Sanjeev Sharma, MD, and Frederick Carrick DC, Ph.D., MS-HPEd discuss brain injury and neurodegeneration as well as the use of BrainEQ in a variety of health care applications.
Dr. Sharma is an experienced Emergency Department Physician with extensive experience brain injury. He and a team of physicians from Toronto, Ontario developed the world-renowned Clinical application BrainEQ. This technology is used throughout the world and provides Health Care Professionals with validated clinical data that can be used to serve humankind at a higher level. Sanjeev also was on the front lines during the SARS and Avian Flu epidemics and brings that experience to our current world’s COVID-19 epidemic, TeleMedicine and more.
This informative video is a snapshot of the personal conversations between these leaders in the world of brain injury.
#carricktrained #carrickinstitute #carrick #clinicalneuroscience #brainEQ
– Okay! Sanj, how are you? This is a really great deal because we’re just gonna talk as we always do, but we’re gonna record this because we have so many people that are asking us about Brain EQ, who are the people, how did it come about. And it’s almost like telling the story of somebody else’s story. So for those people that don’t know you, Dr. Sanjeev Sharma, friend of mine and of thousands of people throughout the world. We have gotten into a really good, I think, clinical safe space, dealing with people with concussions. You’re in Toronto, live. I’m in Cape Canaveral, Florida. We’re in the middle of this Coronavirus pandemic. You’ve had a lot of experience with that as an emergency department doctor for years. You worked through the SARS epidemic, avian flu, a variety of other things, so you’ve got a lot of experience which is fortunate for people with that. But you also have a great experience with concussion, with brain injury, and that’s been a passion of yours and of mine for many, many years. So what I’d like to do is… Brain EQ is sort of the buzz word with most of patients throughout the world and so many clinicians of all disciplines that are using it. The gamification, all of this sort of thing, so let’s just sorta go back to the beginning. You were seeing patients that had head injuries in the hospital, in the emergency department. And then I know that you were, ya know you’re a little bit humble, so I’ll tell a little bit about you, that you had really been the head guy with the establishment of medical facilities throughout Canada that really, ya know, welcomed society in a great way and found the need, if you would, to realize that if you can’t get the patients into the clinic, you can’t serve them very well. What’s an alternative? What’s a realistic alternative? And then out, just at a great opportune time, pops EQ that gives us top quality, validated medical examinations, demographics, data that people can do at home. So just sorta take us back into this brain child and sort of the mission to develop the technology and how you came to this part right now.
– Happy, happy to do so. And thank you, Ted, for taking the time to just chat. This is great. One of my personal struggles, as I was leaving the emerge and starting to move into working in the clinic was, we really, it was a tremendous amount of variability in how people were diagnosed with concussions which meant that there was a tremendous amount of variability in outcomes. And I felt that the lack of diagnostic, objective data was really impacting patient care. And so that was the catalyst, clinically, to move into what we’re doing at Highmark Interactive, coupled with, I had an incident with my daughter where she had a minor head injury. It was concern around potential concussion, and I had, between my wife and my mother and my daughter asking me, “Well is she concussed or not?” My answer was, “I don’t think she is, but I’m not sure.” And they looked at me, “So why not?” And I said, “Well they don’t really have diagnostic tools yet.” And as I said it, I thought, “Ya know, I have to do something about this. “This is crazy, ya know.” This is back in 2016 which led to Highmark Interactive, and here we are.
– Yeah, it’s an amazing, amazing deal. Now, the one thing everyone knows if you’re talking about someone who deals with concussion, everyone knows about Brain EQ because people are using it. It’s marvelous. It gives us the basically, King-Devik sort of thing with eye movements in a magnificent way where the doctor doesn’t have to sit and have a, ya know, a stop watch and then look at their eyes and see if they’re seeing the letters that are on the King-Devick cards, on those four cards. It’s done, and an amazing thing, it coordinates a hand-eye which is really super. So for every one that’s in brain activity, everyone’s using it. But what about people, in your experience now, that are using EQ for non-concussions? What’s the utilization in the general medical practice would you say?
– Well, there’s been a definite increase uptake because what increasing what some people do, I mean, EQ at its base, is really designed to measure different trajectories of brain function so that we can get an understanding of any individual, pre-potential head injury or anything else that might impact their brain. So we had youth and athletes and people that are active onboarding in that first phase. We now are seeing clinicians onboarding seniors to better track individuals as young as sixty to ensure that cognition is stable as it can be, there’s no early warning signs of dementia or degenerative brain changes. And that gives both the patient and the patient’s family and the clinician a tremendous amount of reassurance to see, “Nope, Dad’s cognition is stable, it’s not changing, “it hasn’t changed over time. “Furthermore, you know, he ranks in these top 65 percentile “of all people over 75.” And so the anxiety drops for the patient, the patient’s family and loved ones, and the clinician can take a step back and say, “You know what, Mr. Smith or Ms. Jones? “You’re good for 75, keep doing what you’re doing.” And so it’s been really exciting to see that take hold and even moreso now in the unfortunate era of, ya know, COVID 19 where you want to visit your parents potentially in a nursing home or retirement home, but we’re trying to keep the vulnerable population away. Families can stay in touch through EQ and see that their parents are still, ya know, active, engaged, doing the test, playing the games. There’s no change in their cognition, and there’s nothing to suggest there’s any other systemic infections. And it’s been a real gift for families and caregivers and clinicians in a time where we’re looking to create some of that social distancing because of COVID.
– I think it’s just marvelous. I think the concept of being able, we hate to say baselines anymore, but when we look at– or pre-injury test. All those suggest that you’re gonna have an injury, but I think to have a valid, biomarker or biomarkers on patients that are readily available does allow us to compare. One of the things that I found was just super exciting with the EQ was they, the validity or the reproducibility of the test over time or the, what we call the Cronbach’s alpha, or the idea that if you do something today and you do it tomorrow, if something hasn’t happened in between, it’s a valid test which means we can use it to demonstrate change. And you talked about dementia and you talked about people as we age, having the ability to see a mark, valid marker of a decline allows a family the unfortunate reality of being prepared like do we need assisted living for your mom or your dad or somebody else? And I’ve, ya know, talked to people about this, and it’s always that question like, “Well, how’s she gonna be in a a year? “We don’t know.” However, if we start to see these declines, we have trends, and I’m just super excited. Have you had some experience up in Toronto or throughout the world with people that are using EQ in regards to neurodegeneration, brain disorders, etc.?
– Yeah, we have, so… Increasingly the retirement homes and longterm care facilities are deploying this because you’re exactly right. They’re getting data, and that data allows them to have trends which allows them to run our predictive analytics and model out best case, this is what these scores will look like in 12 months, worst case, these scores look like in 12 months, and the most likely case. And what we’re finding is if families are prepared in advance, both psychologically, financially, and physically, the… way that they cope with this which is very devastating for families to know that they’re losing a mother or a father or a grandfather, it gives them time to prepare, it gives them time to see the data, it gives them time to visualize the graphs, it sinks in a bit deeper, but it also gives them a sense of empowerment because they can see, okay the trend is not that steep, so we can have more time with her, our grandmother or our father. And at the same time, if the curve is steeper, we can put things in place like a walker potentially or a row bar so that they don’t fall and have complications when they don’t need the complications. And when people feel they have control, that makes dealing with a crisis or in a situation much easier because they’re not just helpless.
– That’s wonderful. And you know, it’s everyone that I meet that’s in the brain business that we’d say, knows about EQ. But believe it or not, there’s some people that don’t know about it that are treating people, and I always feel like, ya know, “Where have you been hiding?” But let’s assume that you’re talking to a doctor who hasn’t heard of EQ. What can you do just to sort of summarize the platform, the availability, the ease of it, etc.? Give a, like sort of an elevator talk in what EQ is.
– Sure, sure. What we say to clinicians when we first talk to them if they haven’t heard about EQ is it’s a FDA cleared, CE mark medical device. But the device is software that runs on your mobile application. So if you’ve got an iPad or a cellular phone, you have the ability to use the technology. The technology takes seven to 10 minutes to test a patient. And it gives you objective, quantitative data, and qualitative data about the brain health which touches everything from degeneration of the brain to cognition to mental health disorders. We know that one of the first things that happens when someone’s struggling with a mental health disorder is their cognitive ability starts to be impacted. And so when clinicians hear they can get all of this information that’s been validated through the FDA and the testing takes 10 minutes, it can be done anywhere, and all the person needs is their mobile device, at first they’re shocked like, “Come on, where’s the catch?” And then when they hear the only catch is a one-time, single fee, licensing fee, and they can use it for all their patients, it gets picked up pretty quickly. People are pretty excited about it.
– Well, it’s sure cheap. And thank you and all of the people who have been involved in this project to bring it to the world. It’s amazing. The thing I think that a lot of people wonder is like, “Is this like, too good to be true?” You’ve got all the things that we do in the clinic like putting helmets on and, ya know, fancy gizmos and technology that we all loved and depended on. And you can now have it in your iPhone or your iPad. And is the stuff good? Does it give you a validated data? Well, you know we’ve been working with groups of Collabor Charlotte the World to answer that question, and the answer is yes, it’s valid! And we’re gonna be seeing a lot more of EQ after the new consensus comes out, in Paris, and I know that some of the people you work with, Chris, and some of the other doctors are gonna be there. Everyone is excited about this. The price certainly is something, you know, both of us really don’t concern ourselves with that. But the consumer practitioners do. And I was really thrilled to find out from a colleague that EQ has like a basic price. And then everyone in their clinic, it doesn’t matter if it’s a small one or a big one or a super hospital or whatever, is under that plan. It’s not like per person. It’s like one fee, and they can test as many people and as many families as possible. It’s almost like a gift. And that’s true, right?
– It’s absolutely true. We looked at utilization, and we looked at, ya know, what might be barriers to adoption for widespread use. And we didn’t want cost to be a barrier for anybody. So we looked at this and said, “Ya know, the company needs to operate “and make a little bit of money, “but if we can price this at a point where “a clinic can offer it, not just to 10 or 15 “or 20 or 100 people but to everybody, “then the reason we got into this business “was to make an impact.” It was to improve patients’ lives. It was to improve patient outcomes. Now everybody within a clinic can access EQ. That clinician can manage those patients remotely if they need to. If that individual gets injured on holidays, they can give them EQ scores, and the clinician can see it on their dashboard and say, “We need to shut you down. “You actually reinjured yourself.” We really wanted to eliminate as many barriers as possible, and that was why we changed the pricing. Now it’s, we’ve got clinics that are using this to actually move into the community. We have one clinic in particular who has just landed all the first responders in a large U.S. city. And the relationship that was struck was, the individual said, “I’ll do the baselines. “If there’s ever a concussion, the first responders will come to our facility. “We’ll have all the information through EQ. “If there’s an issue in the field, “I can real time look at the EQ scores and say, “Pull them off or keep them in the field.” And that’s enabled that clinician to continue to service her clients but also bring new clients in in a new manner. And she will, that clinic will have all of a very large U.S. city’s first responders on EQ for baseline, for any concussive issues, and for any muscular skeletal issues that might happen over the course of the years. So when we see that, it’s exciting to us. It’s rewarding, it’s what drives us in the morning to get up and disseminate the technology as easily and quickly as possible.
– Yeah, I love it. I just think it’s marvelous. And the fact that you get the data right there, I know I was overseas and I was conducting my clinical rounds, and I had a patient that had a spinocerebellar type of a syndrome, non-ska spinocerebellar. And I was able to really do some magic with her, but I gave her the EQ and then when they do the test, all of a sudden, you find that what you saw on the Monday is markedly different than what they’re seeing on the Tuesday. And I could immediately make the change in therapy without having her in or before her visit. And that I thought was great. I had another really well-known athlete that had a serious head injury, and I was gone, I was away. And you know how patients are. They often times have the doctor phobia. They don’t wanna see anybody else.
– ‘Cause they’ve sometimes had different experiences. So the EQ was absolutely marvelous. You have the scat, you’ve got the numbers. But the King-Devick, everything was so great. Balance was super. I was able to have a Skype and to have like a tele-medicine talk, and based upon what I saw in the EQ, I was able to really make a significant difference with her like exponentially, really, really quick without having her having to wait to see me or to go through the fear of seeing somebody else that may or may not have worked out. It was absolutely, absolutely beautiful, really.
– That’s amazing. That’s music to my ears. And I mean, we get that feedback fairly regularly, and it’s incredible. The feeling when we know that we’re allowing clinicians to impact patients’ lives positively, nothing beats that. We’re getting feedback now during this time of social distancing, clinics are saying, “Ya know, how do I manage my patients? “Ya know, I wanna treat them, “but I’m not supposed to see them.” And they’re using EQ. They’re having their patients do their testing at home. They’re following them along, and they’re saying, “I’ve seen your scores. “Let’s do a Skype consult or a phone consultation. “This is how we’re going to adjust your treatment “plan for the next two weeks.” And so it’s enabling clinicians to care for their patients despite social distancing. And ya know, if people are traveling, athletes, clinicians, they’re always connected. And that data is always available. We’ve got tremendous redundancy in our systems which we need for HIPAA compliance and FDA clearance. And so it’s been very exciting to move from concussion into the sort of the elderly market and see the technology really take hold on the sort of broader, really 29 countries, I think. It’s stunning sometimes when I think about that.
– Yeah, it’s absolutely phenomenal. I know right now with the COVID 19, my is very actively looking at mental health considerations of social phobia, if you would, as well as the neurological or the brain-based consequences of having viral infections. whether if you’ve got a fever or whatever, your brain function goes down. So this EQ is really, it’s not a diagnostic biomarker for COVID 19, but it certainly is a biomarker of your function and can really help doctors almost do the triage of something. If you see something’s going downhill, it’s going to raise an alarm. And I know you’ve been, you were instrumental with Chris and some of the other people during that SARS epidemic in Toronto, so you’ve got experience with it. How do you think that the having Brain EQ at that time might’ve changed things a little for ya? Just in a retrospect.
– Well, it’s a great question, it’s a fantastic question. If we had the ability to stay connected to our patients, not put them in harm’s way, we, I believe we would’ve had less patients get infected, less healthcare workers get infected which would’ve translated into lower mortality of healthcare practitioners like ourselves and lower mortality of some of our patients. Unfortunately, we just didn’t have the technology at that point at any scalable manner at a cost point that made sense for the market, but we have it now. And so we’re encouraging our patients, unless something has changed dramatically, unless it’s a fresh injury, stay at home, do your EQ testing, we’ll look at the scores. If we need to do a Skype call, we’ll do it. If a phone call will suffice, we’ll do it. And it’s worked out exceptionally well. It keeps the patients safe, it keeps the clinician safe, it keeps the clinician active and busy in their clinics, so they can maintain patient care. And at the end of the day, I think, ya know, that will be one piece of the puzzle that helps us sort of flatten the curve as a society when we really come together and look at what can technology give us to keep us safe but still maintain health. The other point that you talked about is the impact of being quarantined for 14 days or even longer potentially if lockdown happens, and that triggers a mental health issue. If an individual’s cognitive scores start to drop in the absence of any trauma, that would be a flag for the clinician to say, “Maybe these scores are dropping because of anxiety “or depressed mood or dystonia.” Exactly what you said. So there’s tremendous flexibility in how the technology’s used, given that the clinician is interfacing with the patient regularly and watching those scores and watching for trends. We believe it will, in fact we’re trying to do a case study right now to look at outcomes and look at patient satisfaction, patient engagement, clinician engagement, to sort of have real data to justify what we’re saying and what we believe we’re seeing real time.
– Yeah, it’s really, really marvelous. Well the one thing that we all know is that people hate doing paper , pencil tests. Everyone’s seen, ya know, from old ink blots and things coming down, people don’t like, ya know, putting down personal, ya know, information. And sometimes, especially with athletes that we see, they lie about their performance because they realize that if they score at level A, that if they hurt themselves, they could be in jeopardy. So they’ll dumb down their responses to level C. So what I found was really amazing was that the EQ is gamified which means it’s sort of fun, it’s not like someone saying, “Okay, I’m gonna give you this phone number, “and say it backwards. “And I’m gonna give you these sort of things “or M1 or n-back test.” It’s a game! And I love it because when I play, I enjoy it. So I think the gamification of it gives you a truer window of someone’s performance because they’re competing, not only against themselves, but to a virtual community of people. Can ya tell me about what the physicians in your– well, globally, I guess you can speak of it, are finding in regards to that participation and gamification in Brain?
– Yeah. And people… Clinicians love it because they feel they’re getting more accurate data. And the reason is, and you nailed it, when the athletes or just the end user, whoever that is, logs in and realizes it’s a series of games, all of their defensive mechanisms around medical testing sorta drop, number one. Number two, when they realize there’s a leader board and they can compete with their peers and their teammates, they want to accelerate. And then in addition, we’ve set up the game so that if individuals are trying to game the game, so to speak, we’ll be able to detect it. So someone, for example, says, “I’m gonna click on the fast ball page every three seconds.” Well the cadence is off. And so they’ll have a disproportioned high number of strikes which tells us this is somebody who’s really not trying to hit that ball. So for the most part, people love it. They find it engaging. They want to improve their scores ’cause one of the things we do is we give them a score and how they rank on a normative band. So people who find their scores are, for example, in the lowest 10%, next thing that happens is their next test is literally 10 minutes later, and they’ve jumped and improved cause they’re trying harder. And so we’re getting the opposite response where people are trying to do their best, they’re not threatened by the typical medical testing, they love the games, they wanna compete against their peers. And inside the technology is a way for us to catch individuals who still unlikely trying to game the game, so to speak. And we just identify those on our dashboard and say, “Come on. “This is for you. “It’s to protect your brain. “Let’s be compliant.” And thus far, we haven’t had any negative feedback from patients or clinicians, and it’s just been a lot of positive. Kids love it. Adults love it. Seniors love it. We changed some of the size of the icons for the seniors’ market, but we haven’t had any negative feedback on, “I don’t really like to play games ’cause…” I mean, even I play video games on my , on my mobile device when I’m sitting at the airport, waiting to catch my flight. So feedback has been tremendously positive thus far.
– Yeah, it’s brilliant. I mean people are, people are catching on. So we’re in the brain business with all that goes around with it, and tools like this really help us help other people, I think, at a greater level. I think myself, when I look at the EQ platform, I was like, ya know, blown away because it was almost like a wish list has been delivered. We’re, ya know, looking at the base of the chimney when it’s January, waiting for the big guy to come down it. So having had it and used it, I just see a whole load of applications, and I think that often times that people that are dealing with, ya know, brain injuries or neurological disorders, sometimes forget that there’s a whole other complement of core morbidities out there from diabetes, on. We just published a recent paper with our group that showed a… a very high, statistically significant relationship between type two diabetes and depression and then concussion and depression. So that if you’re depressed, you have a high probability of developing type two diabetes. But if you’ve got type two diabetes, you’re gonna be depressed, statistically. We did some interventions that were great. But now with this EQ, we’re gonna be able to see those traits in the neurocognitive world without having the patient coming in, going through that white coat, ya know, phobia and other sort of things. I think it’s amazing. Let me just say a little seg way here because ya know, Toronto or Canada now is sorta like, ya know, the leaf legalized. Oh, I mean everyone is saying, “I gotta move to Canada ’cause I can smoke dope.” It’s almost like Holland, but ya know, it’s just boom boom boom! But I do know, talking to my colleagues up there that people are becoming, are going to work stoned! And that can affect a whole load of things. Tell me about EQ in regards to environmental health or ergonomics, the utilization of that device.
– That’s a great question, and it’s a real issue. I mean, we’ve got people who are driving school buses, city buses, ya know, working on cranes. And so what we, what we’ve done is we’ve created a module called EQ at Work. Now it’s for employers and employees because we live in this, in a time where whether it’s an opioid epidemic, whether it’s cannabis being legalized increasingly through North America and through western Europe, or alcohol, there are more reasons for a worker to show up at work and not quite be fit for duty. And so having a really quick test, so the EQ at Work module is compacted, looking at their fitness for work, it’s five minute of testing so it’s even quicker. And it allows the employer to know if Sanjeev typically scores here, and then one day I show up and my scores have dropped significantly, it’s not meant to be a “gotcha” test. It’s meant to be, “Something’s off with you today, Sanjeev. “Maybe you’re jetlagged “Maybe you have a head cold. “Maybe, ya know, you experimented “with something like who knows? “Today you’re not gonna be behind the garbage truck “or the city bus or the school bus, “you’re gonna be in the office working on paperwork. “And then tomorrow, “when you come back to work, we’ll see how you are.” Sure enough, the next day, I’m not gonna experiment. And I’m not gonna experiment, but you know what I mean? I come back to work the next day, my scores are back to my baseline to where they normally are, the employer says, “Okay, great. “Sanjeev, get behind the city bus. “Get on the airplane.” And it impacts… I mean it’s not just safety sensitive, it’s not just construction, it’s even software companies that are uploading a critical piece of code. If your coder is, ya know, impaired, that could crash the system. And so you really need in every industry to ensure your workers are fit to work. And what eventually will happen is you’ll improve productivity because they’ll know that yeah, I have to be fully on. And you’ll be able to actually improve productivity. But in the near term, we wanted to ensure it was a quick, easy way to ensure safety, both for the employee, the employer, and the broader public. And the uptake on that has been fantastic.
– That’s great, and you’ve got government and community support with all of this.
– Yep. It’s been very– people have been… In fact, we’ve had overwhelming demand, both from levels of government but also from researchers saying, “This is fantastic. “If I can decide somebody’s impaired versus not impaired “with a mobile test, “that I can use anywhere.” So we’ve got a couple of large trials where they’re looking at the technology to see can it be used outside of just the workplace to give law enforcement potentially some guidance as well.
– That’s just absolutely amazing. What a great deal. I know like when you’re driving down the road, you get some of these, ya know, drivers, yeah they’re sick. They’ve got… It’s a hard job, they’re sitting, they’re sedentary, they don’t exercise. A lot of them are obese, they have sleep apnea, they can fall asleep. We used to have the little cards that they’d only be able to drive for, ya know, X number of hours a day. But X number of hours might be good for one person but not good for another person. What a great deal to incorporate these types of testing just for community safety. I’m just jazzed with it. And I know the utilization is just popping up over, ya know, all over the place. Well, I tell ya, Sanj, for you and your team up there and the global team of scientists and physicians that are on board with you, people are dedicated. And this is a pretty amazing deal. Everyone’s excited with it. These are sad times for our world right now. But I think that the excitement of having other tools comes through that we can get the joy of being able to help people which sorta gives everyone, ya know, that uplifting spark which is beautiful. And it’s just, it’s great. I mean, really thanks so much for the dedication to get this out. It’s cutting-edge, it’s contemporary, it’s the buzz word. And ya know, you’re right, ya know, in the middle and central of it so…
– I expect, I tell ya, ya know, no smoking, but I expect that everyone should have EQ in their pocket on their phone and should test regularly. It’s fun, but the data that we get, this is better than a Super Framingham Study. We’re just getting data from people, and they can have it. I think what’s really important for people is to realize that their data is secure, that when they’re working on something, it’s not that your scores are up there and somebody can see them. That these are HIPAA compliant instruments.
– And when they play this game, and they’re sharing, ya know, themselves with the app that that’s secure information that their physician can see and that nobody else is gonna be able to grab. I think that’s so important.
– Correct. No, you’re absolutely right. And that was why we, before we began even commercializing it, we wanted to make sure we were HIPAA compliant, we have that stamp, and that we were FDA cleared so that people have the reassurance of knowing this wasn’t just “an app,” this was truly a Class II medical device that runs a software on your medical device, on your mobile device. And so , it’s been exciting. Ya know, thank you very much for your perspective on it. You’re incredibly respected. You’ve been a trailblazer in treating, diagnosing, managing everything from, ya know, traumatic brain injury to neurologic sequelae and correlations that go along with it. So to have those words come from you is very humbling, and I’m very grateful. And thank you very much.
– Yeah, it’s been a great day. Well Sanj, I think this is great. People can sort of get an idea what we talk about in a little bit of a bit and share. And thank you so much. And I’ll speak to you really, really soon.