Today, every state has a concussion protocol for youth sports, including football.
Public awareness of concussion risk in football has increased dramatically in recent years, and has had a serious effect on participation in football. Frederick Rivara, University of Washington professor of pediatrics and vice chairman of a committee studying concussions in children told The New York Times, “More people are aware of the risks. And coaches are doing a better job of understanding what concussions are, recognizing them when they occur, and teaching the sport in ways to lower the risk of getting injured.” The Times goes on to say that from 2007 to 2013, the number of boys playing youth football dropped by 17,000.
At the college level, football players report six suspected concussions for every concussion officially diagnosed. It’s not always easy to convince players to report concussion symptoms, particularly for certain positions. Offensive linemen and running backs tend to sustain the most undiagnosed concussions.
Concussion awareness is affecting professional football too. In the NFL, all players suspected of having a head injury are required to go through a concussion protocol administered by a variety of personnel, including head injury spotters, athletic trainers, sideline doctors, and neurocognitive testing specialists in the locker room.
Head Injury Spotters in the NFL: Short Distance Telemedicine
One of the most interesting uses of telemedicine in the new NFL concussion protocol is by the head injury spotter, who works in an upper-level booth at every NFL stadium. This person is an experienced, specially trained athletic trainer with a video monitor and a video operator who can replay sequences to evaluate what happened more closely when potential head injuries are spotted on the field. Spotters watch both teams and communicate directly with doctors and trainers on the field via telephones and walkie-talkies.
Head injury spotters look for players who are off-balance, shaking their head, or otherwise acting out of character. They communicate with personnel on the sidelines to tell them to have a closer look. Another task of the head injury spotter is to tag video sequences of plays where an injury has occurred or is suspected. These videos are transmitted to the sideline where they can be reviewed by doctors and trainers there.
Players suspected of having sustained head injuries are interviewed and put through tests by the team doctor and an independent league neurologist. Players are tested on balance and cognitive skills, and athletic trainers – who spend considerable time around players and know what behavior is normal or out of sync – are allowed to weigh in on whether something is amiss.
Mayo Clinic and Northern Arizona University: Head Injury Telemedicine Robot
Mayo Clinic and Northern Arizona University have rolled out (literally) a robot on wheels to assess football players with suspected concussions as part of a research study. This exciting use of telemedicine uses robotic technology and remote control cameras so players can be evaluated by remote neurology specialists in real time. The robot is remotely operated by a Mayo Clinic neurologist in Phoenix to evaluate an injured player for symptoms of concussion and confer with sideline medical personnel on next steps.
Bert Vargas, MD, the Mayo Clinic neurologist in charge of the research says, “As we seek new and innovative ways to provide the highest level of concussion care and expertise, we hope that teleconcussion can meet this need and give athletes at all levels immediate access to concussion experts.”
The study will explore whether telemedicine via robot is as accurate as face-to-face evaluation in identifying concussions and making appropriate decisions about whether a player can return to the field. Mayo Clinic doctors hope this new use of telemedicine will expand access to specialized care to athletic organizations who don’t have such access.
Dartmouth-Hitchcock Center for Telehealth VGo Robot
Dartmouth University’s Hitchcock Center for Telehealth is also bringing robots to football sidelines. VGo, a 4-foot-tall robot, connects to an on-call neurologist from anywhere in the country, allowing teleconferencing and sideline testing. This will allow athletic organizations in rural locations to have access to neurological specialists they may not have otherwise had access to.
When there is a report of hard contact to the head or a player headache or symptoms, the VGo robot brings a neurologist to the field via telemedicine for consultation via camera. The physician can see, hear, and communicate with the player, and can pan and zoom on problem areas. The robot even includes apps so the doctor can watch video of the incident. And VGo is also being used in other environments, including in hospitals and clinics where certain patients need extra monitoring.
On-Field Apps and Devices
Robots and trained injury spotters aren’t the only telemedicine approaches to football head injuries. Reebok has created a device called the CheckLight, which is worn by football players underneath their helmets. The device tracks and measures head collision impact, measuring direct accelerations to the head, rather than the helmet or chinstrap. Significant collisions trigger yellow or red warning lights that coaches and sideline medical staff can see. The device also offers linear and rotational acceleration measurements and can help staff determine the need for further testing.
An app known as X2 has been developed for the NFL and is used on sideline portable touch-screen devices. With X2, a player is asked about symptoms and is stepped through standardized neuro-cognitive questions and physical assessments. If a player is suspected of having a concussion, he must see a league-appointed neurologist. Once a player is free of symptoms, he must follow a step-by-step recovery program, and is not cleared for full practice or a game until being cleared a second time by a neurologist.
Awareness of the seriousness of head injuries in football at all levels, from youth through NFL, has increased significantly in recent years, due to the devastating long term effects these injuries can have. Telemedicine is becoming an increasingly important partner in diagnosis and care for concussions, from the injury spotters monitoring players remotely to sideline robots to wearable devices that are helping ensure that fewer players suffer from concussions without the proper treatment.
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