Combating Concussions

In the United States, there are millions of sports-related concussions each year.

Having one concussion increases your chances of having another and it is estimated that more than 50 percent of concussions go unreported or undiagnosed.

This is a rough estimate because many high school, college and professional athletes do not report concussions. Often the fear of getting benched trumps the fear of permanent brain damage.  

Balance tests are the primary method to detect concussion. However, the current means of scoring these tests relies on the skill of athletic trainers to visually determine whether or not a concussion has occurred.

Specifically, athletic trainers count “errors” while watching athletes stand in different foot configurations — such as on one foot or with feet heel to toe — when a concussion is suspected. Errors include stepping out of place or removing one’s hand from one’s hip and the total number is compared to a baseline test preformed preseason.

This testing method can be both subjective and inaccurate, and can easily be skewed to return a concussed athlete to the field, said Daniel Goble, an exercise and nutritional sciences professor at San Diego State University.

Goble and a team of researchers at SDSU are developing software and an inexpensive balance board device that can measure balance with 99 percent accuracy on the field and in the clinic.

"If you're an athlete and your livelihood depends on the results of these balance tests, you're going to want our more accurate reading on the field," Goble said.

A better test

With help from the SDSU College of Engineering and the Zahn Innovation Center, Goble recently validated the balance tracking system, or B-TrackS, to assess balance before and after potential concussions.

Currently force plates, which are small, square platforms used to quantify balance, gait and other biomechanics, are the primary tools to test for a concussion. But the plates aren't easy to acquire and often cost upwards of $10,000 per plate, so the average high school or university can't afford them. 

Enter the B-TrackS.

Using a low-cost balance board and custom software, Goble’s B-Tracks gives information on how much a person is swaying, which is an indicator of balance. The sway information is just as accurate as an expensive force plate and fully objective.

In fact Goble will soon publish a study in The Clinical Journal of Sports Medicine that shows the validity of the BTrackS system. In this study, a comparison of the current method of scoring balance for concussions and the BTrackS were compared and the BTrackS was clearly more accurate than even the most experienced trainer. 

One of Goble's goals is to make the technology available to high schools and universities for significantly less than a force plate.

"There are athletes out there who are playing with concussions and not knowing it," Goble said. "We're taking the uncertainty out of the equation and giving hard data to quantify whether or not a concussion actually occurred."

The improved board works similarly to the current test — athletes stand on the board and conduct a series of movements based on balance control.  Instead of an athletic trainer determining how many "errors" occur, the board will measure how much athletes sway, and give objective data determining their condition.

"Anybody who runs the test will get the same number, and we can use these numbers and try and figure out what quantifies as a concussion," Goble said.

Put to the test

Goble and his team are now working with SDSU's rugby team to test the most recent prototype.

Rugby is a high-contact sport similar to football, but without helmets. It has the second highest concussion rate next to football.

Goble has recently invited the Aztec rugby team into the lab where researchers will administer tests on the players to get a baseline reading of their balance using the B-TrackS.  If and when the players are later injured during the season, athletic trainers on the team will perform the same test after the injury and compare the scores to see if significant drop-off in balance has occurred.  

This fall, the SDSU men's soccer and women's water polo teams will also be testing the system. 

Moving forward

Goble and his team are making major strides in sports injury prevention.

"This is a great study to be a part of," said Jake Schwartz, a kinesiology graduate student at SDSU. "We're working in uncharted territory and are really seeing some significant results."

Moving forward, Goble hopes to see his research put to use on high school and college campuses across the globe.

Goble also hopes to use the technology to detect more than concussions. It has the potential to identify conditions characterized by balance deficits such as Parkinson's disease, stroke and multiple sclerosis.

"Beyond concussions, we're hoping this system can be used for other neurological conditions," Goble said. "We'd definitely like to get into clinical realms — in terms of disease, we could use this system as a way of tracking balance and knowing when significant changes in balance occur."

CBC Toronto - Detecting Concussions