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Mouth guards aid research at ND

One hundred years ago college football was on its deathbed. The game, still in its caveman stages of evolution, caused double-digit fatalities on the field almost every year. It took a presidential intercession from Teddy Roosevelt to keep university presidents from nixing their schools’ participation in a sport that was deemed far too dangerous for civilized young men.

Twenty-two Notre Dame players technology-infused mouth guards this season to help concussion research.

Football survived and flourished. But a century later, the life-threatening effects of its violent collisions remains one of the game’s most pressing issues. Recent research has started to uncover the long-term effects of taking a career’s worth of high-speed shots to the head. The tragic deaths of football players like Notre Dame graduate Dave Duerson have brought attention to diseases caused by head injuries like chronic traumatic encephalopathy (CTE). At Notre Dame, the football team and others are joining forces with a pair of technology companies to try to provide some new insight into the mystery of what causes devastating sports-related head injuries.

Twenty-two members of the Irish football team wore souped-up mouth guards this fall that provided real-time data on how much force the player’s brain endured on each hit. The mouth guards, created by Seattle-based X2Impact and Bite Tech Inc., are equipped with accelerometers and a gyroscope that measure the G force of every block and tackle. The sensors transmit that information to trainers and team doctors on the sideline who can use it to monitor their players.

Notre Dame was one of four colleges — along with Stanford, Washington and North Carolina — that participated in the equipment’s early trial run this fall. X2Impact’s president and CEO, Christoph Mack, said none of the schools used data to diagnose concussions this season. They first need to collection enough information to determine what a normal level of force is during contact.

“The agreement was we would not use it to make clinical decisions this year,” Mack said. “It’s critical for us to build up that database of what is a normal distribution, what is an unusually large hit. For us, that’s the real value in the data we get from trials at Notre Dame.”

He said average collisions measured about 15-20 G’s of acceleration, but major hits went as high as 100 G’s. To put that in perspective, one G is the normal pull of the Earth’s gravity on your body. When you accelerate rapidly the apparent force of gravity gets stronger. A jolting change of speed on a rollercoaster is about 5 G’s, and a sharp turn in a fighter jet registers somewhere between 10-12 G’s. A football player’s brain accelerates as much as 10 times faster than that in the instant he makes contact with a menacing, oncoming linebacker. No wonder they see stars.

“Thankfully they last for just a few milliseconds at the acceleration level because if you tried to sustain 100 times your body’s weight for any amount of time you would just crush it to jelly,” Mack said.

Mack’s hope is that as the technology develops (They have also created headbands that serve the same purpose) trainers will be able to use the data to know when one of their players might have a concussion.

The biggest obstacle in diagnosing concussions is that researchers have yet to discover the type of impact that causes the injury. Some players can show symptoms of a concussion after a normal 15-20 G hit, while others walk away from a jarring, 100 G collision with no apparent problems.

A look at the newest model of BTX2 Impact mouth guard.

“I’ve been in sports medicine for 25 years, and I still have a hard time figuring out if people have had a concussion or not,” said Dr. James Moriarity, Notre Dame’s head physician. “Even though the [X2Impact] technology is fun and it’s interesting, we don’t know what it means.”

Moriarity has a built a reputation as an expert in the field of sports-related head injuries. He said the new BTX2 Impact mouth guards are a great research tool that might collect enough data at some point in the distant future to help solve some of the mysteries surrounding why some hits cause concussions and others do not.

Two current theories that can eventually be tested by X2Impact’s technology are the cumulative effects of many hits and the effect of rotational force when the brain is hit.

The first theory, based on a recent study of soccer players done in New York, supposes that each hit adds to those before it and when an athlete reaches a certain number of cumulative G’s over the course of time they are most susceptible to a concussion. The mouth guards would hypothetically be able to keep a running tally on the impact of a player throughout their season to see if there is a quantifiable long-term threshold to the injuries, much like a pitch count for baseball players.

The second theory deals with the way a player’s brain rotates after a hard hit rather than just the linear force from a drastic change in direction. The brain is surrounded by liquid and floats inside the skull, attached to the rest of the body with a series of thin veins and capillaries. A big blow to the head can rotate the skull before the brain catches up, wreaking havoc on those veins.

“Imagine you suspend a baseball in a spherical globe filled with water and take little strings and attach that baseball to the edge of the glass sphere,” Moriarity said. “Then hold it in your hand and twist it real fast. The outside sphere is rotating. The inside is not. The skull rotates and it literally sheers all that covering in there away from the brain, you get a tearing effect.”

The gyroscopes inside the new mouth guards and headbands measure the impact of rotation, something no other current research has done, according to Mack. Mountains of data still need to be compiled before any of these ideas can help doctors better understand the injuries, but it’s a step in the right direction.

“You can describe what we’ve done so far as a beta trial, and the beta trial certainly continues,” Mack said.

He said he expects to outfit more players with a slimmed down version of the mouth guard when spring practice starts in April. The added equipment made the mouth guards a little too cumbersome for most players last season and limited the amount of data they were able to collect.

The company has also provided mouth guards and headbands for the men’s and women’s amateur boxing tournaments on campus, which Mack referred to as “a gold mine” of data. He said he hopes to continue to pull more of the school’s teams into the fold in the near future and continue to fine tune the product so it can be used on a wide scale.

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