Athletic trainer Ineka Olbrisch roams the football sideline with a Microsoft Surface Pro close at hand, waiting to see a 3D model of a hard hit to the head.
Some football players at Del Valle High School (El Paso, Texas) are equipped with a small sensor in their mouth guard that detects the force and location of hits to and around the head in real time. Olbrisch has set the sensors to notify her if a player has been hit at or above a certain level of their gravitational force, a standard measurement of impact.
“It’s really cool to me, to see the technology at work and to see the hits come up on the screen,” she said. “To think, ‘Wow, that one little microchip is sending us so much information.’ We’re able to really embrace that and use it as a tool.”
Del Valle was the El Paso area’s guinea pig for the device, called a Vector MouthGuard. The sensors haven’t become widespread yet for two primary reasons.
One is funding.
Andrew Golden, a spokesman for device creator Athlete Intelligence, said the cost for a Vector MouthGuard is $199 per player, per year, though insurance subsidies can lower it to about $185. This makes it difficult for many high schools to afford, particularly because a mouth guard can only be used by one player.
Even with the money, some schools might be hesitant to implement the technology.
“Our coaches still kind of fight us as far as using them,” Olbrisch said. “They’re still scared of the technology. They think that I’m going to use it to, like, every time a kid has a 50-g hit then suddenly they all have concussions.” (A 50-g hit is moderate impact for a high school football player, though it differs among individuals.)
But this technology has the potential to help not just football players, but athletes of other contact sports as well.
Athlete Intelligence also markets a CUE Sport Sensor for headbands or helmets, which collects the same data as the Vector MouthGuard but the data is not reported in real time. Instead, it is downloadable after the game or if a player is pulled off the field. It costs $99 per player before subsidies.
More than 100 organizations that reach 10,000 athletes, primarily in youth and high school programs, use sensor technology created by Athlete Intelligence.
After more than a decade of playing soccer, Corie Linn went up to head a ball during a Thursday high school game.
It was the spring of 2013, and the then-junior at Laguna Creek High School (Sacramento, Calif.) had taken many hits to the head. She had been concussed twice before – once as a freshman, once as a sophomore — but both were minor. However, the culmination of hits to the head was taking its toll.
Linn said she had headed the ball an abnormal number of times in a game two days earlier. She told her coach her head hurt and that she had a history of concussions.
“He was like, ‘OK, well, just don’t head the ball in this game, and you should be fine.’ And I was like, ‘OK,’” Linn recalled.
But going after the ball was second nature for the forward. The impact briefly knocked her out, and as she came to, she saw an athletic trainer running onto the field. Linn answered the obligatory questions, getting most of them correct but taking longer than normal to answer, and was taken out of the game.
“I couldn’t even keep my eyes open, it was too bright outside,” she said. “I was actually out of class for about a week, just because the light hurt so bad.”
She did not return to the field that season.
Linn was forced to give up club soccer after the concussion, though she did continue playing in high school her senior year. She constantly reminded herself not to head the ball because her doctor told her another concussion could cause long-lasting damage.
Before quitting, she tried to play in headgear. The weight and bulk of the equipment (“Imagine, like, a tiara, but instead of diamonds and pretty stuff at the front, it’s like padding,” Linn said) altered the way she headed the ball.
She stopped using it.
The small CUE sensor, which can be set on the back of a headband, might have been an easier adjustment. Linn didn’t wear a headband while playing but said she “definitely” would have if a sensor could tell her how the force was impacting her.
“More importantly, my parents would have made me wear it,” she said.
That doesn’t necessarily mean the technology helps on its own, though. The sensor would have shown the coaches how many hits she took during the Tuesday game, but if a coach or athletic trainer hadn’t made the call to pull her out, she still would have suffered the concussion.
The National Athletic Trainers’ Association has expressed resistance to similar devices, warning that sensors on their own can’t do what a human can. Tory Lindley, the president of NATA, said there isn’t enough evidence that sensors are consistently reliable.
Humans can withstand different thresholds of force by nature, and hits that might render one unconscious may not concuss another. While the Vector and CUE record hits for each athlete individually, sensors can’t recognize the consequences collisions have on each athlete.
If a player gets concussed and the coaching staff isn’t alerted, that creates a huge health risk. Conversely, if the sensor goes off when there is no concussion, that unnecessarily removes a player from the action.
“There are a number of specific-to-the-head impact indicators, both false positives and false negatives,” Lindley said.
Olbrisch noted the former as a concern coaches at Del Valle have with the sensors: How often would she pull a player for testing because she gets an alert?
And Linn, after being told about the sensor technology, jumped to the same thought. It could help players but might not be ideal for a team.
“If your best player is wearing the sensor and heads the ball and it goes off, what, you’re going to take your best player out every time they head the ball?” she said.
Not necessarily. The sensor allows athletic trainers to set the threshold of g-force that sensors will alert them to during instances of head contact, but the sensors record every hit, no matter the size.
Players don’t automatically leave the game if the handler gets an alert. Olbrisch sets the level at a low enough threshold to help keep an eye on the team, but not at a high enough g-force that would typically require concussion testing.
Olbrisch said the device can show that certain players are hit repeatedly in a specific spot, alerting a coach to poor technique. Maybe a football player is dropping his head or getting beat at the snap and needs to work on footwork. Maybe a soccer player is using the crown of her head too much.
“When they do embrace it, it works, but they’re hesitant,” Olbrisch said.
In recording every hit, athletic trainers can go back later and notice when a player has taken an unusual amount of head contact – just like Linn before her worst concussion.
Five years later, she still has lingering symptoms. Remembering things like a grocery list can be difficult, and her headaches have turned into migraines that force her to sit down and go to sleep.
Linn thinks it’s because of the concussions. But she’s not positive.
“I think that’s the point,” she said. “Every time I get a headache or forget a detail, I worry that it is from my concussions rather than just simply from being human.”
Maybe the sensors could have helped prevent this.
Athletic Intelligence is working on developing the CUE sensor to alert players in real-time the same way the Vector does, and the next project is an all-in mouth guard.
But NATA would argue that the first step, even for teams that can’t afford this technology, is a competent athletic training staff.
“Nothing exists that I would prefer over access to an athletic trainer in all contact or collision sports,” Lindley said. “The device can’t replace good clinical judgment.”