Impact Sensors: A Missing Piece of Head Injury Programs
No less a concussion expert than Dr. Julian Bailes, the longtime Medical Director of Pop Warner who played a prominent role in the battle between the National Football League and Dr. Bennet Omalu over CTE featured in the 2015 movie, Concussion, and Jeanne Marie Laskas’ book by the same name, has predicted that “the era of dumb helmets, in which coaches and trainers have no clue how many impacts that brain inside that helmet has sustained, is quickly coming to an end.”
But while more teams in contact and collision sports, at all levels of sports, are using impact sensors (the Arena Football League, for instance, has mandated use of impact sensors in players’ helmets since the 2014 season), widespread acceptance and use have proven elusive, for a number of reasons.
Price: As is often the case with new technology-based products, the impact sensors currently on the market are still relatively expensive, ranging in price from around $99 ifor impact sensors which clip to a headband or helmet and record hits greater than 20g to $289 for Athlete Intelligence’s highly sophisticated and accurate Vector mouthguard (which compiles data on the direction, frequency, and force of hits). The hope is that, over time, the per unit price will drop enough to make sensors more practical and affordable.
In the meantime, manufacturers, in order to build market share and get their products into the hands of more programs, have been providing discounts to programs on large orders. A recent article in the Tri-City Herald, for instance, reported that a Washington State youth football program, the Kennewick Grid Kids Association, was able to purchase 340 Cue helmet sensors from Athlete Intelligence for $72 per sensor.
Indeed, an increasing number of football programs, plagued by declining participation rates, believe sensors are worth the expense, regardless of the cost. “We can’t bury our head in the sand anymore,” noted Jeff Boyus, Kennewick’s president in an August 2018 article in the Tri-City Herald. “How can you look a parent in the eye and tell them their kid isn’t worth $80? …There is an expense, but it’s not as expensive as the jerseys they wear on Friday night.”
Misconceptions: Another impediment to widespread adoption has been the widely-held myth that impact sensors are somehow intended to diagnose concussions or replace the need for athletic trainers and other trained observers on the sports sideline. It is true that there are, as of yet, no well-designed, prospective, randomized, blinded studies showing that teams which equip players with impact sensors help sideline personnel do a better job of identifying concussed athletes than teams that rely on self-reporting by athletes and the observational skills of sideline personnel and game officials.
But it is not at all surprising that impact sensors have not been validated for use in diagnosing concussions via rigorous, peer-reviewed testing, because they were never and are not intended to replace sideline observers, game officials, coaches, and teammates who, if they observe an athlete exhibiting signs of concussion, can trigger a sideline screening using one or more assessment tools.
My experience over two seasons with the Newcastle football team in Oklahoma in 2012-2013, and with youth football programs in four states in 2014-15, leads me to believe that, as long as impact sensors are strictly used for the limited purpose of providing real-time impact data to qualified sideline personnel, not to diagnose concussions, not as the sole determining factor in making remove-from-play decisions, and not to replace the necessity for observers on the sports sideline trained in recognizing the signs of concussion and in conducting a sideline screening for concussion using one or more sideline assessment tests for concussion (preferably by a certified athletic trainer and/or team physician), and long as data on the number, force, and direction of impacts is only made available for use by coaches and athletic trainers in a position to use such information for the limited purpose of adjusting an athlete’s blocking or tackling technique (and not for indiscriminate use by those, such as parents, who are not in a position to make intelligent use of the data), they represent a valuable addition to a program’s concussion toolbox and as a teaching and behavior-modification tool to minimize repetitive head impacts.
While researchers continue to look for the concussion “holy grail” in the form of specific impact thresholds above which concussions are highly likely and/or the number of impacts or the magnitude of impacts per week or per season that substantially increase the risk of long term brain injury, the fact is that impact sensor technology is available right now to do what we can to reduce total brain trauma by using impact data to identify kids who need more coaching so they can learn how to tackle, block and body-check without using their helmets or leading with their heads.
Legal concerns. In July 2013, the National Operating Committee on Standards for Athletic Equipment (“NOCSAE”) – a non-governmental organization which sets performance safety standards with which manufacturers of football helmets and other sports safety equipment voluntarily certify compliance supported by fees paid by manufacturers for the privilege of affixing the all-important NOCSAE sticker to their helmets –issued a statement warning that the modifying helmets by affixing sensors might void the manufacturer’s certification of compliance with NOCSAE standards. The announcement created an uproar, prompting substantial opposition from sensor manufacturers (and, not surprisingly, support from helmet-makers), and led some teams, coaches, and at least one state high school athletic association to bar use of some helmet sensors.
A subsequent clarification by NOCSAE left it up to the helmet manufacturers themselves to decide whether impact sensors – at least those affixed to helmets – voided their certifications; gave them the option of engaging in additional certification testing of their helmets with add-on products (which everyone agreed would be cost-prohibitive); and afforded manufacturers of add-on sensors for helmets the right to make their own certification of compliance, as long as the certification testing was done according to NOCSAE standards and the add-on manufacturer assumed potential legal liability for the helmet/add-on combination. (Again, testing that the sensor companies, as start-ups struggling for capital, could obviously not afford)
NOCSAE’s statements prompted Riddell, a leading football helmet manufacturer (which markets the Insight, its own sensor-equipped helmet), to state categorically that it would view modifying its helmets in any way with a third-party sensor as voiding its certification of compliance with NOCSAE standards. Riddell went on to recommend against the use of any third-party aftermarket accessories altering the fit, form or function of its helmets or face masks, not just because such modifications voided its NOCSAE certification, but because, in its view, it “render[ed] the helmet or face mask illegal for most organized play.”
As far as I am aware, five years later, no helmet company, other than Riddell, has taken steps to correct the impression left by the July 2013 NOCSAE statement that sensors affixed to helmets with NOCSAE stickers void the helmet companies’ certifications of compliance, or, like Riddell, has exercised the right under the NOCSAE clarification to declare their certifications void if a sensor has been affixed to their helmet. Their silence thus continues to create a legal risk to any school or youth football program which allows an add-on sensor on or in a helmet that, in the event of an injury and lawsuit, the helmet manufacturer will take the position that its certification of compliance with the NOCSAE standard was void. The chilling effect of such statements on the willingness of sports teams to purchase helmet sensors, while impossible to quantify, has undoubtedly been substantial, and continues to cause concern among manufacturers of impact sensors designed to attach to helmets.