Carrick Institute

CITV Technology Review: CBS Health

On this episode of CITV, we review CBS Health by Cambridge Brain Sciences!


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Transcription:

– In today’s video, we’re gonna be looking at CBS Health. A cognitive assessment platform powered by Cambridge Brain Sciences, up next. Today we’re gonna be looking at CBS Health which is is a web-based, mobile-enabled, cognitive assessment platform that was developed by Cambridge Brain Sciences. The Carrick Institute along with its scholars has been looking at this technology because we feel it’s an incredible way to get more insight into our patients on the assessment side, which will then dictate our treatment and ultimately it gives more value to our patients because we could help them better. So normally the assessments like these, assessments of cognitive functions, they would require hours of psychometric testing. Typically that would be done with a trained psychologist that would administer the test, they would score the test and ultimately they would interpret the testing as well. What Cambridge Brain Sciences has done, is it created a digital versions of the classic psychometric testing, but they’re engaging, they’re done in a fun way, and more importantly they’re scientifically validated with over 300 published academic studies. And it can be done in a fraction of the time without a psychologist present. We feel that’s pretty amazing. So rather than just kind of collecting subjective data or self-reported data from your patients, you could actually begin to look at quantifiable, scientific and objective data around how your patients are doing in core, cognitive domains. Specifically things like working memory, verbal ability, decision making, planning and concentration. You’ll be able to validate your treatment plans for patients by providing objective information within a group of tasks that are known to be extremely sensitive to change in tracking improvements. That sensitivity’s very important. ‘Cause you need to know if what you’re doing is actually helping your patient. This assessment can be used with all your patients that are suffering from things like concussion, TBI, Parkinson’s, ADHD, PTSD, and really any type of neurological disorder that you’re seeing on a day to day basis. All the patient’s data is gonna be brought into the system and then it’s gonna spit out a really neat, a real visual representation of report that can be used alongside the fMRI information provided to practitioners. I’m gonna show you some of that fMRI information, it’s really neat. So together you could create and adjust your treatment plans. Additionally, you can use the testing to validate whether your diagnosis is heading in the right direction. If you think what you think is happening is actually happening, it’ll help confirm or deny it, which is also very helpful. So for the assessments, there’s any combination of 12 assessments that are offered by Cambridge Brain Sciences. They can even be done at your clinic or your practice or they can be done offsite, even at home in a self-administered fashion. So the patient can actually do these tests right at home on their own, which is great. Your patient can go through a CBS task in about less than three minutes. For example, a four task assessment would take less than 15 minutes. Or you could have the patient do all 12 tasks, to kind of assess all domains, and that would take between 35 and 40 minutes, which is also really good. So let’s take a look at what it actually looks like to use this type of technology in your practice. I’m gonna show you guys a baseline report. Which is what it would like right after you use this testing with a patient for the first time, of their baseline. And you’re gonna see, you’re gonna put in a patient ID here, so you don’t have to worry about canning out their report, their name’s not gonna be on it. And you would also see the patient is grouped by their sex and their age, which is gonna be very important later. Each test or task, it’s gonna let you know what that task was measuring. It’s gonna give you a raw score, and one of my favorite part about this very visual representation is that it gives you this bell curve. And it lets the patient know where they fall on the curve when compared to their, to the same age group. And that visual representation is very important ’cause it’s very easy for them to understand. They even color code it, so like green is good, red’s a little bit, you know, bad, as you go towards the left a little bit more that you see here. It does a really good job of conveying that information. Here you could see another, here’s the task name, Feature Match. Again, this one’s measuring attention. The patient’s raw score was an 80, but again they’re scoring kinda low relative to their same sex and age group. They’re comparing it to their data base, that Cambridge Brain Sciences has, with over 75,000 records. So it’s an impressive data base to be compared against, and again it’s still validated by their research that they’ve done, so it’s very, very useful. Another kind of neat benefit to these tasks, when a patient does the task again, you never have to worry about them memorizing the task. So with the older model of paper and pencil, that would actually be an issue. But what Cambridge Brain Sciences has done in the way they created it, is that you’ll never get the same task again. So in turn you could reassess as often as you want and gather lots information and it really track what’ll hopefully be the positive change of that patient as they move along in your treatment plan. It’s pretty neat. So as we start reassessing our patients, CBS Health has provided another report for us, and it’s their trend report. So I’m gonna bring that up now. All right, great. What I love about this report is again it maintains some of the same visuals, it gives you that bell curve, gives you that raw score. Again, very helpful for the patient. But it gives you two additional things that are absolutely great. It gives you the raw score trends. The patient can see if they’re heading in the right direction. Again, very visual, very simple to understand. But the doctor should also really care about the fact that it’s telling you whether the changes that the patient is having, if they’re statistically significant. Meaning, sure you could have created a change in your patient, and it looks like they’re heading in the right direction, but was it statistically significant? Did that change actually matter? They’ve done the calculations for you. So in this one you can see, hey, they have a raw score of 20, they’re doing great on this bell curve, you could see their score along the way in the trends, and yes, there indeed was statistically significant change there. It makes it easy for the doctor to understand. On this test, though, you could see that a meaningful change has not been detected in regards to their episodic memory, with a Paired Associates task. I love the way they’re doing the calculations for you, and still maintain that very visual way of sharing that information. The reassessment and the statistical significance’s very important. So for example, at Plasticity Brain Centers, we’re using a battery of four tests, and we’re doing the assessment, the baseline on Monday. We’re doing a reassessment on Wednesday, and we’re doing a reassessment on Friday. And we’re able to pull up the trend report and show the patient how in a very short amount of time, we were able to do the testing, and produce statistically significant changes, and one last thing that I want to talk about the reassessment is that cognitive… Cambridge Brain Sciences has done it in such a way that you will never have the same test twice. So again, you don’t have to worry about them memorizing the test, and invalidating the data. It’s gonna be novel every time, still scientifically valid, and give you a trend. So again, I feel that’s very, very valuable. And Cambridge Brain Sciences has done a great way of packaging this up and making it meaningful to you and the patient. So the last thing I want to show you before we actually do some of these tasks together is their FMRI validation stuff. So let me pull that up real quick. Okay, great. So what’s neat is Dr. Adrian Owen, I just recorded a podcast with him recently. I totally invite you to listen to it, it was one of my favorite podcasts I’ve ever done. Very brilliant guy, very nice. I enjoyed my time with him. He actually had people in FMRIs while doing the CBS battery of tests. So they were able to correlate not only with the previous research but with fMRI which areas of the brain are being activated during the testing. Which is very neat. So in this document you can kind of see, it gives you some of the information of how they did the tests and then talks about the brain networks behind the Cambridge Brain Sciences testing. But as you get down here, you could see which tests, what the outcome measure is, so what it’s actually testing, and then what are the related brain regions. So, as you start working with your patients, you could go from your assessment, you start correlating the battery of tests on the baseline along with physical and neurological examination, you make a working diagnosis, and you see if any of the objective data that you have disproves your diagnosis. If it doesn’t then your diagnosis is more than likely correct, but you still have to kind of validate that. And then you go, “whelp, all right, “this is the parts of the brain “that I would want to work with.” And then what’s kinda neat is, CBS Health has a document that’s gonna correlate the tests along with the regions of the brain. And hopefully it all matches up. If everything matches up, you can feel very confidently about moving forward and exactly what you’re gonna do with your patient. But the fact that they’ve done this for you, correlated all the tests with fMRI data in the research, makes it a very valid, very applicable battery of tests that obviously makes a lot of sense and a lot of your patients would benefit and you would benefit from doing this with them. ‘Cause it’s gonna make you more precise in regards to how you serve them. Incredible. So let’s take a look at what this looks like to use in a kind of daily basis here. You would go to the CambridgeBrainSciences.com website, you would login and you’d be greeted with this screen. Here we have the option of adding a new patient or adding a new practitioner if you have a multi-practitioner office. A lot of our scholars typically do. So let’s just add a simple mock patient. I’ll do a 0001, I’ll be male, I’ll do a part of my birthday, let’s make myself even older here. So, great. And I create that patient. Okay, awesome. So here’s my patient, I’m looking at them and I can either send them the assessment or I could have them do the assessment on site. So since I’m not gonna email myself the assessment, let’s do one like I’m actually here. So I will hit Start Assessment. And here you choose whether you’re in person or in email. I will say in person. And here you have your options. So you could either do a full 12 task assessment. Now it would be my recommendation that when a patient comes in, it’s always a good idea to do that full 12 task battery, because it’s gonna give you all the information you need about that patient. And then for the future reassessments, you focus on the areas where your treatment would have served them the best. You can actually see the changes that way. As opposed to exposing them to all 12 tests every single time. So you could do, there’s a full 12 task assessment, there’s a standard four task assessment, and you could create an assessment. So what’s kinda neat is they make this system, they made this system flexible so you could say, these are the four tests, or maybe the six tests or whatever that your practice focuses on and that you want to assess and reassess with for your patients. Which is kinda neat. So let’s see if we created an assessment, we’ll kinda do it here, it pulls this up here and you could see the different ones that are available to you. You have Monkey Ladder, Paired Associates, Spatial Span, Token Search, Odd One Out, Polygons, Rotations and Spatial Planning. Then you have Digit Span, Grammatical Reasoning, and then Concentration has Double Trouble and Feature Match. And each one of those tasks is kind of grouped into what cognitive domain they’re testing. So let’s see here, if I wanted to do one… Which ones are the ones that I should do this time? Let me take a look. Okay, so let’s do Feature Match. Boom, we’ll do that one. Let’s do Paired Associates. All right, great. So we have that one. We have Odd One Out. And let’s do that one. So I think that’ll be pretty good. Okay, so if I hit continue, so this is what it’ll look like. It’s approximately 10 tests, 10 minutes for the three tasks. So let’s give this a go. And I’m gonna just go through it really quickly, we’ll speed up the video so we don’t bore you with this, but let’s see what it looks like. If I hit Start Assessment I say I’m In Person. So I choose that. And here we go. Gives you the instructions, here’s where you can put it in front of the patient. So it tells them to find a quiet environment that would be free of interruptions or distractions during the assessment. Please turn off your smart phone for the duration of the test. Again, reducing the distractions. We’ve come to that time in the world where you have to tell people to put their smart phones away, then get anxiety from it. And then, again, pay close attention to the interactive tutorials to familiarize yourself with the task instructions. So you hit Start Assessment. And it’s gonna give you a tutorial. It says, “two boxes appear on the screen, “each containing some abstract shape. “Judge whether the two boxes are identical or different. “Click MATCH if they’re identical, “Click MISMATCH if they’re not.” So those are, looks like two green squares there. So I would say match. And well I see a difference there, so I’m gonna say mismatch. And one more, it looks like a match. Okay, great. “Work quickly but carefully. “Your score is based on both speed and accuracy. “Incorrect answers subtract from your score “After a correct answer, “the next puzzle will be more difficult.” And get as many as you can in 30 seconds. All right. And here we go. Okay, so I scored a 148. It tells me to continue. Kinda fun. Definitely got harder. All right, Paired Associates. Another one, it’s a tutorial. Let’s see what this looks like. It says, “several boxes appear on the screen. “A moment later the boxes will open, “one after the other to reveal the objects inside.” Okay. “Remember which object appears in each box. “Next, an object will be displayed “in the center of the screen. “Choose the box that the object appeared in.” All right, I got this. “Try it out.” Okay. That was one in there, so that’s correct. And the next one, the little radio active symbol, that was in there. All right. That was an easy. Let’s say if it was over there, and we go “Oops, that was wrong.” So maybe it was in this one. Nope, that was different. All right, down there’s the correct one. And now that one’s up there. The little person with the garbage was in there. All right. So this one has no time limit but the puzzle ends if you click the wrong box. “After three mistake, the test ends.” All right. “If you successfully complete a puzzle, “the next level will have more boxes. “For the best score, get the highest level you can.” All right, let’s see what happens. Okay, so I scored a four. All right one more out, called Odd One Out. Tutorial. “Nine patters appear on the screen. “Determine which pattern is different from the others. “In simple problems, “like when there is only one blue pattern, “the answer is obvious,” okay. “In harder problems, you have to pay attention “to the types of shapes and numbers of shapes “in the pattern in addition to color,” okay. Let’s try it out. So I see the blue one. So the odd one out to the blue one… Oh I get it. Ah, out of all them, all right, I see now. All right so I got, one, two, three, the odd one out. Kay, there’s only one gray one. So this one’s a bit harder. Kay, both speed and accuracy. “Incorrect answers subtract from your score,” okay. “Get as many as you can in three minutes.” Here we go. Okay, great. So at the end it says the results are gonna be sent to your clinician, your health care professional. Which is awesome. Okay logs them out so the patient can’t see what’s happening. Why don’t we take a break here, I’ll log in, pull up the report and see what that looks like on this mock test. I’ll be right back. So now that that small battery of tests is complete, the clinician could log back into their system and they would see this. They would see their patient, for again our mock patient in this make-believe test, they’re number one there. And it says the assessment was completed on April 18th. So it just tells you when it was done. Also just wanted to point out that when the patient’s doing it in your office or even at home, you can even customize the messages that they see after they complete the battery of tests. So if they’re doing it in the office, you could say, “go see your assistant, “go see the doctor now, “they’re waiting for you in this room.” So it’s kinda neat they make the system really flexible that way. So let’s take a look at this report for this mock test. It pulls it up, again it’ll tell you the test or the task that they did, what you’re testing and it says what the raw score is and where this mock patient would fall on the percentile rank. So you can see that it was an 86 on one, a 30 on another and a 69 on another. What my raw score is and the test was done in a way that’s valid. So there wasn’t any issues during the testing process. Again, I love the visuals they’re doing. And then what I could do is, I could take that information, and again I cross-reference it with my FMRI information. So if I look at Feature Match, let’s go look at Feature Match over here. Feature Match, let me find it. Areas where I could focus my treatment would be, right inferior frontal gyrus and mid-ventrolateral frontal cortex. Which is great to know that. You take that information, you go into your battery of clinical treatments that you have, and how can you bias your treatment to activate or strengthen that part, those parts of the patient’s brain? Having that information is invaluable to us. I’m just very impressed by what they’ve done here. So again, I love the report and how easy it is to, one, put a patient in, either add a practitioner, add a patient. Either send it to them at their home so they get to do it and they come in with the tests already being done. Or again, very easy to do in an office setting. Just very impressive the way they put it together. So let’s kind of wrap this up. So to me this is one of those pieces of technology that feel like anybody who has that functional neurology impaired in my care or is applying clinical neuro-senses practice would really benefit from having in their practice. We know the importance of providing objective data for our patients. That’s why we do video oculography, and computerized dynamic posturography. We love having that technology, that objective data. But it’s also important to have that data so we could plan out our treatment plans and adjust the treatment plans that we’re doing. So let’s kind of summarize what we learned about the CBS Health platform today. We know that CBS Health provides you with an easy to understand report which compares patients to people of the same age group, which makes the interpretation and the analysis pretty simple. We know that CBS Health is mobile-enabled. You could use it on a tablet, desktop or laptop. And it’s web-based so you don’t, you just need a web browser, no special software to install. The assessments can be used with all of your patients as long as they have the ability to touch a screen or use a mouse. So it’s pretty simple there. And we also know that the product’s pretty flexible. You could pick and choose which tasks you want to use with each individual patient, or you could do a whole battery of 12 or 4, create your own battery. Again, really flexible and useful in that way. And again the tasks, they designed them to be fun. So they gamified it. Which is a big thing in clinical science research now. They’re trying to gamify things. It’s easy to use, easy to understand, and your patients will actually enjoy doing the tasks. Each task takes about three minutes and you can do an entire battery in about 30 to 40 minutes. You could send it out to them by email or have it done in the office. And again the tasks are really sensitive to pick up a change in a patient, so we could reassess with high frequency and actually find out if we’re creating a positive change in our patient. And again, one of the most important parts is that every task is associated with a specific region of the brain, allowing you to create treatment plans based off the assessment. And it’s backed up by literature and fMRI studies. It’s really a total package. So that kind of sums up Cambridge Brain Sciences and their CBS Health platform. I hope that really gives you an insight into that platform and why we’re big fans here at the Carrick Institute. And places like Plasticity Brain Centers are also employing this technology to help form and drive their treatment plans and their reassessments to show their patients the changes they’re creating. If you’d like to learn more about CBS Health, you can go to their website at CambridgeBrainSciences.com and also you can go on our website, we also have a clinical tools listing on our website, if you go. And you can see all the tools that we’re recommending, Cambridge Brain Sciences’ out there and I think they put something special together for Carrick Institute scholars. So if you go on the website, check that out. See what they’ve put together just for you guys. So I hope you enjoyed this technology review of the CBS Health. My name is Dr. Freddys Garcia, and until next time.

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