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How a smartphone app and $15 piece of cardboard are taking on football concussions

Concussions and their symptoms are hard to diagnose with the naked eye, resulting in a lot of players playing when they shouldn't be. A new app hopes to change that.

Your eyes concentrate on the ball as it sails toward you on a punt. Only once you've secured it do you see the gunner out of the corner of your eye. As your head hits the ground, it's as if someone dimmed the lights. Your ears ring. The band is playing your team's fight song and it sounds like it's coming from the far end of a tunnel. Your coach -- who you assume is your coach, he's a blur -- asks if you're okay.

Most sports injuries can be detected by the naked eye. Concussions often can not. A lot of attention has been paid to the damaging long-term effects of cumulative brain trauma, but that attention is still a relatively recent development. Many young athletes have been coached to stay in the game if they physically can. Doing so may mean deliberately ignoring obvious concussion symptoms, assuming they know what the symptoms are at all.

Three University of Arizona researchers believe they can solve the problem, at least in part. Ricardo Valerdi, Hirsch Handmaker and Jonathan Lifshitz teamed together to head a project to create a virtual reality app, called Brain Gainz, that gives athletes a first person demonstration of what it's like to experience a concussion. Their goal is to eliminate the guess work that happens in the heat of a game.

Using a $15 Google Cardboard peripheral with a smartphone (the app was developed for both iOS and Android phones), users assume the role of Wildcats punt returner who gets tackled during drills. On some occasions, he is able to dust himself off and continue to take reps. More often, he experiences some symptoms of a concussion, ranging from relatively mild blurred vision and hearing distortion to quadruple vision and heavy visual trailing.

The user does not have much control of the simulation -- he can look around and press a button to catch the ball, but no matter what he's going to get hit. The most important choice comes after the rep when he must tell his coach whether he can keep practicing. If he decides to stay on the field, he is subjected to more hits, potentially worsening the severity of the concussion.

The app was consciously designed so that, at a certain point, the user can be so concussed he can no longer discern the prompts on the screen -- essentially, the user is no longer physically able to decide what is best for his own health. The scenario is a warning of what can happen when an athlete tries to fight through symptoms. A minor concussion greatly increases one's susceptibility to a major one.

Arizona athletes were enlisted to help shape the app, including linebackers Jason Sweet and Scooby Wright. As players in a contact sport, they're aware of what it's like the get their bell rung. And as players in a contact sport, they know their ability to simply stay on the field is one of their most important attributes, which begs questions.

"So what is the gray area to where, me as an athlete gets concussed, and I go report that?" Sweet told SB Nation. "Because I want to compete, too, I don't want to get taken out of the game, so how do I know that I've experienced a concussion that's severe enough to go report it?"

The NCAA tries to educate athletes with presentations and flyers listing symptoms such as dizziness, confusion and sensitivity to light, but there's still subjectivity in those supposedly telltale signs. If an athlete feels dizzy but his vision is okay, does he have a concussion? What if he doesn't believe he's confused, but can't be certain because he doesn't trust his own thought process?

The ability to decide whether you're able to play becomes more difficult as you become more concussed.

And just how dizzy does one need to be to be considered concussed? When a player is passed through concussion protocol, he goes through a series of diagnostics to determine the extent of his head injury, but is often kept dark about what is being tested. They are simply told, yes or no, whether they can suit up.

Brain Gainz tries to demonstrate, in clear terms, what a concussion looks and sounds like so that athletes can quickly recognize it. In its nascent stage, the app still doesn't come close to encompassing the spectrum of possible symptoms. Some, like nausea and headaches wouldn't be practical or safe to simulate. Beyond that, the app can't fully account for the fact that concussions are unique from individual to individual. In its current form, Brain Gainz can display five distinct concussion reactions, far short of the complete range of combinations of visual and auditory distortions that can be experienced.

But it's a start, and the team hopes to keep improving the app. It has garnered a lot of interest so far, gaining funding through the Mind Matters Challenge, a joint NCAA and US Department of Defense sponsored competition to develop projects that advance education and research of concussions and, ultimately, protect athletes and service members. Brain Gainz was honored as one of six winners in the education category.

The next step is to get bigger. The team is trying to set up meetings with military leaders, and the NCAA's chief medical officer, Brian Hainline, visited Arizona after the Mind Matters Challenge to try out the app for himself. The team would like to expand its app to include more sports and symptoms. It sent a proposal to a Pac-12 grant program that would add baseball, wrestling and cheerleading scenarios to the app and distribute it to athletes on select Pac-12 campuses. The rate of concussion reporting on campuses with the app would be measured against the campuses without it. The hypothesis, not surprisingly, is that the better-educated athletes will be more likely to report concussions.

That's ultimately the goal, because as cool as the technology is, it still has to be proven effective. To that end, the team isn't relying solely on its immersive experience to educate athletes. When users are done with the simulation, they are given a set of pre-written tweets they can send from the app as a call to action and a commitment to treat concussions more seriously.

Beyond the app itself, the team is also developing what it calls "social norm marketing," which Valerdi, begrudgingly, equates to propaganda. By putting messages within common sight of athletes -- on posters in the weight room, or on the flat screen televisions in the locker room -- the hope is that positive habits towards health will be reinforced.

Whether the team can overcome entrenched attitudes remains to be seen.

"It's always really surprising how much adrenaline and human decision making play a role in terms of overruling any training or any rationale," Valerdi said. "Like guys will be bleeding, man. Out the nose. That doesn't mean anything to them at that moment because they want to win."

Sweet says he was taught to hit guys as hard as he could in high school, "in the numbers, double-legged, takedown." There were no penalties for targeting. The current generation of college football players are still fighting developed habits that now feel innate.

Brain Gainz doesn't pretend to solve the problem entirely, and whether it can be solved is still a question. "You can have an unlimited amount of training and you're not going to change everybody's perception," Valerdi says, "you're going to maybe -- a few people -- chip away at what they think."

Even a little progress would still be progress, however, and there's some comfort in knowing that perhaps time will only continue to give us better tools to address the problem.