Over the last decade, the number of high school athletes playing football has fallen. Some researchers credit the drop to growing fears about the health risks of sports-related concussion.
Despite this increasing awareness, sports-related brain injury remains common among high school and college athletes.
And, the diagnosis of concussion often depends on a subjective symptom-screening test conducted in less-than-ideal conditions, such as a noisy sideline.
In today’s installment of our Scratch innovation series, we hear about a new Dayton-based mobile app designed to make concussion screenings more objective. Its creators hope the app could keep more injured players off the field -- safe from repeated concussions and potentially fatal brain damage.
Students mingle in the hallway during class change at Kettering Fairmont High School.
In an exercise room near the gym, senior Emily Galentine describes how she ended up with a concussion two years ago. The 18-year-old track and field athlete played point guard on the basketball team.
“I was in a jump ball and this girl was three times my size and kind of like went up and slammed me down and my head like nailed on the floor.”
In accordance with Ohio’s 2013 Return-to-Play law, Galentine’s coaches removed her from the court. They guided her through a 22-point paper screening checklist to assess balance, cognition problems and other symptoms that could indicate concussion.
They also gave Galentine a standard eye test.
“I was dizzy, really lightheaded. I had a headache. And doing like the eye test, my head hurt more. And I just couldn't focus,” Galentine says.
According to the American Association of Neurological Surgeons, concussion sometimes involves loss of consciousness, but not always. Symptoms may not be visible right away.
Fairmont athletic director and Kettering Health Network concussion specialist Robin Lensch says that’s one reason the eye test is critical to identifying concussion.
“Neurologic deficit is neurologic deficit,” Lensch says. “If that system's not working properly the eyes are going to tell us.”
A non-injured person’s eyes, she says, should track steadily across their field of vision and be able to change direction in a coordinated way.
“But, an injured athlete might just say, I can’t do that. They might be struggling through it but their eyes are moving very, very slowly,” says Lensch.
The concussion eye test looks similar to tests police might give suspected drunk drivers on the side of the highway.
Lensch lifts her fingers in the air at shoulder height to demonstrate with Galentine.
“Keep your head still, and we're going to do about a 10 to 12 second count. Emily's eyes are going back and forth and hitting the targets of my fingers out on either side. And good. Relax,” Lensch says.
Lensch is observing Galentine’s ability to follow directions and studying how her eyes move from side to side.
“I am trying to objectively identify those things by watching her,” Lensch says. “And that's a little bit of a challenge.”
It's a challenge because Lensch is trying to watch both of Galentine’s eyes at the same time.
That’s where Vye could come in. It’s the name for a new mobile app Dayton engineers are developing. Lensch is helping to study Vye at Kettering Fairmont High School. She says the school typically documents between 35 and 60 concussions a year.
The app uses a smartphone or other device camera to play an interactive eye test similar to the real-life test.
“OK. Are you ready?,” says Lensch. To demonstrate the app in action, she hands Galentine a phone. She pushes a button to start the test.
“You're just going to keep your eyes fixed on that yellow dot,” Lensch says.
A yellow dot appears on a black screen and moves back and forth in different patterns.
“Emily's eyes are tracking that dot back and forth and the iPhone app is actually capturing data about her pupils,” says Lensch.
The Vye app records Galentine’s eye movements, reaction time, velocity and abnormalities that could indicate a concussion.
Not picking up on these abnormalities could be dangerous.
Returning to play with a concussion can lead to longer-lasting symptoms. It also opens athletes up to another hit to the head. And that can lead to a rare but potentially catastrophic condition known as “second impact syndrome” that includes life-threatening swelling of the brain.
“And second impact syndrome can cause a major, major debilitating neurologic sequence of events, up to death,” Lensch says. “So, those are the situations we know we have to keep our athletes out of.”
University of Washington School of Medicine research suggests adolescent athletes may be at a higher risk for second-impact syndrome.
The Vye app is the first technology to come out of Ascend Innovations medical technology lab, a health care research and development partnership that includes a Cincinnati design firm and the Greater Dayton Area Hospital Association (GDAHA).
But Vye isn’t the first app to offer a test for concussion. Other professional and consumer software can also track eye movement. But the software can be expensive or difficult for the average person to access.
Corey Ellis, M.D. is skeptical. He’s a Boonshoft School of Medicine assistant professor, physician and director of the Wright State Physicians Concussion Clinic, and team physician for both Wright State University Athletics and Beavercreek High School.
At his Wright State office, Ellis says he’s seen other mobile apps fail to prove their ability to consistently identify symptoms of concussion.
“People are trying to come up with ways to have a test that is easy to do, that still provides good information,” Ellis says. “There has not been one that is clear-cut, do this, yes or no, it’s cheap easy to do and reliable.”
And, Ellis cautions that no matter how effective any app might be, it’s no substitute for a thorough concussion exam by a trained medical provider.
Vye’s mobile platform and its ability to track both eyes through a guided stimulus –– that yellow dot on the screen –– is unique, says Ascend Design Engineer Maria Lupp, but she stresses the technology is grounded in long-established clinical concussion-screening methodology.
“We don't want to reinvent the wheel, these tests are really important and they get really good accurate results,” Lupp says. “But we make it completely portable. It’s a phone that sits in your back pocket of your jeans and you can have on the sideline with you at any point in time.”
For more than a year, Lupp’s team has been busy testing the app’s reliability against a database of existing confidential hospital injury data, along with baseline comparison data being collected at Kettering High School.
She says the goal is to make sure Vye is as accurate and reliable as tests already used by doctors and sports trainers to identify concussion.
Nationally, the United States Centers for Disease Control and Prevention estimates there are as many as 3.8 million sports-related concussions every year. But health officials say this number is likely an undercount because many people never see a doctor after a head injury.
The University of Pittsburgh's Brain Trauma Research Center rates the likelihood that high school and college athletes playing a contact sport will suffer a concussion as high as 19 percent each year of play. Football players are at especially high risk, its research finds.
Vye-maker CEO Ryan Smith says the app is not intended to take the place of medical treatment.
“I think we would all feel more comfortable going to our primary care physicians, but how do you make those decisions? Do you have any information at all as a parent to be able to do that? And so, I think this provides a quick, easy and affordable way to gain information to help you make the best decision on your next care steps,” Smith says.
In addition to concussion screenings, Smith says the Vye app also shows promise for identifying alcohol and drug, including opioid-related, impairment.
Kettering’s Robin Lensch says the app is already a far cry from the way she and other trainers used to identify concussion.
Before the current screening protocols took effect, a lot of it was simply asking players hyped up on adrenaline to rate their own symptoms, she says. It wasn’t very scientific.
“And that just turns my stomach right now. But that was the standard early on. Really, the screening was, how you feeling? You feel pretty good? Symptoms are gone? Yup. Alright, well, let's give practice a try.”
She says today’s concussion paper-based screening is much safer than the old method.
And Vye’s developers say the app won’t come to market unless it’s at least as reliable as the current screening. They’re working to secure approval from the Food and Drug Administration as a Class II medical device.
If approved, Vye could be on the sidelines by the beginning of the next fall’s football season.
About the Series:
A century ago, Dayton helped drive the global economy with inventions that changed the world – think, the airplane, the cash register, pop-top cans, the self-starting engine. In our spring series Scratch, WYSO explores some of the people and ideas that could impact life and the economy in the Miami Valley and beyond. The series was inspired by a simple question: where is Dayton’s famous spirit of invention still alive and well in the Miami Valley? And, who benefits?
Learn more, and add your voice, by clicking here.