As I was driving into work a couple of weeks ago, I heard on the radio a story about a Division I college football coach at a large University who was being questioned and criticized regarding his decision to allow his quarterback back into a football game after possibly sustaining a concussion. The discussion focused on how it was difficult to understand how this coach could make this apparent mistake given the recent improvement of sports-related concussion management and wide-spread media attention about sports concussion. More recently, I read that three high school football players died while playing football. Immediately, there were questions as to whether they had sustained a head trauma during the game and what could have been done to prevent this from happening. Although I do not know all the details regarding these incidents, and it appears that at least one of them was not related to the game, it is clear that if we could identify football-related concussions more effectively, it would result in fewer tragedies.
Identifying athletes who have sustained a concussion, particularly in a sport with as many players and moving parts as football, is challenging. I do not envy team trainers, doctors or coaches who are responsible for identifying in real time whether a player has struck his head. While the eye of the casual observer is focused on where the action is on the field, a head injury may be happening somewhere else. There are obvious times when a player has sustained a concussion. If a player loses consciousness - he had a concussion; if a player is dazed and confused after getting up from the ground on a play - he had a concussion; if a player goes to the wrong huddle after a hard hit - he (probably) had a concussion. However, not all concussions are obviously identified.
Traditionally, observing behaviors has been the strategy to identify the signs of a concussion. Extreme fatigue, mental fogginess, forgetfulness, and confusion are all signs of a concussion. While these symptoms are easily evaluated in a clinic, or even on the sideline post-injury, initially identifying a player who may have “rung their bell,” but does not lose consciousness on the field is not easy. Football is a contact sport: players collide, hit the ground hard and get tackled. There will be times that players get off the ground a little slower because they experience pain. Yet, not every hit results in a concussion. In fact, most do not.
While advancements in technology and web-based cognitive screening tasks have assisted in concussion management, identifying a concussion immediately after the event is still reliant on observation. As such, while concussion management during the recovery stage has improved, identifying concussions can still be challenging. This is clear as Second Impact Syndrome (SIS) still happens. SIS occurs when a player sustains a second head injury prior to the resolution of a prior concussion. SIS leads to devastating neurobiological dysregulation with severe consequences, including possibly death. It is easy to wonder why SIS still occurs given our knowledge of concussions. It seems that developing and applying new technology could help stop this from happening.
Utilizing technology to initially identify a concussion is in its infancy, but has made advancements. The integration of sensory technology within a football helmet can help to measure the severity and number of hits a player experiences. Helmet mounted sensors can also potentially collect data regarding the player’s speed, reaction time and motor functioning. If technology placed within the helmet could be developed to reliably collect data to identify when changes in brain activity or behaviors occur, we would be providing the “frontline” team trainers, doctors and coaches the tools that they need to appropriately remove players. It seems logical that sensors within helmets is a good step toward applying technology to help with concussion identification. Other technology could follow.
Removing a player from the field of play immediately after a concussion is vital for immediate safety, but also for faster and more thorough recovery. Our focus in concussion management has been tremendous and now needs to continue to progress toward immediate identification of a concussion. As such, safety will improve and SIS will be eliminated. New technology is being developed and studied to immediately identify when a brain has encountered a blow that would result in a concussion. Applying what we know about the neurobehavioral changes from a concussion to the development of new technology will assist us to know when a concussion has occurred, which will result in more immediate care and treatment. This, in turn, can result in what the player, coaches, family and team trainers want most: to return to play safely and quickly.