INOVA/Brain Sentry/Loudoun County

Football and Lacrosse Head Impact Surveillance Proposal

Summary
Underreporting of concussions is a problem.
The proposal herein presents an approach to reduce underreporting by using new
technology to improve the monitoring of football and lacrosse players.
Sensors will be used to augment the usual means of identifying which players need
to be assessed for concussion. This is an observational study that will involve
collecting data from Brain Sentry Impact Sensors, which are small electronic
biosensor devices that attach to the outer shell of athletic helmets. These devices
measure the force of impacts sustained by athletes during practices and
competitions. Data collected from the sensors, along with data regarding
concussive injuries sustained during the season, will be used to correlate impacts to
injuries, to rene the device algorithm, as needed, in future versions of the
biosensor device, and to help to inform future clinical research regarding
concussions!
In order to continue to improve the safety of its athletes and to continue to be
proactive in addressing concussion management issues, !oudoun "ounty will team
with I#$%& !oudoun and Brain Sentry for the '()* season for a year+long
observational study for the county,s lacrosse and football programs-
I#$%& will support !oudoun "ounty with evaluation of all of the athletes pre+
season, mid+season and post+season. I#$%& will provide these testing services at
no cost to !oudoun "ounty .up to ',((( athletes/.
!oudoun "ounty will outt all high school football and lacrosse players with
impact sensors .for a total of )0 high schools/. Brain Sentry will provide sensors
at a '12 discount .appro3imately 41( per student/.
I#$%&, Brain Sentry and !oudoun "ounty 5ublic Schools will wor6 together to
establish best practices for identifying athletes who need to be assessed for
concussion. In success, !oudoun "ounty will be a model program for all
secondary school football and lacrosse programs to emulate.
Bac"#round
$%e Problem o& 'nderreportin# o& Concussion- Unli6e a structural injury that
involves a bro6en bone or a 6nee sprain, a concussion is not always immediately
apparent or detectable, so athletes often continue playing without 6nowing they are
at ris6 for debilitating outcomes. 5layers who try to play through a minor
concussion e3pose themselves to the ris6 of then getting hit again in the same
game 7 a second impact. Second Impact Syndrome .SIS/ can occur when an athlete
sustains a second blow to the head before recovery from the rst concussion.
Seventeen cases of conrmed SIS have been reported in the medical literature, but
the true ris6 and pathophysiology of SIS has not yet been clearly established. &
study of &merican high school and college football players demonstrated 8*
catastrophic head injuries .signicant intracranial bleeding or edema/ over a )0+
year period from )88)+'((*. The rare but usually preventable catastrophic head
injuries in youth sports occur at an annual rate of '.9 cases per )((,((( population
of sports+related brain injury that resulted in hospitali:ation or death.
Unfortunately, previous methods for determining which players need to be assessed
for concussion have largely depended on the athlete self+reporting symptoms.
;esearch has shown that football players usually will not report symptoms of
concussion. The result is many concussions go undiagnosed, and players e3pose
themselves to the ris6s of second impacts.
(oal o& Proposed )*ort- I#$%&, Brain Sentry and !oudoun "ounty 5ublic Schools
will wor6 together to establish best practices for identifying athletes who need to be
assessed for concussion. In success, !oudoun "ounty will be a model program for
all secondary school football and lacrosse programs to emulate.
&ll athletes will be assigned sensors for their helmets. Sensors will help detect the
unusually strong head impacts and will provide an alert to trigger a sideline
assessment. The athletes will also benet from additional education that they will
receive, as well as from the education that their coaches, athletic training sta<,
referees, and parents will receive.
The athletes who consent to participate in the proposed study will benet from
being assessed at three times during the season by the clinical sta< at the new
state+of+the+art I#$%& "oncussion "enter. The assessments will include cognitive
screening, neurologic assessment, balance=vestibular assessment and
musculos6eletal assessment. These assessments will help identify athletes who
may have sustained undiagnosed Traumatic Brain Injury .TBI/.
$imeline- The program will 6ic6 o< with the spring lacrosse season beginning in
>arch '()*. 5rior to the season, I#$%&=Brain Sentry will team to schedule 5arent
Information Sessions and will distribute and manage the process of obtaining
Informed "onsent forms from all of the participating athletes, families.
Bud#et I#$%& !oudoun will fund all of the testing for the athletes. Brain Sentry
will collaborate with I#$%& !oudoun to create and sta< 5arent Information Sessions,
to create research consent forms for players=students to participate in the study, to
handle other administrative duties to nali:e the study, and to o<er the sensors to
the county at a '12 discount. !oudoun "ounty will purchase sensors for all of the
lacrosse and football teams in the county.
Loudoun County as a Leader Use of an impact sensor may help identify
athletes who e3perience signicant impacts so that those players can be removed
from play and thoroughly assessed for concussion.
&lthough the chance of su<ering catastrophic SIS is rare, repeat concussions in the
same game often lead to prolonged recovery periods, including signicant absences
from school and multiple seasons of sport. Despite the e<orts of even the most
vigilant coaches and referees, it is nearly impossible to watch up to '' players on
the eld at once, and young athletes may sustain a second blow to the head before
the rst concussion is ever recogni:ed. & second blow may be relatively minor but
still can lead to signicant long+term problems.
Importantly, even if the e<ects of the initial brain injury have already resolved .9+)?
months post injury/, the e<ect of multiple concussions over time remains signicant
and can result in long+term neurologic and functional decits. These multiple brain
insults can still be termed @repetitive head injury syndrome,A even though they do
not t the classication of SIS.
These injuries can be addressed with the Brain Sentry sensor. The impact sensor
represents an immediate opportunity to reduce the incidence of missed concussive
injuries on the playing eld. The Brain Sentry device accurately identies when a
strong accelerating impact occurs, enabling easy identication by coaches,
referees, and even teammates, to allow for safe removal from play and rapid
sideline assessment for concussion.
In addition to the brain injuries described above, long+term repetitive impacts are
understood to have a causative e<ect in a chronic debilitative condition called
"hronic Traumatic Bncephalopathy ."TB/. ;esearch indicates that )C2 of
individuals who e3perience repetitive concussions will develop "TB. >ore research
is reDuired to determine the severity or recurrence rate necessary to initiate "TB.
Brain Sentry sensors provide an opportunity to contribute to this ongoing eld of
study by counting head impacts to potentially develop guidelines for "TB, much the
way that arm safety was revolutioni:ed with the '((C mandate of pitch counting in
!ittle !eague Baseball.
!oudoun "ounty will be at the forefront of advocating for player safety as the rst
county in the nation to mandate sensors on football and lacrosse helmets for the
entire county.
(oals + Ob,ectives Eigh g+force impacts or multiple moderate g+force impacts
sustained by athletes in contact and collision sports correlates with concussions
sustained. Data obtained from biosensor devices and correlated with injuries may
be used to rene the device algorithm in the development of future devices as well
as return to play decisions.
Study -esi#n/.et%ods This will be an observational study that follows all the
members of !oudoun "ounty,s football and lacrosse teams longitudinally throughout
their '()* season. Brain Sentry Impact Sensors will be mounted on the helmets of
all participating athletes. In conjunction with the coaching sta<s, athletic trainers,
I#$%& sta<, and Brain Sentry sta<, I#$%& will regularly collect the data from the
devices. In addition, the team sports medicine sta< will collect data on concussions
sustained during the '()* season, to include- subject study number, date of injury,
and date cleared for return to full activity.
Sa&ety Considerations &s this is an observational study only, there will be no
direct impact on the athletes=participants. 5articipation in the study will not impact
status on the team or playing time, and any and all injuries or illnesses will be
evaluated and treated according to department policy. #o individual information
about a player will be identied in the study.
-uration o& t%e Study This study will ta6e place through the end of the '()*
calendar year. Eowever, we will plan to follow any concussions until the athlete
returns to full and unrestricted activity, and the study will remain open for ongoing
data analysis through Fune of '()1.
/is" Assessment Because of the observational nature of this study we anticipate
the ris6 to the athlete=participant to be minimal. There will also be no direct benet
to athletes=participants for ta6ing part in the study.
Loudoun County
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INOVA Loudoun
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Brain Sentry
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&ttachments-
&. Informed "onsent Horm
B. 5rotocol
". Brain Sentry $rder Horm