The fall sports season is tantalizingly near; players and fans alike are gearing up for the Friday night lights and Sunday afternoon showdowns. But the season comes at a cost; every bone-jarring hit and wince-inducing header carries the risk of sustaining a concussion.
Most media coverage focuses on the National Football League’s professional players, but 65% of traumatic brain injuries are sustained by children. The majority are thought to be undiagnosed, but the Center for Disease Control estimates that 1.6 to 3.8 million sports-related concussions occur each year. This puts athletes at risk of sustaining a second concussion before their brains are fully healed, leading to longer recoveries, permanent neurological damage, and the potentially-fatal Second Impact Syndrome.
A just-released app hopes to change that. Sway Medical, founded by Chase Curtiss in 2011, aims to help health professionals objectively rate the risk of concussion at the source: on the football field or soccer pitch. On-the-spot concussion diagnosis is just the beginning, though; in the near future, the young company plans to enter the hospital space by the end of the year.
The FDA-approved app, called Sway Balance, uses proprietary software and the iPhone’s accelerometer to assess an athlete’s balance over time. In a phone interview, founder and CEO Chase Curtiss said that the app can be used by a health professional to “set up a baseline,” then “compare an athlete over the course of a season to that established norm.” Poor performance compared to baseline is indicative of a possible concussion.
Health care professionals can purchase a yearly subscription to the app for $199 – a fraction of the cost of a typical balance platform – and the patient-facing app is free to download.
Sway Medical has partnered with ImPACT Applications, an organization which Curtiss described as conducting the “gold standard of concussion testing on the market.” ImPACT uses baseline cognitive testing – verbal and visual memory, processing speed, and reaction time – and synchronous testing immediately after a hit to assess if a concussion has occurred.
“But you don’t have an element of physical control of the body,” Curtiss said – which is where Sway Balance comes in. “[ImPACT’s] interest in us is in pairing a balance test with cognitive testing.”
Like many in neuroscience, I’ve been thinking about the consequences of traumatic brain injury in football. In thinking about this, I think I’ve figured out how American-style football will end. I’m putting the over/under at about 10 years.
The simple explanation of football is this: football is the optimal activity to put the maximum explosive energy a human can develop and deliver it to another human, pause, catch your breath, and do it again. Football is a game of inches, and so the ball is carried by huge, weight-lifting sprinters who hurl their 200+ pound frames at a line of huge, weight-lifting thugs who try to stop them cold. I am not anti-football: I played a little football in high school, I played full-pads, full contact intramural football while an undergraduate (an insurance company’s nightmare), and was a rugby player and coach as a graduate student. My own athletic skill was thuggery.
The problem with this is that repetitive shocks to the brain seem to create pathology in the brain of the protein tau. Athletes who engage in contact sports have a tendency to suffer from chronic traumatic encephalopathy (CTE), which is identified pathologically by finding dense tangles of tau. Dense tangles of tau have been found in boxers, football players, professional wrestlers, and soldiers. There is concern in hockey players and soccer players who head the ball. One researcher found tau tangles in 8 of 9 donated brains from former NFL players. This kind of accumulation of tau is associated with young-onset dementia, cognitive change, and mood disorders.
After a decade of conflict in Iraq, our troops have come home, producing the largest increase in the number of American veterans since the 1970s. After Vietnam, an America tired of war and consumed with political angst neglected its veterans. Fortunately, the veterans of today are receiving the homecoming they deserve. To make that homecoming complete, America needs to ensure that our returning warriors have access to one of the most important benefits they have earned: health care provided by the Department of Veterans Affairs.
A Health Care Challenge: Fewer Battlefield Deaths, More Injuries
The United States military is the most technologically sophisticated fighting force in the world. This technological advantage means that our troops in Iraq and Afghanistan are subject to fewer casualties than in Vietnam. But those who do receive injuries are significantly more likely to survive because of body armor and the high quality of medical care. According to a study conducted by the University of Pennsylvania, only 13 percent of those injured in Iraq were likely to die compared to those injured in Vietnam, where the fatality rate was nearly 25 percent. But our ability to save lives also means that many more veterans are returning home after losing limbs or suffering from the after-effects of traumatic brain injuries (TBI) from blasts experienced in battle or as a result of improvised explosive devices.
A frightening aspect of TBI is that it can be quite difficult to diagnose. It is possible for someone exposed to an explosion to show no signs of injury until weeks or months later when symptoms—such as depression, anxiety or anger issues—become apparent. Untreated, these symptoms can lead to major depression, substance use problems, unemployment and ruined family relationships. In addition to TBI, other problems—from back injuries to exposure to toxins—may only become apparent after the veteran has been separated from service for months or even years.