Columbia physician Thomas Bottiglieri's personal experience with concussion was a defining moment in his life. He was a football athlete, but after the start of his sophomore year in college, was medically retired due to repetitive brain injuries. Now, as the chief of the Primary Care Sports Medicine division in the Department of Orthopedics at ColumbiaDoctors and head medical team physician for Columbia University Athletics (and many high school and community teams), Bottiglieri cares for those with athletic injuries. He's also developing ways to improve that care.
It isn't always easy to determine if someone has a concussion after experiencing head trauma in sport. Currently, most concussions are identified based on self-reporting of symptoms combined with clinical evaluation, both of which can be subjective.
And most go undiagnosed, research shows, as athletes are reluctant to report the symptoms that could force or keep them out of the game.
"We measure electrocardiograms and cardiac enzymes to determine whether someone with chest pain has had a heart attack, but we have no clinically usable biomarkers to help us accurately identify concussion," Bottiglieri says.
Finding a new concussion signal
Initially, Bottiglieri explored ways to refine a concussion screening tool called VOMS (vestibular ocular motor screening). The tool involves a series of examinations to identify disturbances in eye movements and must be conducted by a trained clinician.
But the VOMS test lacks well-defined cutoffs defining normal and abnormal results, so interpretation depends on a clinician's experience with using this test for diagnosing concussion.
Bottiglieri reached out to Linus Sun, a neuro-ophthalmologist studying the link between eye movements and neurological conditions, to help him identify clear thresholds.
"One day, Sun asked me if I had ever noticed abnormal head movements in any of my concussion patients."
The inability to stabilize the head is known to occur in people with injuries in the cerebellum-the brain region that controls coordination and balance. The damage can occur after a stroke, chronic alcohol abuse, multiple sclerosis, and neurodegenerative conditions such as Parkinson's disease. But nobody had thought to look for these abnormal movements in patients with concussion.
Christopher Driscoll, then a graduate student in Sun's lab, had a keen interest in this area based on his previous experience as a manager of a division I football team. He began building the code to isolate the signal.
To Bottiglieri's surprise, once the team started looking for the abnormal head movement in his concussion patients, they found it. But the movement-a subtle oscillation of the head-is almost imperceptible, making the diagnostic tool and measurement a key to unveiling concussion injury.
Christopher Driscoll (left) and Thomas Bottiglieri are developing a new tool that may be able to screen for concussion in under five minutes.
A novel diagnostic for concussion
Bottiglieri and the team engineered the software to record the oscillation. Driscoll, now a research coordinator in Bottiglieri's lab, then developed a machine learning-based algorithm to analyze the recording and determine the frequency and amplitude of the oscillations.
Using the technology, Bottiglieri's lab developed a biometric database of over 200 patients, including a control group of people without concussion, to define the normal and abnormal cutoffs of their signal. Preliminary analyses suggest that the technology can accurately distinguish between individuals with and without concussion, indicate the severity of an acute injury, and detect chronic injury.
"Unlike other assessments that require interpretation, our approach gives us either a 'yes' or 'no' answer, and it can't be gamed by players," Bottiglieri says. "It will not only help us identify athletes and other individuals with concussion who need treatment but may also be used to determine when a patient is ready to return to normal activities," Bottiglieri says.
The exam takes under five minutes to perform and requires no specialized training. The technology, which can be loaded onto a laptop, can be used in a doctor's office, athletic training rooms, or on the field.
Bottiglieri and Driscoll plan to publish their results in hopes of commercializing the technology. They also continue to develop the technology as a screening tool for neurodegenerative diseases.
"Having an objective and easy-to-use tool to help identify concussion in athletes and others with head injury will be a real advance in the field," Bottiglieri says.
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Additional information
Thomas Bottiglieri, DO, is also director of research for the Primary Care Sports Medicine Division and director of well-being in the Department of Orthopedics at Columbia University Vagelos College of Physicians and Surgeons.
Columbia University filed a provisional patent application for the technology in 2025.
