Outfitting a Football Helmet to Diagnose Concussion

When Columbia physician Thomas Bottiglieri, DO, played football in the 1990s, his teammates called the sport "pudding head." The constant headaches, memory loss, and blackouts that Bottiglieri experienced during football season were just considered a normal part of the game.

“We never left the field because of a concussion,” says Bottiglieri, assistant professor of sports medicine in Columbia’s Center for Family and Community Medicine and in orthopedic surgery at Columbia University Irving Medical Center (CUIMC). “The team came first, so we just continued to play and hoped any symptoms would go away.”

Though awareness has grown in football and other sports about the dangers of concussion, neurologist James Noble, MD, says concussion detection on the field at the time of impact has essentially remained unchanged for decades.

“The fundamental problem is that most concussed athletes don’t get diagnosed,” says Noble, assistant professor of neurology at CUIMC. “Athletes could attribute some symptoms, such as headache or nausea and vomiting, to something else, like an ill-fitting helmet or playing in hot weather. And given the tremendous pressures athletes perceive, many are motivated to keep playing. As a result, symptoms are often ignored.”

So Noble went looking for a technology that can detect concussions objectively at the moment of impact—without waiting for the athlete to report symptoms. His idea is to equip a helmet with sensors that capture the brainwave "signature" of a concussion as it unfolds in real time.

“Having a concussion detection tool that could monitor for changes as they occur would be a welcome change in the practice of sports medicine,” says Bottiglieri.

Looking for a concussion ‘signature’ on the field

In the past decade, several devices that use accelerometers have been tried on the field as a proxy for concussion. But adoption of such devices has been hindered by a lack of evidence that they can detect concussion and improve outcomes.

Instead, Noble reasoned that electroencephalography (EEG), which records electrical activity in the brain, might serve as a physiologically relevant concussion biomarker at the moment of impact.

The idea isn’t completely new. For decades, researchers have known that EEG can usually detect abnormal brainwaves immediately after a concussion.

In the 1960s, researchers experimented with taping EEG electrodes to the scalps of college athletes. But the technology was cumbersome and the signal it emitted was weak and unreliable, so the project was abandoned.

More recently, some teams have experimented with deploying a simplified EEG screening device on the sidelines. “But this approach doesn’t solve the original problem of waiting for an athlete or someone on the sideline to report a possible concussion. Because of that step, at least three out of four concussions are not recognized until after the game,” says Noble.

Making the technology practical

In late 2013, Noble thought that improvements in EEG technology made it feasible to put sensors inside football helmets. Noble approached Barclay Morrison III, PhD, professor of biomedical engineering at Columbia University, about developing a prototype.

Noble and Morrison’s design—developed with help from the Columbia-Coulter Translational Research Partnership—outfits a typical athletic helmet with EEG leads and sensors. The helmet has unique mounts to eliminate the wearer’s risk of injury. A novel algorithm enables it to reliably identify the EEG concussion signature, accounting for movement and position. From there, the sensors send a signal to a monitoring device on the sidelines to unambiguously indicate whether a concussion has occurred.

“The only thing a post-concussion EEG signal might be confused with would be fainting,” says Noble. “Either way, that athlete needs to be taken care of quickly. ”

Noble and Morrison know that the helmet EEG can pick up brainwaves when in use. In a preliminary test with several Columbia football players, the helmet detected brainwaves while the athletes practiced and consistently broadcasted the EEG signals to their base station on the sideline. There is also evidence that EEG could be used to pick up "sub-concussive injuries," which may occur far more frequently in some sports.

“Additional work is needed to miniaturize the technology and ensure that it works consistently on the field without getting in the athlete’s way,” notes Morrison.

Then, a study will be undertaken to confirm that the helmet’s ability to identify concussion correlates with clinical diagnosis.

The hope, say the developers, is that this approach could become the gold standard in diagnosing concussion on the field, allowing athletes to get treatment.

“In any sport, or even in combat, returning to the field before fully recovering from a concussion puts the injured at greater risk of subsequent concussions or orthopedic injury and longer recovery time, so it’s important to identify these events as they occur,” says Noble.

###