Sports

Headbanger's Windfall

Playing With a Concussion Might be a Thing of the Past
01/31/14
In the Magazine
This might be the last Super Bowl played with doctors making bad guesses about whether a player has a concussion Scott Cunningham/Getty

During Sunday's Super Bowl, there's a good chance at least one player will get his head smashed hard enough to injure his brain. Football players get concussions nearly as often as lifeguards get tans.

Oddly enough, with all of today's medical technology and all the money being poured into brain-injury research, there is no sure-fire, verifiable way to know if a woozy player has a concussion. One of the NFL's concussion "tests," for instance, involves seeing if the bonked player can stand on one foot with his hands on his hips.

And then, once it is determined that a player has a concussion, there's no certain way to know when he's well enough to take the field again.

That's about to change, thanks to a cross-fertilization of neuroscience, math and technology. A New York University neurosurgeon, Uzma Samadani, seems to have discovered a new way to track minute eye movements and correlate those results to brain injuries such as concussions. She just started a company, Oculogica, to commercialize the discovery. She's submitted four patents and has two pending scientific papers on the research.

There's some excitement building around Oculogica because of a belief that its capability, called EyeBoxCNS, can be built into small, inexpensive devices that every team could have in the lockerroom. Heck, there's a chance this could end up as a smart phone app, allowing a suburban soccer coach to conduct an accurate sideline concussion scan anytime a couple of players knock heads.

Rich Ellenbogen, a neurosurgeon and co-chairman of the NFL's concussion committee, has looked at Oculogica and sounds a note of cautious optimism, adding that it's still more science project than proven technology. Yet from what he's seen, he thinks Oculogica "can give us objective data about brain injuries, which is what we don't have now."

Concussions are big news in sports these days. Last year, the NFL agreed to a $765 million settlement in a lawsuit over brain injuries filed by 4,500 former players and family members. The National Hockey League is having its own problems with concussions, and a recent report said teams have lost hundreds of millions of dollars paying players who have to sit out because of brain injuries. Beyond sports, nearly 4 million Americans a year suffer concussions-from car accidents, falls and, in certain occupations (such as writing), banging one's head against the wall.

Concussions, though, are medically invisible, which is why you hear about athletes going back out to play while their brains are still injured, which can cause even worse damage. Concussions don't show up on MRIs or any other diagnostic tests, explains Sean Grady, head of neurosurgery department at the University of Pennsylvania. Every other test currently being used involves a physician's subjective judgment and leaves open the possibility that the patient could cheat by giving false answers.

"So (Oculogica's) work with visual tracking is very important," Grady says. "It's a repeatable test that's not subject to interpretation. You can't fake it."

A lot of effort is going into putting sensors in helmets to measure the force and number of blows to the head, but those can't indicate a concussion, either. Potential harm does not equal actual harm. It would be like proclaiming someone had a heart attack based solely on how many Big Macs that person ate.

As with so many breakthroughs, Oculogica's happened by accident. Samadani, as part of her work at NYU, wanted to find a way to measure the level of damage in people who had brain injuries so serious they could not follow the instructions typically given to assess a concussion. She and her colleagues decided to experiment with TV. Anecdotally, brain-injured people have a hard time watching TV. "We thought, if we can quantify how well they can watch TV, we might have an outcome we can measure," Samadani says.

Her team set up a camera facing patients to track eye movements 500 times per second while the patients watched the screen. She worked with NYU's math department to write algorithms that could sort out each eye's movement independently and compare the two sets of data.

The goal was to tally how well the patient focused on the TV screen. The surprise from the data was something different: In every patient, the level and type of brain injury correlated to a set of metrics that showed how well the two eyes moved in lock-step. The more injured the brain, the more such micro-movements of the eyes were out of sync. The differences between the movements of the two eyes is too minuscule for any doctor to observe. But the technology could see it.

On February 10, 2012, Samadani was sifting through the data from her tests and had her epiphany. "I almost fainted," she says. "I couldn't believe it. I couldn't sleep for the next two months thinking maybe I was wrong."

But so far, after repeated trials and presentations to peers, the data is proving to be right. It still needs to go through federal and scientific peer review, but the technology seems to diagnose concussions, measure whether someone is getting better, and show when the injury is healed enough to resume activity.

Samadani says that Oculogica's plan is to partner with established companies to develop a commercial product. The only funding the company has so far came from NYU. A next step will be to hire a team and seek investments. In the meantime, the technology is being piloted at hospitals in New York and Philadelphia.

The wider this promising technology can reach, the more society will benefit. So let's hope Oculogica partners with the kind of fast-moving tech company that would build an easy-to-use, inexpensive version. An iPad could work as a platform: show a video on the screen while an attached eye-tracking camera watches eye movements and an app correlates the data.

Then I'd have a way to make sure my daily wall-butting sessions don't get out of hand.

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