Quantitative Assessments for
Sports-Related Concussion

Head impact sensors are used to quantify biomechanical load exposure during competitive game play. In the US, there are more than four sports-related traumatic brain injuries every minute. There is emerging evidence that sports-related concussion (SRC) can affect academics, behaviors, and neurocognitive processes, such as working memory, concentration, processing speed, and eye and motor function.

A recent Institute of Medicine report on sports-related concussions in youth revealed how little is known about concussion in the young brain and called for urgent attention to determine the incidence of SRCs in boys and girls by sport and demographic; research to identify unbiased, sensitive prognostic and diagnostic metric and marker; longitudinal studies to determine outcomes; and to delineate age- and sex-related biomechanical determinants of injury risk.

Objective Translational Multi-domain Early Concussion Assessment Study

Study Objectives

This research project, funded by the National Institutes of Health (National Institute of Neurological Diseases and Stroke) focuses specifically on developing a suite of quantitative assessment tools to enhance accuracy of sports-related concussion diagnoses, with a focus on eye-tracking and measures of cerebral blood flow. The study is determining sports settings with highest impact exposures and integrate across animal (porcine) and human studies to relate rapid head rotation magnitude and direction to short-term outcomes. These data will provide prognoses of the time-to-recovery and safe return-to-play for youth athletes. This study also looks at sex-specific data to see how prevention and diagnoses strategies need to be tailored for males and females.

Investigational Plan

Over the course of the 5-year study, researchers are pursuing the following aims:

Aim 1 --  An unbiased numerical assessment suite for SRC will be developed and validated. Objective metrics include assessments of balance, oculomotor function, visual and auditory processing, and sleep. Researchers are determining if these metrics or certain combinations of these metrics identify the presence of SRC with high sensitivity and specificity and are predictive of days-to-clearance for sports. The research team are then validating the findings in a separate cohort.

• In a 2019, study, published in Medicine & Science in Sports & Exercise, researchers found that a device-based measure of balance did not produce better discriminatory ability than two clinical assessments. One assessment, the complex tandem gait, has the additional benefit of being an easy-to-perform and graded test with highly sensitive and specific individual components. 

Aim 2 – Because the Aim 1 objective metrics are nonverbal and effort-independent, we are “translating” their use to an animal model of TBI, where human-like measures of physical, cognitive, and sleep deficits are associated with SRC in piglets after rapid controlled head rotations. In Aim 2, we are using this juvenile porcine TBI model to determine SRC mechanisms by relating the influence of sex and load frequency, magnitude and direction on neuro-function, biomarkers and neuropathology. Both single rapid head rotations will be studied as well as a multiple sub-concussive rotations. In this line of study, by developing new technologies to translate human outcome metrics to animals, we provide a human-like platform to develop and test injury treatments in the future. 

Aim 3 – The insights from Aim 2 will be translated from animals to teens, where head impact sensors are used to quantify biomechanical load exposure by sport and sex, and relationships between load exposure and neuro-functional metrics using the numerical assessment suite developed in Aim 1. This will provide new knowledge regarding high-risk biomechanical settings for the young brain.

• In a 2020 study, Video Confirmation of Head Impact Sensor Data from High School Soccer Players, we determined that head impact sensors can record a large number of false positive impacts during real game play in high school competitive soccer games. The extra step to video-confirm the sensor data is essential to minimize false positives before using this data for research and in injury prevention strategies for player safety. 

Of note, the study is using BOTH male and female high school athletes and piglets in a deliberately parallel study design to determine optimal SRC assessments and identify mechanistic relationships between sex, energy loading conditions, and SRC symptoms.

Watch how Dr. Declan Patton uses instrumented mouth guards to measure head impacts of high school athletes in his research: