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Impact Sensors: A Missing Piece of Head Injury Programs

Protecting the status quo.  A third reason impact sensors haven't, pardon the pun, made the impact I thought they would when I first began writing about them six years ago has been the lack of support by groups and organizations which appear to be satisfied with the status quo.

On February 16, 2015, my local paper, The Boston Globe, came out with a powerful editorial in which it urged college, high school, and recreational leagues in contact and collision sports to consider mandating use of impact sensors, or, at the very least, experimenting with the technology, to alert the sideline personnel to hits that might cause concussion, and to track data on repetitive head impacts.

The Globe editorial viewed as "shortsighted" the reluctance of players and coaches to adopt the use of impact sensor technology out of fear that sensors, if they triggered an alert, might result in a player's removal from the game for concussion screening (that, after all, is the whole point) or result in the player being labeled a wimp (what NIH's Institute of Medicine has labeled the "culture of resistance").  The editorial called on professional leagues, like the NFL, to follow suit, suggesting that star players, by using the devices, could help break down barriers to their more widespread use.

Unfortunately, on February 19, 2015, just three days after than the Globe went on record as urging the NFL to set an example for colleges, high school, and youth leagues to follow by equipping its players with sensors (as the Arena Football League had already done the previous season and continues to require in 2018), the league did exactly the opposite.

As first reported by Sports Business Journal and, later that same day, by The New York Times, the NFL decided to suspend a pilot program using sensors in players' helmets for the 2015 season because data collected during the 2013 season was not considered reliable enough (for what, they didn't say), and because the N.F.L. Players Association questioned whether the data would be kept private and not used against a player.  As far as I am aware, no testing of sensors has since been undertaken by the NFL.

Researchers who have collected impact data for years using the $1,000 per sensor HITS system, including Stefan Duma, who runs the biomedical engineering department at Virginia Tech and helped develop the STAR helmet rating system, were quick to say that the league was being too careful.  While not perfect (a 2017 study of commercially available sensors found significant error rates), he argued that sensors provided useful data, not only in football, but in analyzing head hits in sports like soccer and hockey. I agree.

Duma speculated that one reason the N.F.L. and the players' union might have been ambivalent about the use of sensors was because they might show that players were receiving more blows to the head than was commonly thought. He feared that the decision could dampen research efforts by others and didn't acknowledge "all the good things" that sensors do.

I agree with Duma on that point as well.  Indeed, efforts to preserve the status quo and to make schools and sports clubs think twice about using impact sensors are themes I explored in a 2015 law review article, co-authored with MomsTEAM Senior Editor and practicing attorney, Lindsey Straus, in the University of Maryland's Journal of Business and Technology Law.  Our article was primarily about the role organizations such as NOCSAE  play in setting performance standards for add-on safety equipment, such as impact sensors (it was our position then and continues to be our position now that standards for sensors should be set either by governmental agencies, such as the Consumer Product Safety Commission, or by truly independent standard-setting groups, such as ASTM International, and not by groups such as NOCSAE and the Concussion Legacy Institute funded, primarily or in part, by the equipment manufacturers whose products are subject to the very performance standards they set).  

We also, however, addressed the concerns raised by Dr. Duma: that groups like NOCSAE, the NFL, and its players' union, appear to have a vested interest in protecting the status quo, which, in the case of impact sensors, has put the brakes on widespread adoption of sensor technology, not because their use is unlikely to make sports like football safer (I, along with many experts, think it will), but for fear that it might open Pandora's box by making it clear just how hard and how often players are getting hit, and scare off parents from letting kids play contact and collision sports.  (Comments from the head of the Washington State youth football program in the August 2018 article in the Tri-City Herald discussed earlier in this article suggest, perhaps counterintuitively, that the use of sensors might actually assuage parents' concerns about football's safety).  Is the current sensor technology perfect? No, it's not. But, like Dr. Duma, and others, I believe that, in hitting the pause button on the use of sensors, the NFL essentially threw the baby out with the bathwater, and sent out exactly the wrong message about sensors.  

The national organization for high school sports, the National Federation of State High School Associations (NFHS) did the same.  While recognizing that impact sensor technology "continues to advance and improve" and "can now be used to look at impact forces in real-time, while the players are actively participating in a sport," the NFHS appeared in a 2016 Football Point of Emphasis to its member state athletic associations to go out of its way to pour cold water on the use of impact sensors, not only reinforcing the status quo view that sensors were only "valuable as a research tool," but warning  players, parents, coaches and administrators "to be careful not to rely primarily on unproven technology to diagnose a concussion," (never their intended use), "or even as a tool to decide if a concussion should or should not be suspected." (one of their principal uses!).