Concussions: Exploring Preventative Technological Solutions to an Epidemic

By Anthony Adams & Andrea Bowman
University of Montana, College of Business, Fall 2017

Often made analogous to war, the game of football is as stereotypically American as it gets: massive humans slamming into one another at breakneck speeds in an animalistic display of pure will, size, and physicality. Players of the sport are revered for their toughness and tenacity, both mentally and physically. The nature of the sport leaves even the strongest bloodied and bruised, but it’s the injuries beneath the surface of the skin that pose the most grave danger to the sport itself.

Chronic Traumatic Encephalopathy–or CTE, as it is more widely known–is a disease of the human brain that can be caused by repeated trauma to the head. Researchers have successfully linked repeated concussions–a rather commonplace injury in the collision-centered sport of football–with the development of the disease. CTE often manifests in its victims through violent mood-swings, uncontrolled outbursts, severe depression and confusion, resulting in victims acting dangerously towards themselves or others (Belson).

Unfortunately, CTE can only be diagnosed postmortem; that is, after an extensive autopsy. After the suicide and subsequent CTE diagnosis of former professional linebacker Junior Seau in 2012, concerns began to arise regarding the safety of football. Such concerns crescendoed over the years, reaching deafening levels when, in July of 2017, Boston University published its research on the brains of 111 deceased professional players. The study found that 110 of the 111 brains examined were afflicted by the disease (Belson).

Aaron Hernandez–a former tight end for the New England Patriots of the National Football League (NFL)–is the most infamous case regarding CTE in the short history of its research. Hernandez was tried and convicted for the 2013 murder of his friend, and was also accused for the drive-by shootings of two other individuals in 2012. In April of 2017, Hernandez hung himself in his cell with his bedsheets (Belson). Tragedy was soon followed by even more disturbing news: Hernandez’s brain had the most advanced form of CTE doctors had ever seen in a man his age. At just 27 years of age, Hernandez’s brain resembled that of former deceased players with CTE in their 60s. The severe atrophy of his brain cells astounded researchers, and many believe that his erratic behavior was a direct result of the disease he developed by playing football (Belson).

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Hernandez’s estate followed the findings with a lawsuit against the NFL, the New England Patriots, the National Collegiate Athletic Association (NCAA), and the Florida Gators, his alma mater for which he played football as a student-athlete (Belson). With the Hernandez case fresh in the minds of every mother and father in the United States, the game of football is at a crossroads. Once revered for its violence and brutality, its defining qualities are now being cited by many as reasons to choose another sport.

Since its inception in the early 1920s, the NFL has grown into a behemoth organization, both in terms of revenue and reach. The game of football has grown into the most popular sport in the United States, and the NFL’s dominance as a business is best illustrated by its enormous revenue stream, currently estimated between $13-$14 billion, which is the highest in the world (Kutz).

Despite growing revenues and reach, there is concern surrounding the longevity of football as the dominant sport in the United States due to the health risks the game poses to its players. Specifically, concerns regarding concussions—and the long-term effects of sustained concussions throughout a career—have received a great deal of media attention in the last decade. As concerns rise, the future of the game has come into question; thus, the NFL has dumped billions into research regarding concussion prevention and treatments.

The purpose of this paper is to discuss a few of the technological solutions that have come out of—and are being perfected by—such research. While concussions may never be totally eradicated, researchers hope to bring increased safety to participants of the most popular sport in the United States, from the NFL down to the lowest level of pee-wee football.

Legacy Technology: The Polycarbonate Helmet

The first use of technology to increase the safety of the game came in the form of a helmet. The first leather helmets were introduced in the 1930s, and while there was incredible progress in the development and improvement of these helmets, the technology has remained largely unchanged since the 1970s, when the first polycarbonate helmets were introduced. The formula for these polycarbonate helmets was simple: a tough outer shell to protect, and padded interior for comfort. The helmet, at this point in history, was designed to prevent skull fractures and brain hemorrhaging, and it was incredibly successful at this initial task (Tracy).

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The helmet made great strides from its leather beginnings, but after the 1970s, design changes focused more on comfort and style than concussion-preventative functionality.

But the NFL became complacent, refusing to invest in helmet technology and effectively ignoring the long-term effects of concussions on a participant’s life after football. The last decade, however, has been littered with concussion-related tragedies, and the media has brought the national spotlight to such issues. The negative press has forced the NFL to invest billions into concussion research and product development, with the largest advances being made in previously lethargic helmet technology.

Potential Solution #1: VICIS and the Zero1

Enter VICIS, a Seattle-based company backed by the University of Washington, looking to capitalize on the demand for concussion-reducing helmet technology. VICIS—Latin for “change”—has developed a new kind of helmet, which the company has named the “Zero1”. VICIS introduced the Zero1 with a single goal in mind: reduce the force sustained by the participant during a collision. After all, concussions—VICIS hypothesizes—are simply a physics problem: force is a function of mass and acceleration. Because no helmet can change the mass of participants, VICIS has singled out acceleration as the key to solving the concussion problem. Therefore, VICIS’s goal was to slow the acceleration resulting from a collision, thus reducing that half of the equation and lowering the force that is applied. The Zero1 incorporated car safety technology to its helmet, designing it to crumple and absorb collisions rather than directly opposing them. The result is reduced acceleration when compared to the incumbent polycarbonate technology, earning the Zero1 the NFL’s highest safety rating in the industry (Garcia). Further advancing the safety of the Zero1 is its unique “columns” that lie directly beneath the outer shell. The columns are designed to disperse force vertically through crumpling, but are also designed to disperse force in an omnidirectional fashion by twisting and compressing simultaneously. The development was key in addressing a large amount of research that suggests concussions are largely “caused by rotational motion, rather than angular—or forward and backward—motion.” (Tracy).

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VICIS has positioned itself as the leader of the advanced technology helmet industry, but the company—despite the promise surrounding its developments—is not without its challenges in implementing its technology. The first hurdle is cost; the Zero1 clocks in at an astonishing $1500, and while this price represents loose pocket change for professional organizations, it will prove to be an enormous barrier to entry into the larger youth and high school markets. Furthermore, VICIS’s chief concern lies not with the roughly 2,000 NFL athletes, but with the millions of youth and high school aged participants of the sport (Garcia). While the value of the helmet is clear, the premium price is difficult to afford. Thus, VICIS will be forced to roll out its first few waves of helmets in more affluent markets—namely the NFL and a select few college programs—until it perfects its research and development process, manufacturing, and other processes enough to reduce the price to the consumer to a more palatable figure.

The second major challenge to VICIS and its helmet technology is information. Despite the buzz generated by VICIS and its revolutionary Zero1, it remains to be seen if helmet technology really has any statistically significant effect on the amount or degree of concussions. Researchers and developers simply do not have sufficient information, in terms of breadth or depth. Further complicating the issue is the individuality that comes with any health-related diagnosis; two players may undergo the same force, and one may suffer a concussion while the other does not. Finally, there may exist several more effective routes in concussion prevention and treatment than helmets, which would stop the flow of funding and put all VICIS projects on hold (Mayer).

Supplemental Technology: Q Collar

Another route in concussion prevention, although controversial, has entered the market to both challenge and supplement the use of helmets. Q Collar, a flexible band worn snugly around the neck, gently compresses the jugular veins which causes the brain to swell and “fit tighter” within the skull (Taylor). This effect is thought to reduce the amount of twisting and slamming in the brain, therefore reducing the chances of an athlete sustaining a concussion. Q Collar, which is designed to accompany a helmet, has created a revolutionary internal solution to a problem that has previously only been addressed externally by changing the size of an individual’s brain inside their skull instead of creating a hard shell to go around one’s head.

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Although tampering with the brain’s composition may seem like a radical solution, David Smith, PhD and co-inventor of the collar, has based his design off nature’s biological mechanisms to prevent brain damage from concussive-type impacts. Through his studies, Smith discovered this brain-swelling technique being employed by both head-ramming sheep and woodpeckers. The migration patterns of the sheep show, “they are hitting at high altitudes, which we believe to increase blood volume in the skull” (“Q30”). Woodpeckers use a slightly different technique, wrapping their long tongue around their jugular vein to “raise venous pressure” which in turn creates a bubble wrap effect (Glatter). Both animals use slightly different approaches, but they are able to achieve the same results as the Q Collar to protect their brains from long-term damage.

Q Collar has yet to receive FDA approval, but initial studies have shown very positive results in the changes of white brain matter for athletes wearing the collar. The first study conducted utilized MRI scans before, during and after the season for 15 varsity level high school hockey players. These scans indicated that, “changes in the brain’s white matter (an indication of brain injury) were significantly ameliorated when the Q Collar was worn” (“Q30”). A similar study performed with a larger sample of football athletes found similar results. Researchers assigned 25 players to wear the collar throughout the season and 27 players to a control group, wearing only traditional helmets (Glatter). Special devices verified players from each group experienced a similar number of impacts at similar intensities. For those who did not wear the collar, fMRI scans showed a greater amount of neuronal activity after an increased number of impacts at a greater intensity, indicating an increase in brain injury. Meanwhile, “those players who wore the collar throughout the season did not see any appreciable change in neuronal activity on the MRI scans from preseason to postseason testing, in spite of sustaining similar amounts and magnitude of head impacts throughout the season” (Glatter).

Even with positive results from its initial studies, there have still been many concerns regarding the risks associated with wearing the Q Collar. Compressing the jugular veins that drain the brain, the purpose of the collar, could increase the risk of blood clots (venous thrombosis) from chronic gentle compression (Glatter). The Q Collar also reduces cerebrospinal fluid in the brain while elevating intracranial pressure which could be life threatening when paired with a traumatic brain injury (Glatter). Uzma Smadani M.D., Ph.D. and associate professor of neurosurgery at the University of Minnesota further explains, “After a brain injury, oxygen delivery to brain cells is absolutely critical to prevent cell damage or death. One wonders if the five subjects who either dropped out or crossed over (opting to switch from wearing the Q Collar to the control group wearing only a helmet) felt ‘strangled’ or oxygen-deprived while they played” (Glatter).

The (Multi) Billion Dollar Question

Q-collars, compressing helmets, concussions as a physics equation: while millions of dollars have been dumped into research, and clever proposals and prototypes have surfaced, the same question still looms. How do we know if any of these technologies are actually effectively reducing the number and severity of concussions? The problem underlying concussions may not be directly tied to physics or even biology; perhaps the problem—and therefore, the potential solution—lies in understanding the problem itself, rather than its causes.

There still exist many discrepancies and misconceptions regarding concussions, as the medical community has yet to reach a consensus on exactly what constitutes a “concussion”. The answer, therefore, might lie in data as opposed to a tangible product such as a helmet or Q-collar. In order to understand how to approach concussion prevention—and arguably more importantly, to evaluate the approach’s effectiveness—researchers must understand exactly what causes a concussion.

Dr. David Camarillo, an assistant professor of bioengineering at Stanford leading a lab dedicated to inventing equipment that reduces traumatic brain injuries, addressed this point on a September 2016 episode of NPR: “The manner in which you absorb the energy, I think, matters. And this comes back to really one of the research challenges in the field, is that if you want to evaluate if a helmet’s going to protect against concussion you need to understand the details of what causes a concussion. And that’s something that’s been missing and a tough nut to crack.” (“Reinventing”). Sensors, data, and interpretation of such information, Camarillo argues, will be the key to unlocking the solution to the concussion epidemic. But sensors in the helmet, he claims, are an ineffective and outdated method for data collection. “We’ve found that the best approach is not so much the most obvious thing, which is to put sensors on a helmet. The helmet, if it’s doing its job, moves significantly with respect to the head. So we’ve been targeting one of the hardest substances in the body: your teeth. So we put sensors in a mouth guard that essentially snaps into the player’s mouth and gets quite precise measurement of the head’s motion. And then we can start to infer what’s happening inside the brain.” (“Reinventing”). Camarillo and his team hope to uncover the true secrets at the heart of concussions through data collection via sensors placed in mouthguards; in doing so, Camarillo hopes to utilize the information to develop technology that will effectively reduce the number and severity of concussions sustained while playing contact sports such as football.

Looking Forward

In reality, concussions are unlikely to ever be completely eradicated. The goal is, and should remain, to reduce the frequency and severity of concussions in the game of football so as to reduce the negative, long-term effects of traumatic brain injuries the violent sport inflicts on its participants. Truthfully, it is unlikely that the helmet alone will be the solution, nor will the Q-collar or even sensors and data collection. The solution most likely exists at the intersection of many efforts, including the aforementioned technologies now being researched and produced. Dr. Camarillo reiterates this notion of a combined solution in his statements to NPR: “I think it’s probably going to need to be a little bit of (everything). I think if you have a combined and holistic approach (with)…modifications in rules and technique along with improvements of technology, there’s significant opportunity.” (“Reinventing”).

There exist several technological developments that could potentially lower costs and make these technologies more accessible and affordable to every segment of the market rather than just the professional and upper-echelon collegiate program athletes. One potential power to be harnessed is that offered by 3-D printing. The technology would allow companies to produce prototypes more quickly and at a lower cost, as well as provide precision fit instruments for maximum effect. For example, as 3-D printing becomes a viable production measure, VICIS could print single model iterations of a Zero2, Zero3, Zero4, Zero5, and so on and test them immediately. This solves the scalability issue that could prevent technologies from advancing at maximum velocity. As another example, Dr. Camarillo and his team at Stanford could 3-D print precise, individualized mouthguards with built-in sensors so as to ensure fit, comfort, and accuracy of data collection.

Another promising technology, virtual reality, may soon be able to effectively assist coaches and players in training by running virtual drills with the players and giving instant feedback on the consequences. As an added benefit, virtual drills would also decrease the number of hits athletes receive in a practice setting.

Looking quite a bit further into the future, some speculate that 4-D printing—the printing of 3-D objects that possess the ability to change over time depending on the coding of the “smart dust” which comprises them—could unseat 3-D printing as a tool for manufacturing as soon as ten years from now. As this technology matures, perhaps helmets can be designed to completely crumple with each hit and reassemble seconds later, allowing the equipment to absorb nearly all of the acceleration of a collision.

On the treatment side of the equation, human augmentation and gene manipulation is expected to take great leaps forward in the next decade and beyond, which could slow or even completely eliminate the long-term consequences of repeated concussive blows by restoring the brain’s normal—or perhaps even advanced—functionality.

It will be pivotal for researchers to continue to implement the most sophisticated technology available to them at any given time in their research and development of concussion-prevention and treatment solutions. While 4-D printing, smart dust, and human augmentation seem like distant tools unrelated to the development of such solutions in the present, staying current and flexible in the implementation of technology will separate the successful researchers from the others. The answer to the concussion epidemic likely exists in between all of the current proposals, and the convergence of brilliance will one day, researchers hope, bring increased safety to the game of football.

Works Cited

Belson, Ken. “Aaron Hernandez Had Severe C.T.E. When He Died at Age 27.” The New York Times, The New York Times, 21 Sept. 2017, http://www.nytimes.com/2017/09/21/sports/aaron-hernandez-cte-brain.html.

Garcia, Ahiza. “Vicis Zero1 NFL helmet aims to reduce head injuries.” CNNMoney, Cable News Network, 18, Sept. 2017. money.cnn.com/2017/09/16/news/companies/vicis-nfl-helmet-concussions-safety/index.html.

Glatter, Robert. “Can The Q-Collar Help Preserve Brain Function In Football Players?” Forbes, Forbes Magazine, 16 May 2017, www.forbes.com/sites/robertglatter/2017/05/16/can-the-q-collar-help-preserve-brain-function-in-football-players/4/#3a97d4f745b6.

Kutz, Steven. “NFL took in $13 billion in revenue last season – see how it stacks up against other pro sports leagues.” MarketWatch, 2 July 2016, www.marketwatch.com/story/the-nfl-made-13-billion-last-season-see-how-it-stacks-up-against-other-leagues-2016-07-01.

Mayer, Ryan. “New Helmet Technology Isn’t A Cure-All For Football’s Concussion Issues.” CBS Local Sports, 23 May 2017, sports.cbslocal.com/2017/05/23/new-helmet-technology-vicis-helmet-nfl-concussion-football-head-trauma/.

Myer, Gregory D., et al. “The Effects of External Jugular Compression Applied during Head Impact Exposure on Longitudinal Changes in Brain Neuroanatomical and Neurophysiological Biomarkers: A Preliminary Investigation.” Frontiers in Neurology , Frontiers, 29 Apr. 2016, www.frontiersin.org/articles/10.3389/fneur.2016.00074/full.

“Q30 Innovation’s Q-Collar shows promise in reducing brain injuries.” Cision PR Newswire, Q30 Innovations, 15 June 2016, www.prnewswire.com/news-releases/q30-innovations-q-collar-shows-promise-in-reducing-brain-injuries-300285009.html.

Taylor, Tom. “New collar shows promise for concussion prevention.” SI.com, Sports Illistrated, 15 June 2016, www.si.com/edge/2016/06/15/concussion-prevention-technology-qcollar-neck-wearable-football-hockey.

Tracy, Abigail. “Could This Helmet Save Football From The Sport’s Concussion Problem?” Forbes, Forbes Magazine, 23 Mar. 2016, www.forbes.com/sites/abigailtracy/2016/02/04/nfl-cte-football-concussions-injuries-helmet-vicis-zero1-super-bowl/#188128b5f050.

“Reinventing The Football Helmet: Is Improving The Technology The Answer?” NPR, NPR, 18 Sept. 2016, www.npr.org/2016/09/18/494451651/reinventing-the-football-helmet-is-improving-the-technology-the-answer.

 

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