Are Concussion Sensors Selling A False Sense of Security?

Looking for a good business idea? Something to pitch on Shark Tank? Here's one: Get a motion sensor, like the one in the latest iPhone, and a couple LED lights and put them into a mouth guard or a football helmet. Design it so a red light turns on when there is a big impact. How big? Your call. You don't have to make any claims about diagnosing concussion. Just call it what it is: an impact indicator. Tell people it's just a tool in the anti-concussion toolbox. If you make it sexy enough, other people will connect the dots for you. Fast Company might even give you an award, as it did Reebok's Checklight indicator, and tell the world your product does things-amazing things-that it does not in fact do: "This skullcap embedded with sensors lights up when it detects dangerous head injuries in athletes, tackling one of the sports world's most difficult problems."

Welcome to the wildly unregulated world of head sensor technology.

Over the last several years, the public has become more conscious of the prevalence and severity of sports-related head injuries. A growing body of research links concussions and subconcussive brain trauma to mood and behavior disorders and long-term cognitive harm. Kosta Karageorge, the Ohio State football player, may be the latest high-profile case. Karageorge complained of the effects of football-related concussions before going missing last week. He was later found dead, a suspected suicide. Just a few years ago, associating concussions with suicide would have been considered an irresponsible leap. Today, it's a plausible theory: Jovan Belcher, the former Kansas City Chiefs player who in 2012 murdered his girlfriend, Kasandra Perkins, before committing suicide was later found to have signs of the neurodegenerative disease chronic traumatic encephalopathy (CTE) in his brain, and a neuropathologist reportedly will examine Karageorge for signs of traumatic brain injury.

Football is in a full-on crisis. The NFL is being sued by retired players over long-term brain damage. The NCAA is in the same boat. Youth participation is down as parents opt to have their children play sports that aren't linked with cognitive harm. Those sticking with football want to make the sport safer. That's where the sensors come in.

There are all kinds of practical problems associated with diagnosing head injuries in football. Players are unlikely to self-report a heavy impact if it means potentially leaving the game. Coaches are incentivized to keep concussed star players in the game if they're the difference between a win and a loss. And then there's the training necessary to properly diagnose a sometimes-subtle injury, a job made even harder by oft-chaotic sideline conditions. Add it up, and experts believe that between one in two and one in 10 football concussions go unreported and undiagnosed; a recent Harvard University study found that college football players report having six suspected concussions and 21 so-called "dings" for every diagnosed concussion.

But wait! There's the technological solution: what if a light came on when a player was concussed?

While a great idea in principle, things aren't quite that straightforward. For one thing, there's no consensus on how much force, or what kind of force, causes concussions. Some data indicates that greater the force acting on the head, the higher the probability of a brain injury; problem is, lower-force impacts also can produce concussions. So where do you draw the line? And what if each sensor draws the line at a different place?

As a way to standardize the sensor industry, the nonprofit Sports Legacy Institute and Boston University developed the Hit Count certification system. Hit Count is optional, and the $25,000 cost of participating in the program has been criticized. To date, Hit Count lists just three certified products out of the dozens of sensors on the market. In addition to football, it certifies sensors for unhelmeted sports, men's lacrosse, and hockey. According to its website, the inspiration for the Hit Count came from baseball's pitch count system, "which is believed to have reduced the number of arm injuries in youth baseball." As stated in the Hit Count Threshold White Paper, certified products "will register a Hit when peak acceleration exceeds 20 g's in a 40 millisecond window."

That's all well and good. The 20g threshold is just outside what Hit Count deems normal. And we know repeated concussions are particularly dangerous. But Hit Count only measures linear head acceleration (think a boxer being hit in the head with a straight jab), not rotational acceleration (think a boxer being hit with a hook). Depending on head impact type and location, the two can be highly correlated. But not always. Moreover, the relationship between the two types of acceleration and brain damage is far from fully understood. For Hit Count to take one into account and not the other is like a pitch count that only includes fastballs. (Hit Count hopes to add rotational measurements to it's certification process in the future. Many sensors already measure both.)

Some of the sensors on the market are quite advanced, providing the kind of detailed, much needed data that hopefully will contribute to a better scientific understanding of how various impacts and head accelerations relate to brain injuries. And the more data they collect, the better. Others are simple traffic lights. When standardized, they could help make it more difficult for, say, a shook-up star to dodge a diagnostic examination. But none of the sensors can make that diagnosis on their own, a fact that appears multiple times on Reebok's website.

As the Fast Company award illustrates, the presentation can obscure the message. People see that green light and think safety, when that's not what it means at all. Minus any standardization, it's tough to say if that green light means anything. Parents want their children to be safe. They're willing to spend money to make that happen. And like all of us, they increasingly put their faith in technology. But what they're being sold isn't safety. It's an illusion.