary  2:28  

First of all, thank you very much for having us. And it's been a tremendous time already. But when I think about why I'm here it was back in 1976. Starting having the opportunity to play football was really great for me. I remember when I first went out for the team, and everything I learned about tackling I learned in seventh grade. And I remember my coach telling me, you always have to keep your face up and keep your neck in your shoulders and keep your mouth closed. And so those were things that that I remembered when I got that technique. And I just begin to practice that I begin to, you know, over and over again, putting myself in position being able to visualize my technique at all times, and until it just became second nature. And when you fast forward that to what's happening today, in today's game, it's really amazing that there's not a lot of skill there. I mean, guys are playing or flying to the football and there's so little time to really practice your technique. You have to do it now when you go home. And so when guy started getting hurt, right when I retired from the game and and all of a sudden you know, 10 years later I'm hearing guys suffer with CTE because of concussion or whatever and I'm thinking you got to be kidding me. And I I don't ever remember having a concussion I played the game and cracked a lot of helmets and shoulder pads and things like that. And to me it was just the way you play the game. And but I was always consistent with my neck and my shoulders and my face up and my eyes wide open and I'm seeing what I'm hitting. And because of that I believe that That is the reason that I didn't have concussions. Because I believe our brains are so tremendously amazing that when you see what you're hitting, when you see what's coming, and your neck is in your shoulders and your mouth is closed, you know, with the jaw being the strongest muscle in your body, you prepared for that blow, you're prepared to deliver that blow. And so it's amazing to me when I look at the game today. And still, if guys really knew if coaches really could understand how important it is for players to keep their eyes open. And for the neck, and the shoulders, that relationship. If they can understand that, and how important that is, the game would be different. I see a lot of misconceptions about why certain calls are called you know, man, that was a bogus call, why did he make that call, but let's not even talk about quarterback. I'm just talking about tackling. That's a whole nother subject. But you know, one of those, there's the flag. Okay, let me get back to the homes. Right. So anyways.

Oh, that's good. That's good. So anyway, it's getting back to the tackling part of it. When, when you can see what you're hitting, and you can follow through. It's a safe game. It is a safe game. And so now when refs are very inconsistent, you know, any, any time a kid or young man or any young lady, whatever, anytime your head goes down, there should be a flag. That should be a flag. Because I believe that anytime that your eyes are not on what you're doing, your eyes are not on your opponent, your eyes are not on what's coming, you're vulnerable, you're at risk. And anything can happen. If you don't see that blow coming. If you don't see, when there's action, then who knows what you might wake up to think about it this way. When you look at a boxing match, it is not the really hard blows that come from way back here. And they swing and they hit the guy. Those are not the blows that knock the guys out. The blows that knocked the guys out are the ones that they don't see is the quick ones who, like you're out. Why? Because he didn't see it. And when you don't see it, then you can't prepare for it. And so for me as I begin to study this, that's why I drove me to meet Dr. Batjer, I begin to ask questions around Dallas, Texas, my hometown right now. And so I was trying to find out who can help me find out what's going on with this concussion stuff. You know, I'm the guy that when you talk about hitting, and I remember they wrote an article about me being dangerous to the game. You know, why is Mike Singletary allowed to play this guy is dangerous. I was like, Wait a minute. First of all, I'm too small to play. And now you gotta tell me I'm dangerous for the game. I'm one of the small guys. I'm the one you should be trying to protect. So I got to find Dr. Batjer and I find out to Bader and we meet several years ago and we began to talk and I'm just fascinated about the brain. I'm fascinated about what the brain can do and what an amazing tool it is. And being here and looking at everything that everybody's doing here that's working with the brain. It is so amazing. You're trying to develop apparatuses that that really makes a difference. But I wonder if we ever ever if we can ever really delve deep within the brain and find out even now, how wonderful our brain is and what it what is really capable of doing. I will be fascinated as to what we will find.

Henry Peck  9:46  

Yeah, Dr. Batjer, I'd love to kind of take a point that Mike raised about the game and the way it's played and, and for you Dr. Cullum as well. On this panel. We're fortunate to have perspective from player coach At the highest level, and individuals that have worked on the management and rules side of the game. And so when you think about what he was saying around the way the game is played, the relative risk of different types of hits, a lot of these things that we're seeing now in the hype cycle around CTE and what the general public has seen about the game, that may be before a lot of the rules changes, or things that you were a part of, and a part of working on and implementing. So maybe give us some perspective about what was going on on the other side during that time that we didn't see, and what can we as the general public expect from the future of the game with the things that you have been a part of?

Dr. Hunt Batjer  10:40  

Well, Henry, that's a very good question. But I would like to start by picking a little bone with you. He introduced me as a neurologist. Now, I can accept lizard, politician, sub human primate. But, but it would be like you referring to Mike, as a nationally known Gleek, Glee Club star. And

Henry Peck  11:11  

I got vascular in there. I was close.

Dr. Hunt Batjer  11:13  

A neurosurgeon does not call neurologist. Just FYI. Now,

Henry Peck  11:22  

My apologies.

Dr. Hunt Batjer  11:26  

So I do forgive you for that. 

Henry Peck  11:28  

Thank you. 

Dr. Hunt Batjer  11:29  

But the question relates to the play as Mike played it 70s 80s. And the rules were not forgiving for the head. And coaches would kick players that were down and kick them until they start moving and then get up, get back on the field. And even when I interviewed at the NFL Park Avenue, back in 2009, I believe, and Commissioner Goodell, he was, we had a very pleasant day, and he was leaving me out. And he said, Doc, you gotta come join us. And we need some so well, you know, there's there's a number of issues here. And I built some reputation over the last few decades and not sure I want to have a bullseye on the back of my head for an organization that's not really kept up in my view, he said, when we talk, what can we do? I said, Well, you don't have a rule that a concussed player has to leave the game for the day. He said, We don't have it. No, you know. So the next day he did, and he honored his commitment, believe me. and I we're unpaid volunteer medical members, rich Ellenbogen and I and we put together a team and it was really fantastic. With the national priority of CTE, that Mike Webster's autopsy brought this to the public for, and to really put together the pieces of, of how to protect players, rules matter, rules matter. And the elimination of spearing back in 1971. Shut off on field deaths almost zero immediately. So these things count and putting together, you know, the definition of concussion, how you manage the players, well, how we prevent them as best we can, and then return to play, knowing that that trickle down of all those rules would go to protect hundreds of millions of children worldwide. That played contact sports, FIFA football, for example. So that was that was sort of a forum for that. And it was really an honor and a great deal of fun for all of us to sort of start from scratch, and how can we do this in the right way, and it's continued to evolve. And I think that the onfield near death that occurred this season. You know, there's the two safest places to have cardiac arrest in the universe are at the American Heart Association meeting. And, and probably even safer is at an NFL game. There are 25 medical personnel on the field, and they know what they're doing. And as you can see, they launched into action and saved life. So thank you.

Henry Peck  14:45  

And you mentioned a little bit about the, what we saw this season, being you know, emblematic of a transition that's happening in the game, maybe changing the focus from the highest level down to the younger levels of the game where they don't have those same kinds of have resources especially outside of you know, Friday Night Lights football, there is a lot of there are a lot of young athletes in places where those resources aren't available. And so the a lot of the onus may be on local coaches, parents. And so I'm curious, you know, for a lot of the parents in the room? How do you answer the question of somebody who has a six or seven year old child that's wearing a Chicago Bears jersey and wants to play the game of football? What do you say to that parent about the the efficacy or the kind of the the risk profile of the game for that child and what they can do to manage it? And maybe for for everyone on the panel?

Dr. Munro Cullum  15:39  

Well, I do get asked that question quite a bit from parents. My son was a Division II soccer player had a share of concussions also. But I always talk about is the child at whatever age they're going to begin. And we can have that debate also. So it's a tough parental decision. Everybody has a different opinion on it. But the child has to be physically ready, and also psychologically ready. That's, that's something I really stress. I mean, if you're young Joey and in, in the fifth grade is, you know, 300 pounds and six foot four. That was a joke. You won't see that I don't think maybe outside of Texas but but if Joey's got the mentality of "Yeah, I just want to hit people. I want to, you know, I want to see him laid out", Joey's not ready psychologically, for that. Just like if you've got little, little, little Ross over here, who may be, you know, weighs 80 pounds soaking wet. And he wants to, you know, be the be the, you know, on the offensive line or something like that? Well, you might want to wait a few years give that some thought. We were doing research to look at frequency of concussions at different ages, we do see, at least in the state of Texas, that we see more concussions in the ninth and 10th graders than we do in the 11th and 12th graders. So we think that as the kids are learning more about the game learning being hopefully taught good practices, like Mike was saying that they are learning and the concussions are lower in those. But we still have a there's a lot to learn, you know, when we're talking about concussion, it's a clinical diagnosis, there's no single test for it, a brain scan won't show it, at least not at this point in time. And I'll leave that for later. This is a good group to be having this discussion, and I feel but right now, there is no brain test for it. An MRI is not going to show you if you got a concussion, there's no scan, there's no blood test for it. It's a clinical diagnosis based on behaviors, signs and symptoms demonstrated by an individual. So but a good it does require a good diagnosis. So when you're talking about these kids in these environments, you want to make sure that the the coach or the parents, the organization asked about their concussion policies. If little little Joey has a concussion, what do you guys do? And if they look at you blankly and say, What, well, we've never had one, well, you're going to at some point, so you want to know that they're also in good capable hands from a coaching or management perspective, too.

Mike Singletary  18:15  

For me, I wanted to, as I began to learn about young kids and bone structure and all of those things, I, I held our sons out until they were 12 years old. And because there were so many kids, and I talked to a doctor about this, and he said, you know, Mike, when when kids are so young, and they break bones or you know, have knee injuries or whatever it is more difficult, you know, first of all, the bones are still growing, and they're still maturing. And so they haven't even had a chance to have a basic knee that fully ready to participate in force, you're still growing. So if they have an injury prior to they mature, then it's always going to be trying to catch up, because it was never fully mature and ready to play to begin with. So when I heard that I just allowed my sons to play flag football until they were 12 years old. And matter of fact, I had one son, you're talking about maturity. My oldest son, you know, he that I want to play, I want to play I want to play they give me every day I want to play son, you're not ready to play, but I want to play I want to play Okay, finally. He was 12 years old. And he played and got the snot knocked out. And I get a call I'm coaching I get a call your son is wants to talk to you on the phone. And I'm like, really, you know, I knew he had his first game that day. And I get on the phone and he's like that I don't want to play tackle football. I don't want to play ever again. Like I was trying to tell you, if not what you think is pretty, but I'm gonna tell you something when the heat is on you. It's different, very different.

Dr. Hunt Batjer  20:17  

To good, I think I get asked that question about should my son or daughter play. And a really good litmus test to me is, if you present a scenario, what if what if I'm the mom and I'm at a game? And I've see Johnny or Susie come back from the field, and they're not right. And I tell the coach, what's going to happen? Well, if he says, Well, don't worry, honey, we'll take care of everything. That is the wrong answer. And the answer is, that's not the place to play. And the underprivileged areas, and so forth, don't have an athletic trainer on every field. And they don't have physicians there. And they don't have people that are really attending to this. So you got to really think about the environment that the child is going to be playing in. And pick, pick carefully. And age is my very nicely articulated equipment, impoverished areas, they recycle their helmets, refurbish them, and they can go 25 years, and they lose a lot of their characteristics over those times. And so that's something to keep keep track of also.

Henry Peck  21:28  

Thank you. And so in thinking about what you're talking about here, the the types of injuries that these players from the youth level to the highest levels of the game are prone to even with better rules, even with better instruction, maybe as we kind of get now into the future of this space, the technologies and the clinical needs. Can we define for the audience a little bit? Because I think as a whole, there's a lot of misconception and misunderstanding around what is a concussion versus versus TBI. What is CTE players are suffering from XYZ, let's get these terms set so that we can kind of continue the discussion thoughtfully. So Dr. Batjer, as a vascular neurosurgeon, please. Of course, I feel there is no one better to take this question on it. 

Dr. Hunt Batjer  22:11  

Henry is young and kind of slow, but he does learn. 

Henry Peck  22:19  

How'd you know I was the youngest one on stage?

Dr. Hunt Batjer  22:20  

So, you know, one of the things that is and I think Munro is going to is very better qualified to address a couple of those things. But I would say that the problems that we're talking about tonight are really they seem different, on first glance, traumatic brain injury, and stroke. And what would they have in common, and I'll give you a couple of perspectives on that? Well, they're both major public health problems. We have a million and a half stroke victims in the United States a year. And of those many, many die, and many are turn permanently disabled. And it affects the underserved population much more severely than the affluent population. That's an issue. And that's in common with brain injury, brain injury, we have hundreds of 1000s of Americans a year, who are killed or disabled for various types of head trauma, both severe and minor. And we have over 4 million Americans at least suffer concussions every year that Monroe has been talking about. Those are problems that are also focused on the underserved in our country. So that's another characteristic. But the really important one is that both of those areas, head trauma and acute stroke, require things that we don't have right now. Instant diagnoses that are accurate. And avoiding misdiagnosis and delays. That is fundamentally critical. stroke patient stroke is 1000 things, it's not one thing. And it's hard to make a diagnosis over the phone for someone receiving a call. So the paramedic gets there. And if that paramedic takes the patient to the wrong hospital, there's not equipped to deal with the severe types of stroke that costs hours of time. And brain is measured in minutes. And that patient has a very, very substantial chance of not surviving if he or she has the bad kind of stroke. And the same with with brain injury. So I think that's the common thread here. How do we get to the point of having a red light green light? Yes that that patient has a stroke. It is potentially a very bad one, we have to go to a comprehensive stroke center period. No more secondary and tertiary stops. So direct line. And for the, for the concussed player, if only we didn't have to do all the things that happen now. And it's deliberate. And the problem is 10% of those people don't get symptoms on the day of injury. They get symptoms on Tuesday or Wednesday as they start increasing their activity. So we need a red light green light for both of these diseases. And I think and that's really the common thread that we've gathered.

Dr. Munro Cullum  25:39  

I think that's really, really well stated. So concussion that you mentioned, there's a lot of myths and there certainly are. So loss of consciousness. If you see somebody there, they fall, they hit their head, they're out there motionless. That's, that's pretty clear concussion, right? Everybody can identify that you see on TV while there's a concussion, however, that occurs in less than 10% of all concussions, most concussions was occur, and they're not knocked out. They're not lying. They're motionless. So it can be a challenging diagnosis to make. There. There are other myths as well. So you mentioned that the issue of chronic traumatic encephalopathy or CTE that seems to be all over the media these days, I always encourage people, you've all been trained at some level, I know there's a lot of entrepreneurship, there's a lot of business interests, but you've all been trained also to be good consumers of information. So I always tell the parents of the kids that I work with, read behind the headlines, read the article, then go look at the original dataset. So you know, CTE is in the news. If you read certain papers, you'd think that it's like it's ubiquitous. If you hit your head, you're gonna get it. There was a survey done by NIH, for parents of young athletes. 25% said they were concerned that their kid was going to get CTE, if they had a concussion or participated in collision sport. Well, the likelihood of Johnny or or Joe set, getting CTE is probably less than the likelihood of them getting a host of other diseases or perhaps even being hit from the fallout from from, you know, an airplane flying above that accidentally discharges something, right? So, CTE exists, it is a brain pathology, it's only diagnosed postmortem with a brain sample, there is no living diagnosis of CTE. Although I hear about that, we are asked about that we see patients that come in and say, Well, my doctor said I have CTE well, your doctor shouldn't said that. Because they don't have a sample your brain, I'm pretty sure. But so we there's so much we don't know about CTE it does exist, we think it's rare. It's an abnormal accumulation of proteins characteristically in certain parts of the brain where it does look a bit different than some neurologic disorders. But it's been seen in patients without any history of traumatic brain injury, without any history of repetitive head injury. It's the accumulation of the abnormal proteins occur in about 20 other conditions. And we also don't know that there's any correlation between that pathology and any behavior in life. So when you hear about some of the exaggerated claims of suicide rates, well, actually, former NFL players do not take their lives as often as the average American male does over a certain age. So there's a lot of fallacies out there. But we don't think that CTE is something that everybody ought to be too worried about. However, we do need to learn who's really at risk for it, that's really what some of our research is, is is focused on to is figuring out who's going to have those lingering symptoms from concussion. So most people recover from a concussion within seven to 14 days, on average, it does vary by age kids take longer to recover. And then there's it's a bimodal distribution sometimes falls with older folks, they can take longer to recover too. But then there is a subset of people that still seemed to have some symptoms that go on several weeks, or even months later, and those are the ones we really need to understand better. We don't have a clear picture of what's going on with them. But again, you know, early detection early, good diagnosis is so important.

Mike Singletary  29:27  

I think one of the things that you're saying is so true and so important, because I remember when I started going back to some of the reunions and some of the guys that I played with some teammates, what have you, you know, you'd hear that so and so. You know, has CTE or so and so had a lot of concussion. And as teammates you know, you you know, who's doing the hitting and who's not. You remember the coach telling guys Hey, he Somebody hit somebody. And you know, later on, you're seeing this guy, and he doesn't know what his name is. And it's kind of like, I'm thinking, there's something more to it than that. Because a lot of guys that supposedly got a lot of concussions, they never hit anybody. So when I look at that, it's kind of, you have to take a step back and begin to really look at, maybe there are other factors, you know, some of the lifestyle, the some of the guys that, that I remember playing when I played, they live pretty, a tough life, that you can live and play the game at the same time you're burning the candle at both ends, you got to be able to get to sleep and you can't drink that and you can't smoke that and you can't snow at that. And so there are a lot of other factors that are involved in CTE. And I think when most people are talking about it, it's there's so much information that you have to sort through before you really really put your finger on. This is really, as a result of physical contact in football.

Dr. Hunt Batjer  31:22  

That's a great point and tell you the the hype around CTE as has been fodder for a lot of disinformation out there. And and Joe Maroon, a neurosurgeon and neurosurgeon reported this 70, only seven years worth of CTE experience worldwide. And 20% of those people diagnosed at autopsy had a history of opioid abuse and and opioids are an independent cause of tau apathy in the brain. So that's a confounded variable. The other is, you'll hear people making the diagnosis, they'll see a former player, former serviceman or woman getting cognitive issues and depressed and so forth. And they say, well, it's CTE. And there have been examples of people that were so depressed by that news. And one in particular, that I know, didn't want his children to see him deteriorate. And he took his own life as a result, and he did not have any degenerative brain disease, he had depression. So keep that in mind. That's it's an pathological diagnosis, not a clinical one.

Henry Peck  32:44  

It's really interesting to hear you guys talk about this problem. Now as as just in those last few testimonials, we've touched on populations far beyond just the athletics community. And obviously, these conditions affect the athletics community, and in many, many ways based on the types of games that we're talking about here with football and professional hockey. But you mentioned juvenile to elderly populations and the aging, you mentioned, athletes, veterans, as Dr. Batjer mentioned with with servicemen and women. So I'd love to kind of now widen the aperture a little bit to beyond athletics, inclusive of athletics. But beyond that, the problem space that we're in the clinical need. And the issue is, as you mentioned, with missed and delayed diagnosis of these conditions, and maybe over to Geoff to talk a little bit about the clinical problem that you and your team had sense neuro diagnostics are solving and what you're seeing from the opportunity to use innovative technology to remedy some of those gaps in the diagnostic and monitoring journey that Dr. Batjer, Dr. Cullum and Mike are talking about.

Geoffery Klass  33:46  

Sure, thank you. And you know, I do need to say, as Mike would tell you, you're only as good as the players on your team. And here at Sense we are really fortunate to have these players on our team helping us with what we're trying to do. So we're very appreciative. The other thing is, I'm not a neurosurgeon, so don't accuse me of that.

Dr. Hunt Batjer  34:06  

He's a neurologist.

Henry Peck  34:11  

We are not going to make many friends in the neurology community tonight. Dr. Batjer. 

Geoffery Klass  34:15  

So anyway but so it says, We understand delayed treatment is the big problem. Right Time is brain is what we say. So and your every minute of delay is costing that individual millions of brain cells. So that's the problem we're trying to solve. Dr. Baker talked about, give me a device, it's red light, green light. We have a contract with the military and we're developing a device that is exactly like that. So if a warfighter is hurt out in the field, they put the device on it's very similar to this one, but it has a red light, and a green light. Green light is okay. Red light, bloods present if the light starts flashing, that bleeds expanding, and that device will then flip into monitoring mode. And we'll monitor his condition until he's medivac and gotten into a field hospital. So we're trying to solve this problem, this device here will be used both in the ER, and in ambulances. And this device, when put on the patient will tell them if they're having a stroke. But more importantly, what kind of stroke it is. So if it's a large vessel blockage, a crowded arteries block, that's very important, you have to get that person, right to a comprehensive stroke center. If it's smaller blockages taken to a regional, they get TPA, which is a clot busting drug, the sooner the better, you get that into them. So and then if there's blood present from a traumatic brain injury, it's going to tell them right away. So in the field, they know what hospital to take them, they get them to the right hospital at the right time, for the right treatment, in the ER, stroke is one of the most misdiagnosed cases that they deal with. So, but they don't have any technology. Again, it's a very subjective assessment of that patient. Again, now with this device, someone comes in, they have a neurological client problem, but the device on their head right away, for those patients that are most acute, moving to the head of the line, get them into a CT, give them the kind of treatment that they need. So you know, the device is what you have, I mean, this is really sensitive, it, it works in two and a half seconds, it gets 360 data points to the brain, the entire cranial vault, we can see blood as small as a half a CC, so that's about a half of a green pea. So we're seeing it really small. And but by giving that kind of information to the clinician, or to the ambulance personnel, they really know what to do with, we're able to pull that person who is most at risk, and get them to the head of the line there, it's 40 to 80,000 preventable deaths in the US happened each year, just because of misdiagnosis. So getting this kind of device out in the field as quickly as we can, is very, very important. The other thing that we're developing is another device, which will monitor a patient's brain when they're in the neuro ICU, that lead can expand. And they don't have any way to really determine if in fact, that leads expanding until they show outward signs of decline. With our device, it's going to scan him every minute, they'll do that two and a half second scan once a minute. And if the bleed begins to expand, we pick it up right away, we'll alarm people come in and take that patient, then move them off, and get them the kind of treatment that they need. So serious problem is Dr. Baker and all have have, you know, said but, you know, we got the technology now that we could do this. And we're going to be able to, you know, treat these patients get them to the kind of treatment that they need to really save lives. So we're close. We have our bleed detection device, which is probably about 14 months from market. You know, we're only about $2 million of a trial short. But we're really, you know, our plans are there. And then we'll move to the triage device in the monitoring device. So that's where we're at Henry. Thank you.

Henry Peck  38:14  

Thank you. You mentioned stroke by subtype. And the importance of that. And I think that's probably something that, you know, a lot of people are unfamiliar with, we know as we talked about stroke and TBI and understand those different conditions now, but talk a little bit more about the importance of that identification of stroke by subtype and how that's impacting clinical decision making, especially in those emergent moments.

Geoffery Klass  38:34  

Right, exactly. So, you know, right now, ambulance EMTs come up on a patient, they think they have a stroke, they're not sure they have a stroke, or they they were in a car accident, they think they may have a problem. But the most typical, it's scootin scope and scope is what they do is the model. So you pick the patient up and you get them to the closest Regional Hospital. It's when they get in there, then they take them in for a CAT scan. And then somebody comes along and reads the CAT scan. And then they go, Oh, we got a problem. Right. And that's the four hour delay that Dr. Batjer talked about. Because at that point in time, they realize we have an active bleed, we have a blood clot in the carotid artery, we've got to get this patient out of here because we can't take care of this. So but by the time they get everything, you know, the paperwork done and get that patient loaded back up and moved over to the neurosurgeon to treat. They've lost an awful lot of time. And again, millions of brain cells die every minute. And now your four hours of minutes that have been delayed for the treatment of that patient.

Henry Peck  39:36  

It's incredible. I'm curious from all the different perspectives and hats that are on this panel. With technology like this now, what do we see being next when this is becomes available? How is this going to impact the work and the research you're doing the communities that you're a part of in serving and working in and around? And what do you see as being the next evolution of this type of technology, be it other technologies that partner in support this future indications are areas where this could be useful and valuable to serve more patients. What kind of what happens now that this is made available?

Dr. Hunt Batjer  40:13  

That's a hard question to answer the, but I think the point has been made that safer stroke is a very heterogeneous problem. There are some that are minor, that need aspirin, for example. And that's all and they're going to do fine long term. It and the at the other end of the spectrum is a large vessel occlusion, the blood clot and in the middle cerebral artery of the basil or trunk. And that is that is a very important group, that 80% dead and disabled in three months is the result of that disease. And it often isn't the young patients that get it. So that's the one that we really want to be able to get quick. Because the stroke revolution of 2015 was for prospective randomised trials that showed that embolectomy by endovascular techniques to take the clot out of the artery is dramatically life saving if you get it done quickly by by the proper team. And I think that differentiating that patient from all the others, is going to be really critical. And that sort of moment of pickup or first moment in the in the ER to be able to make that sort of determination, because that tells you exactly what the patient needs and where they need to get it. The other possibility that we've been batting around is the idea of reaching out to the underserved areas, to provide infrastructure and even through I won't get into the details, but robotics to be able to intervene in that critical patient that has a 80% chance of being dead quickly. Then it can be taken over by somebody remotely. And with a robot in that er, to do the take over the procedure. So that's something that we're batting around Mike and I and Munro and I've been talking about that concept, and we're going to make that happen. But we have to have the quick diagnostics,

Mike Singletary  42:27  

I think it definitely would make the difference in saving lives. I know that you're in my family, I'm the last of 10 kids. And several of my siblings were being rushed to the hospital, whether it's hypertension, whether it's obesity, whether it's whatever it is, and you know, I think a device like this gives the doctor the physician it empowers them to make the right decisions. And, and to when you have a life in your hand, it makes a difference and too often people that live in the low socio economic areas. You know if if you go into the wrong hospital, nobody knows that it was the wrong hospital to begin with. This makes it corrected it creates accountability, it creates empowerment. And I just think that it just anytime that you can really have something that helps you make the right decision, then you got a chance. Everything else is great, but you got a chance

Dr. Munro Cullum  43:48  

I'm really excited about the potential future of technology in neurologic diagnosis quite honestly, I'm a neuropsychologist so we administer tests of memory attention concentration, thinking speed things like that. So we we evaluate patients after concussion several days later to see if their return to normal Are they still a little bit slow? The NFL was one of the first ones to have a careful return to play protocol, the NHL as well, all the major sports now even NASCAR have pretty detailed concussion protocols. But I think in the future, we're going to be more relying like Dr. Batjerwas saying we want a red light green light sort of thing that'll, that'll that'll, that we can get in the hands of people that aren't necessarily the concussion specialists and all the major cities are where there's no athletic trainer, which is very common in a lot of the smaller schools across the United States. So if we can get groups like the brainpower here in these rooms and working working with y'all and others together to to start applying these technologies To brain health issues like this, I'm really encouraged and excited about it. I'm always the skeptical scientist, I want to see the data, I want to look at the data. I want to know that something works. But But I'm really encouraged also from seeing a lot of the talks that are going on in terms of the remote monitoring this use of sensors, the our ability or growing ability to measure how the brain is functioning. So everybody's mentioned in CAT scans or MRIs, that shows you a structural picture of the brain. But like a patient with Alzheimer's disease, they often have a normal MRI, not always, okay, it's about 50 50. But a lot of times the the structure of the brain looks okay, but they have a dementia, often Alzheimer's disease, and there's not a brain scan right now that that measures structure alone and can detect that there are functional measures of brain imaging that can that can discern Alzheimer's disease, but concussion is tough. So you mentioned the term traumatic brain injury. A concussion is a traumatic brain injury, it is a mild traumatic brain injury. So it's essentially one in the same it's all degrees of severity. And, but even though we use the term mild, that doesn't mean trivial, it doesn't mean like totally, don't worry about it, it needs to be evaluated, it needs to be carefully diagnosed. And people should know there are treatments for it also, we know that rest is good right after, but not too much rest. And that's another fallacy that you hear about. For a while there was a practice of they were calling it cocooning where you, you take your 14 year old after their concussion and you lock them in their bedroom, take away their phone, take away the TV, no XBox friends can't call you. And then then you take them out several days later, you feed them, you know, give them water. But several days later, then they return to their normal life. And well, then there's anxiety, there might be some depression and might be irritability. And then are you measuring the concussion effects or the fact that you just took all these things away from a 14 year old. And now they're they're having a tough time read readjusting so that there actually is some miss attribution of symptoms that occurs in the concussion diagnostic world. So it is it is very complicated. So I think anything we can do in this technology sphere, to inform us about the status of how the brain is looking, as well as is working is going to be to our benefit.

Henry Peck  47:31  

Well, this has been incredibly informative, do something you want to add in Jeff, please just one

Geoffery Klass  47:35  

thing that you and I share is the need is the global need of devices like this, because you got developing countries and in the city, they're going to have a CAT scan, they're going to have an MRI. But out in remote villages and towns and villages, there's nothing. So this is a really inexpensive option to get out in those remote villages in town so that people can be, you know, assessed and then brought into the city as quickly as possible for treatment. So we're doing a lot of work in India right now we're doing our clinical research in there as well. But that's a real big problem that we'll solve with this kind of technology.

Henry Peck  48:14  

And it's Forgive me if my if my stats are wrong, I may make another mistake. So please jump in on me here. But I think there's something this issue goes so much. This issue of access in rural areas versus affluent areas in the US versus globally goes, you know, obviously is inclusive of TBI and stroke, but goes beyond I think when you talk about Alzheimer's, for example, there's something like under 5000 PET scanners globally. And even here, it's near impossible to get a PET scan unless you're enrolled in a clinical trial. And there's a whole thing there. So this idea of making point of care diagnosis that's accurate, rapid, is able to detect by subtype and then have a monitoring platform to Boone really can change the game, not just in the US but globally. So I want to pass it to each of you to wrap up with any kind of final thoughts retrospective or prospective thinking about what we discussed the experiences you all bring to the table and any other sort of kind of forward looking projections that you want to leave the audience with around the future of traumatic brain injury, stroke, diagnosis, monitoring, and how we make the idea that time is brain really the standard in how we treat these conditions.

Mike Singletary  49:24  

For me, I'm I feel very privileged and honored to to know these doctors to get to know Geoff. And just I'm just very excited about having the opportunity to be here. And when you begin to really talk about the brain. I just know that is it's an organ that's so important and we Have to have it protected. And to be able to have something that can detect whether it's bleeding or no bleed, to get about all of the other stuff bleed or no bleed. Green light, red light is life changing.

Dr. Munro Cullum  50:20  

Well, I'm a measurement guy, I measure cognitive function in these different domains. I envision and hope to see some day that we're sitting peep patients after whether it's a traumatic brain injury of a mild wound, like a concussion, or if it's if it's after a stroke, or if it's in an early stages of, of a dementia, such as Alzheimer's disease is one example. I would love to see that we sit the patient down, we we do run them through a series of cognitive challenge tests, quizzes about memory and, and reasoning and thinking, but at the same time, we're measuring what's going on in the brain. And then we're using probably machine learning AI, other technologies to bring all these sources of data, I enjoyed the Big Data talks here. Also, I think the concussion, especially is a big data challenge, as is, in many cases, I think the early detection and differential diagnosis of dementia subtypes. So I really see a bright future in this whole technology. And it's just it's really been a privilege being here. And I've enjoyed all the talks, I've sat in on having understood everything, but I'm not a business guy. But it's really been enjoyable. And I am excited to see where this group and others like it lead us over the next decade.

Dr. Hunt Batjer  51:48  

You know, I would add just a minor thing to that I think the the fear that's out in the communities, about the risk of sports is is really misplaced. And I think the participation in athletics and other forms of physical activity is critical for the development of healthy, productive people in all, in all walks of life. In my own personal situation, I had a lifelong history of sports, and conditioning, it was just part of everyday life, for forever. And then, two years ago, I had a fall,  at home and spinal cord injury as a result. And I wasn't supposed to walk or do much of anything. And I think a lot of that muscle memory from repetitive daily activities, is responsible for maximizing recovery even in a 70 year old person that would not have happened without that background. So you know, celebrate the joy of movement and yourselves and, and your patients, those of you that have patients and instilling that in your in your children and contacts. It's good. And we're doing a study now on on collegiate athletes that didn't go on for professional career. And I'm certain we're going to find exactly that. The data aren't in yet. But it's it leads to more productive, more successful people and my personal experience, thank you.

Geoffery Klass  53:37  

For from our perspective, I would just say that, we're really excited, we're laser focused to get our technology through the FDA. And what excites us is that success is now measured, not in years, it's measured in months. So we're on the short track to make all of this stuff happen. And that's extremely exciting for us. But we also when we don't try looking at it, but we we know what's in the future. And we and we've talked about this, but you know, to be able to address concussion to be able to address oncology to address things like sudden cardiac arrest, other neurodegenerative. There's a huge world out there of things that we can apply our technology to. We're excited to get to that. Take care of problem number one first, though. Thanks for your time today. Really appreciate it.

Henry Peck  54:30  

Well, thank you guys all for joining us for this panel. And thank you everybody on the panel again, Geoff. Dr. Batjer, Dr. Cullum. And Mike, thank you so much for being here. We'll have some time at the end here for questions off the stage. So if you have questions, feel free to come we'll have a little bit of time reserved. But other than that, thank you again for joining us for the panel and enjoy the rest of the evening in the event.