Can a small head-borne sensor help save athletes' lives?

When it comes to concussions, knowing is half the battle

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German midfielder Christoph Kramer never saw it coming. In the 19th minute of the 2014 World Cup Final, Argentina’s Ezequiel Garay dashed behind Kramer, clipping Kramer’s head with his shoulder. Kramer spun like a top and went down hard, hands cradling his face. Glassy-eyed and disoriented, Kramer got up and played another 12 minutes before being pulled off the pitch. At one point, he asked the referee whether he was indeed playing in the final. "I can’t remember that much from the game," Kramer later told The Guardian. "I don’t know anything from the first half."

As many as 3.8 million Americans experience concussive events as a result of athletic or recreational activities every year

It’s estimated that as many as 3.8 million Americans experience concussive events as a result of athletic or recreational activities every year. But as many as 50 percent of these injuries go unreported or undiagnosed, and the results can be life-threatening: athletes who have suffered one concussion are more susceptible to future concussions, and secondary blows before the brain has had time to recover can have devastating and permanent effects. Repeated blows can bring on chronic traumatic encephalopathy, a disease marked by cognitive dysfunction, dementia, depression, and suicidal tendencies. Difficult to measure and diagnose, concussive injuries have plagued players and coaches for decades. But a tiny head-mounted sensor called the Linx Impact Assessment System could change all that.

Over the last two decades there’s been a push to examine the lingering effects of these injuries in professional hockey, soccer, and other full-contact sports. In 2013 the NFL settled a class-action lawsuit over head-related injuries with former professional football players to the tune of $765 million. The league is also tweaking the rules of the game to discourage brutal, debilitating collisions.

Linx IAS

But for amateurs without the benefit of a doctor on the sidelines, concussions continue to be a prevalent and little-understood threat. Coaches may have basic training in detecting a concussive event, but many don’t know when it’s time to pull a child off the field or whether to bench them for an hour, a week, or the rest of the season.

Dr. Dave Borkholder is an associate professor of electrical and microsystems engineering at the Rochester Institute of Technology. He’s also the father of two sons, both of whom play soccer and baseball and practice Tae Kwan Do. "We need our kids to be playing sports," Borkholder says. "It’s an important part of their lives — it’s important for our culture. But they need to be able to do so safely."

"We need our kids to be playing sports... but they need to be able to do so safely."

Dr. Borkholder founded BlackBox Biometrics Inc., a company that specializes in the development of wearable sensor technology. BlackBox’s first product, launched in 2011 with a grant from the Department of Defense, was The Blast Gauge System: a combination of three sensors placed on a soldier’s chest, shoulder, and head that measure the source, magnitude, and impact of explosive events such as IEDs. The Blast Gauge System emerged as an important tool for objectively assessing what Dr. Borkholder refers to as the "signature" injury of the war in Afghanistan: traumatic brain injury. Through their work on Blast Gauge, BlackBox Biometrics developed "a core capability in developing and deploying sensors that measure environmental factors that impact brain health," Dr. Borkholder says.

"The notion that this type of technology — though it is a different technology — has an application in the sports and recreation world… that happened very early on," says Rick Spotts, who joined BlackBox Biometrics as its CEO in late 2014. On the heels of The Blast Gauge System, the company began research and design of the Linx Impact Assessment System, a head-borne sensor that can measure the severity of concussive impacts.

The Linx IAS system is relatively simple: it uses a thin, light-weight sensor the size of a USB key placed in either a headband or a skullcap to fit under a helmet. When the sensor detects a significant impact — whether it be a knee to the head during a wrestling match or a poorly executed header in soccer — it relays that information to the sidelines, where a coach or parent can monitor the situation on a tablet or phone. Player by player, the system logs the severity of impacts, the frequency of the blows, and whether or not the player needs to be pulled from the game.

BlackBox Screen

"In a sport-related concussion, you’ll have an impact to the head," explains Dr. Borkholder. "That can either be a blunt-type impact where you’ll actually have the brain impact the skull and it can rebound and hit the backside. Or you can have rotational effects which can cause shearing and other problems. When that occurs, just like with an explosion, you may have the individual lose consciousness — they may be vomiting, they may be clearly disoriented. There’s obvious signs of the concussion. But there are also symptoms, and those are things that you can’t directly see but you’re relying on the athlete to tell you about. Maybe they have a headache, or they feel a bit woozy…our device is giving you an objective measure of that exposure."

For Dominic Arioli, known as "Coach Dom," a system that can accurately detect dangerous blows could be transformative. The owner and coach of ROC Boxing & Fitness in Rochester, New York, he has been involved with boxing for 48 years — more than 30 as a coach. Arioli works with youth groups as well as adults and says that even though he discourages powerful blows to the head, even small, repeated hits can add up. "As a coach, it’s hard to tell when a kid’s taking too many punches," Arioli says, sitting in his gym. "If they take a decisive blow, that’s obvious — but the accumulation of punches is another thing."

"If they take a decisive blow, that’s obvious — but the accumulation of punches is another thing."

Arioli volunteered his gym and some of his students to work with BlackBox Biometrics to help test and develop the Linx IAS system. A system that can help monitor heavy hits wouldn’t just allow him to monitor the safety of his students, but could also open boxing to communities that currently feel the sport is too dangerous. "As a coach, I have a real passion for this sport. Boxing is one of those pure sports," he says. "But you are taking blows to the head. If we can understand when a person gets hit, understand concussions, and prevent concussions…the boxers would be safer for it."

Dr. Borkholder has a personal motivation for developing the Linx IAS system: his older son was hit hard during his black belt Tae Kwan Do test and experienced a concussion. Dr. Borkholder believes sports are critical to the development of young adults—learning to play on a team, how to win, and lose. "Those are things that’s difficult for them to get in any other way than sports," he says.  "But at the same time I’m really worried about the concussive threat. Linx IAS technology is a way to monitor what those exposures are and then we can make an educated decision on their play."