Dr Enora Le Flao (Postdoctoral Scholar, The Ohio State University) ,Dr Lizzy Williams (Senior Lecturer, Sport and Exercise Sciences, Swansea University) and David Powell (PhD student, Swansea University) discuss concussions in Rugby Union and instrumented mouth-guards, which have embedded sensors to measure linear and angular kinematics of the head.
Time Stamps:
0:00-4:20 Intros
4:20-5:09 What is the rationale behind all this?
5:09-11:23 How has this been previously done and where are we now?
11:23-12:59 Is the mouthguard a replacement for visual monitoring – medical threshold?
12:59-14:44 False positives and negatives
14:44-17:59 What causes concussion?
17:59-22:58 How do the mouth guards work? What are they monitoring?
22:58-26:17 Training and workload
26:17-30:25 Sex differences
30:25-32:03 Misconceptions and eventual aims
32:03-40:00 Further research
40:00-42:52 Other sports
42:53-46:20 Further information
46:20-47:28 Outro and goodbyes
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Welcome to the experts in sport podcast brought to you by the school of sports exercise and Health Sciences at lury University round two of the Six Nations rugby featured an historic moment as Scotland hooker George Turner became the first player in the championship’s history to be removed after his smart
Mouth guard detected a collision which could have caused a concussion headlines in the times The Daily Mail and the guardian have called smart mouth guards a game changer in Rugby’s battle with concussion the introduction of such technology and particularly the removal of players from the field of play hasn’t
Been without controversy and we’re hoping to unpick some of that controversy a little today I’m Dr Stuart MCC Naylor and I’m joined by Dr anara lefl of the Ohio State University in the USA and Dr Lizzy Williams and David Powell both of Swansea University in the UK Anora Lizzy David welcome to the
Experts in sport podcast thank you glad to be here great to have you all I wondered I don’t know what order do you want to go in but just to start with could you just give our listeners a really brief overview of your current roles and I guess your background in
This area that we’re going to be talking about today I can start um so my name is Anora lefl um I come from a mechanical engineering background so I got a masters in mechanical engineering in France and then specialized in sports injury biomechanics then I went on to do a PhD
In uh New Zealand where I really wanted to use head impact sensors to understand concussions and then in that process I realized that there were a lot of uncertainties with many of these aspects like how to diagnose a concussion how does that technology operate and I decided to really focus on the
Technology itself I wanted to do it with rugby which is one of the attraction about New Zealand for me um but ended up working with boxers and that has now become like my main research interest so I’m really interested in general to like what are the strength and weaknesses of
Those devices and really understanding how we can use them to answer the questions that we need to answer about concussions so I’m Dr Liz Williams so I am currently a senior lecturer in sport and exercise science at Swansea University my background is actually forensic science so my PhD was in blood
Stain patent analysis and biomechanics of crime scene reconstruction due to a r a random combination of circumstan ances I ended up working in Silicon Valley for a big data tech company sap where I got involved in the more big data analytics side of head impact elmary when it was
In its very early days and that job led to this job that I have here so Silicon Valley to The Valleys where I’ve been for the last seven years and my research has really grown here into looking at head impact biomechanics in female sports so particularly Rugby Union CU
That’s what happens a lot around here so I’ve really come from this forensic background of applying injury mechanics principles to to crime scenes to using those same sort of principles in sportsite Rugby Union to help understand injury mechanisms in live people particularly females so we’ve found a
Lot of differences with females over the years so that’s really my key area at the moment hi I’m David Powell so I’m also from a mechanical engineering background um having done my masters at swans University um following uh that I saw the opportunity for PhD studying with
Liz Williams um so Dr Williams my supervisor uh focusing on the use of Industry with and mouth guards um in University Sport and with a datadriven approach to um improving the functionality and reliability um of those devices is so um at the minute I’ve just uh finished writing up my PhD
Thesis and yeah I’ll be sitting a a vior soon to uh hopefully complete the process brilliant thanks everyone and yeah I think from Silicon Valley to The Valleys was my favorite quote in that um but yeah it might seem really obvious but what is the rationale behind all of
This so why do we need to continuously monitor head impact during match play in these Sports so I think the real reason for me is that we need a tool that is objective because unfortunately concussion diagnosis is very much subjective and it can be fooled relatively easily so players know what
Answers they need to give to a doctor if they want to go back to the game and that like not many competitor like competitors will want to be put on the sideline because of a concussion so we need an objective tool to identify when they are injured and when they need to
Be taken care of when they need to recover to like protect them in the short and long term and how has this previously been done then before these instrumented mouth guards came around what was happening in recent history when I first got involved in this whole area it was all American
Football helmets so when I was in California with sap we started looking at a con set for using the big data analytics platform to look at these American football helmets and we started you know people had been doing this for approximately a decade prior to that in American football so it was becoming
More and more obvious that they were while they were it was a very important step in the development of where the head impact limitary field is now anything in biomechanics when you’re measuring human motion suffers from coupling problem so the what the actual sensor is measuring has to be very very
Well coupled to the body so the actual thing that you’re looking to measure to give valid and reliable data so there were situations where helmets were flying off heads and recording data which obviously wasn’t what the head was doing so then over time that system you
Know there the one of the companies in the states who were doing these American football helmets that are doing patches so um IMU sensors so neutal motion unit sensors which are a combination of accelerometers gyroscopes and magnetometers were being put into little plastic um patches which were being
Stuck to the mastoid process behind the ear so that was it was a direct connection to the head but it was sitting on the skin and while it was a bony prominence any bony Landmark any when in biomechanics we talk about bony landmarks being the repeatable um places which which
Minimize soft tissue AR effect where we put sensors whether they be Imus or um Optical sensors but these anything on the skin suffers from skin artifact or soft tissue artifact so you do still have a lot of motion of the skin underneath the sensor which causes big
Um you know errors in the data so there was a paper by you probably know the the values off the top of your head by lindia woo in I think 2017 which Quantified the error around 53% I think it was in some cases so you
You do have a lot of and we’ve written a paper ourselves um more recently about characterizing soft tissue artifact and is it possible to predict it I mean there’s lots of things you can do to minimize it with postprocessing but ultimately it’s not predictable enough to um to really get
An accurate measure of what the skull is doing so it’s the skull that you want to measure so the actual solid part of your head so there are well the ways to do this would have been either drilling into the skull which you can’t do in live people um something to do with
Ethics or having having the senses coupled really tightly to the top teeth the top teeth mve as part of your skull with very very little soft tissue artif so there’s still some but it’s very very minimal and the better the fit so the smaller the components get which has
Happened over the last especially 5 years or even even more recently than that that the size of the actual sensors the component tree that goes with it and the batteries um have become so small now that it’s possible to have a very tight fit um mouth guard which will move with
The teeth with very minimal shaking so the more recent editions of the mouth guards have approxim sensor so it diff for different brands but usually it’s an infrared sensor which will tell you how well it’s stuck to the teeth during the impact so how much it how much the guard moves
Additional to the teeth while the actual impacts being recorded so that will give if it’s if it’s constantly really bad it means the guard’s not fit very well so the data is going to be a bit questionable so that’s um that’s pretty much where that technology is now so if
You go back even further than the you know the 10 years um people started measuring head impact stuff for military applications and in American football back in the 60s where the technology they had was considerably bigger than it is now so um I’ve been reading papers
That were published back in the in the 1960s early 1970s talking about like 3 to 5,000 um GeForce values going through a head which of course is not possible it’s just because of the the way that the measurement techniques that you use will dictate what the data is going to
Turn out like yeah it’s it’s funny because the the idea of monitoring head impacts is definitely not new I remember also seeing some papers from like 1987 I think where you could see like on the videos not on the videos but on the photos in the paper you could see like a
Massive scaffolding like above a boxing ring because researchers how to stand above the ring to hold the cables from the accelerometers that were placed on boxer’s heads so that it wouldn’t get in the way so obviously the technology has evolved like a lot and we’re now in a
Position to like do some relatively good measurements on field um I’d like to add to what Lizzie just said that in parallel of like developing the technology um Sports have develop methods identify concast players as well so in rugby specifically the head injury assessment so the hia
Assessment has been like the norm for many years now and they use um for example spots and doctors on the sideline that identify when a player sustain like a a big looking head impact so like show signs of concussion that are used to like trigger that assessment
And the mouth guards right now really just adding to that existing process okay so with the mouth guard now then is that a replacement for that assessment happening on the side of the pitch or is it a replacement for visually noticing signs of a concussion and thinking that
Somebody needs to be assessed on the side of the pitch um right now it’s an addition so to my knowledge nothing has been changed to the hi process itself but they’re just adding one layer of identify of potential identification of a concast player so what happens is that
Well rugby has come up with some thresholds based on that acceleration that the head goes through to the the amount of motion of the head after an impact they found some threshold from years of research that they’ve done before to identify when a player might need to be
Assessed one thing that I think is very important to understand is that these thresholds are not based on potential injury or like tolerance threshold to brain trauma they are really based on like what is the threshold that is going to trigger one additional head injury assessment per game so they want to try
To better identify players without putting too much pressure on the medical staff and without having like without taking the risk of having too many false positives um in this new data set does that make sense it does yeah and I think that I might have come on to this a bit later
On but I think that idea of false positives and false negatives is a really interesting one to dig into a bit further so yeah how obviously we don’t want to miss a real concussion but then if you make it you know really sensitive so that anything that could possibly be a
Concussion you’re removing players off of the pitch that then has its own negative consequences so yeah I don’t know if anyone has any thoughts on that balance of false positiv false negatives where we go with that it’s um um a tricky one to answer I think I guess
It’s a case of identification isn’t it you there’s always going to be issues with the devices there’s always going to be uh issues with the identification of concussion um but I suppose it’s just yeah I think for now it’s probably going to be a data Gathering exercise in which
These tolerances need to be updated and become more accurate because I truth be told I don’t know the exact numbers and I don’t know the exact number of data that the um current thresholds have been derived from but there are so many factors to a specific person’s tolerance
To acceleration there’s so many factors um you know that can change very quickly that it’s um a metric that’s going to need to be updated quickly in my belief additionally as well the metrics used know they they will also be able to be refined in the future as well because um
Not all 60g impacts are equal as well and there there could be factors that um can be analyzed such as the duration of acceleration over certain thresholds the sort of um the impulse of the impact that could play a major part into this um and allow for more accurate
Thresholds to be set in the future and do we know then if we forget about instrumented mouth guards for a moment if we could actually measure force on the brain or acceleration of the brain which I know we can’t but what would we want to measure what is it that actually
Causes concussion do we know that kind of is it Peak force or impulse or a repetitive number of smaller impacts over the course of a game I’m not a neurologist but I do work with some who are particularly brilliant at this and from what I understand as a non-urology person traditionally all the
Hidden head injury brain injury models equations were deriv purely from acceler linear acceleration so from what I understand the linear acceleration has been associated with these changes in the pressure gradient through the brain with you know the the brain moving but more specifically and this is papers from um
Robert Stern and mck is when you have these rotational quite High rotational impacts so in American football and rug rugby is a particularly rotational game you have your hemispheres overly simplistic explanation hemispheres oscillating against one another so you have the force being propagated down through the forks and
Then you have the connection center of your brain is the Corpus colossum so you have these connections going between the hemispheres in the colossum the Corpus colossum itself which is right in the middle of the brain so from what we’ve seen from these papers you have these hemispheric rotation so you have the
Sharing and tearing of these ax down in the middle of the brain so the connection center of the brain that’s where the most of the atrophy is seen and when when they publish these crosssections of the brain after you know during autopsy so the wastage so
The like sort of like a a muscle wastage when you stop using it so around the middle area of the brain that’s one of the the things that has come out of that that I’ve read in these neuropathology papers is they damage the Corpus colossum itself the commun ation center
Of the brain the interhemispheric connection center because of the stretching tearing rather than the outside of the brain um in those early Contra C kind of concussion diagrams that you see with like you say bruising just on the frontal Lo so that’s my understanding of
That for me at least that reminds me of a lot of the talk around say external and internal training load monitoring or a lot of wearable technology based work saying how can we estimate what’s happening inside the body from measures being taken outside the body and I guess
It’s a lot of those familiar challenges but for anyone who I guess is somewhat familiar with how these mouth guards work how does what Lizzy just described internal within the brain relate in any ways the things that we’re actually measuring so are we just measuring linear acceleration or are we measuring
Linear and rotational aspects and how does that I guess Link in with what we know about the internal mechanisms link to concussion that we’ve just discussed so with the mouth GS we can measure the motion of the head or the motion of the skull like actually the motion of the
Sensor that we use as an estimation of the motion of the skull which some people have now been working for like a few years on um numerical models of the head and brain so um I don’t know how familiar the audience will be with finite elements but it’s basically some like numerical
Technique that allows to measure the deformation of like very tiny elements that would constitute the brain and so by using the kinematics like so the measures from the mouth guards into those head and brain models we can actually try to estimate the The Strain and the stress on each on each part of
The brain and so that relates to exactly what Lizzie was saying um about the actual like mechanical damage so there are models that are in development to better understand that um it still hasn’t it’s still very much work in progress but I think the field is moving towards that
Beyond um the peak acceleration of the head so that’s something that is very promising for the future other field okay and then I assume then from what you’ve said we’re not saying if it goes any of these measures go above a certain threshold you are going to be conquested
It’s more there someone certainty involved in it and it’s almost a risk factor of if something is triggered then this person potentially needs looking at in more detail does anyone know in the applied sense how that is working as in I’ve obviously seen headlines of players being removed from
Matches is that if a threat shoulders exceeded players are then removed for the rest of the match or a set period of time or is it they’re removed for further assessment that then determines whether they go back onto the field or not and I guess linked in with all of
That if there are any answers for any of this how might that change the role of some of the clinicians or other people involved in that setup in any way so um it’s pretty early days so it’s January the 1 2024 this year that um world rugby mandated the use of
Instrumented mouth guards for the professional teams um actually I think it’s been a bit longer with the women’s game I think it started in October last year for the women’s game and somehow we don’t hear about women’s rugby I I only follow women’s um yeah no
They did these in the wxv last year that was the first time but so the Mandate was January the 1st 2024 for all professional teams worldwide so as I understand it um there was an or Orchard study so done in New Zealand over the last few years so this was done you know
In conjunction with World rugby so led by Daniel S and Melanie busy and so they create they collected instrumented mouth guard data for a big number of elite and Community level teams from that data they took a value over which only I think it was 1% of impacts happened um a
Very small percentage of um impacts were over this particular threshold so that’s where they started so I think they started um with the champ with Women’s Championship last year at 50g um but that you know didn’t work so they had to they brought it up to 60 and
Now I think it’s 70g for um the um for the Six Nations and 75 for the Pacific Super Rugby I’m not sure exactly but those thresholds have have changed so they were they were based on um statistics done from the otaro study and being refined from there and they will
Have to be refined further so it’s not to say that’s those 60 or 70g and 4 and a half or 4,000 RADS per second per second or 4 and a half thousand which I think it is now they’re not based on whether or not somebody’s brain is going
To um experience injury at those forces it’s based on a probability that that’s only going to happen for one in every something like a thousand impacts that they’ve recorded if I’ve understood that correctly I wonder as well in relation to all of this what value there is in
Sub threshold data I know this is a very developing field and you say things are changing thresholds are changing people are starting to learn how to make effective use of it but I wonder whether body knows of this being used in training and not just competition and
Whether there is you know scope for monitoring sub threshold impacts over the period of a day or a week or a month or a season and whether anything can be done with that data not just the kind of one time all season when it does exceed a big
Threshold yeah yeah I know there are quite a few teams using this in training to over to quantify the overall load so like workload so as if you’d use a GPS in training to quantify how many meters you’ve run how many high intensity meters you’ve run on your overall
Workload um these mouth guards all different brands are being used in training for various teams to do that same thing but with head impacts so quantifying you know the number of head impacts at a certain at a certain intensity and the overall number of impacts you right down
To the bottom thresholds which depending on I was talking to David about this yesterday the minimum you know what the trigger threshold is so is it triggered over 60 or over 10g Andy so how you know how many impacts they getting down that bottom end and the cumulative um overall exposure there so
Using those to limit and mitigate the chances of of brain injury from limiting for the the exposure in in training yeah I think one of the key thing here is that we still don’t really know what those data points mean um because we don’t have that connection between acceleration of the
Head to brain strains to brain trauma really so right now we can’t really use those like absolute values to identify when someone is injured or when someone needs care um but it can still be used to like identify for example where whether there’s like a type of drill or
Like a type of training session that generates more head impact on players or there’s like some players that for whatever reason sustain more head impact than others for the same playing positions and like identifying whether there’s like like a technique Improvement that needs to be make to protect them or whether there’s like
Some like changes into the like um into like the schedule of the training sessions to adapt for like higher contact load um sessions so there are are still things that can be used uh for player welfare and we’re like really much still learning about it and some
Yeah as Li said some teams some clubs are working independently of researchers and I’m not involved with any clubs and I would love to see how it’s being used um in clubs to like know what they’re doing how they’re using it what are the benefits to the player what do what do
The player think the benefits for them are I think would be very interesting what we’re doing here at swans University so we’ve got three women’s teams currently Ked out with instrumented with these instrumental mouth cards what we found so a paper that we published in 2021 we instrumented our men’s and women’s first
Drug me teams with instrumented mouth cards to compare I wanted to look at sex differences but of course we learned a lot more from that than we originally thought we would so we were looking at I was looking for six differences in how head impacts are sustained so this these
This mouth guard technology has enabled you know these findings and and the implications from those findings are a lot wider than than you know we expected so we found just looking at the mouth guard data over the course of a season so that season was cut short for Co so
It was only seven games per te but there was no if we just looked at the data by itself there was no overall statistical difference in the magnitudes of head impact sustained by the women’s team and the men’s team throughout That season however coupled with video analysis
Which you have to do anyway what we saw were completely different mechanisms between these two teams so we thought oh sex differences right so we found that as we found a lot of very like one of the most common mechanisms for the women’s team was this head to ground
Impact it wasn’t just head to ground like you see in the professional men it was it was an uncontrolled Whiplash like a car crash head to ground right so you know that that was very Stark difference between the men’s and the women’s team so the men we only saw that maybe twice
In a season and once was when the guy got knocked out first but the woman we saw it right throughout every game right then you dive a little deeper you think oh that that’s interesting so we we tested everybody’s neck strength we’ve got these big neck strength machines
That we’ve made here behind me the woman did have a 47% difference in absolute NE St that’s not corrected for body weight that’s just 47% difference but if you’re just looking at outright measures you know so there’s that but then the average playing age for the men so everything else was very comparable
So similar ages very similar ages similar background demographics all from similar areas of wherever they are in the UK Wales England but one group was female one group were male the males had an average playing age of 13.5 years the men’s team the women’s team had an
Average playing age of 3.5 years so while we were getting all excited and concerned about these sex differences that we’d found because of the mouth cards I we we inste of go hang on a minute one team are kind of semi-professional Academy level players who have been playing for most of them
Over a decade they started when they were five between five and 10 the other team uh a lot of them couldn’t play rugby through school cuz it didn’t exist for them so they’ve started playing rugby at University they’ve done three training sessions and they’re playing against national team reps so is that a
Six difference or have we just made a really obvious connection between playing experience and opportunities for for girls to get involved in rugby and the kinds of head impact that we’re seeing so then we had some students and collaborators from other places look at the professional women so look at the
Black Ferns and look at England and you don’t see that out of control head and packed to ground in those teams or France in fact at the World Cup I saw just I was just there on the sideline I saw it in Canada the Canadian team who
Ended up Force at the World Cup and the teams going down from that I did see it quite a lot the first those first two three teams so England New Zealand and France hardly any at all that suggests it’s not a sex difference really is it
It’s um more to do with your the expertise you know the your the experience that you have playing rugby and the expertise of the coaching that you’ve had all that time so those mouth guards have given us all of these really cool insights that we’re now you know
Using to improve things I really like that idea as well of combining multiple data sources to say actually how can we get more insight by combining instrumented mouth guards with video as you said potentially you’ve got GPS data you’ve got whatever else how can all of those combined give even more insight
And on that note as well of things maybe being not quite what they first seem or did into it a bit more and I guess finding out more than was first expected are there any common myths or misconceptions around the use of instrumented mouth guards or anything whether it’s something you’ve seen in
The media or something you’ve seen on social media or just anything you’re aware of where people are generally misunderstanding how these things are used and how they work that you might be able to try and educate us on or help people to understand a bit better that
We haven’t already done so well I suppose the um the main thing you see um when you’re looking at comments and articles and that sort of stuff is is always uh the phrase sort of concussion detection is the one that I think people are getting most excited about and
That’s the sort of um yeah I think that’s what people somewhat expect um from the devices perhaps um I think yeah the most important thing to know is that probably is that’s probably the longterm aim of instruments of mouth guard use and probably the gold standard the sort
Of like Batum goal would be to achieve a device to create a device or software that can achieve that sort of um level of accuracy and insight but I think at this moment in time it’s fair to say that’s a long way off but the eventual
Aim of the device and if that’s the long-term aim what do we need to do whether it’s as researchers practitioners what kind of scientific Community the Sporting Community what are the steps to get there or what would you like to see from research over the next few years to help us bridge that
Gap um so yeah with with anything related to data science and machine learning and those sort of projects the answer uh to that question is always more data um so the I think the yeah to to achieve these kind of things you really you really need a sort of um glut
Of data you need lots of data which is high quality and accessible by many researchers as well to explore different Avenues and explore different relationships between the data and the actual um like uh outcomes so yeah I think that the main way to achieve or to
Make fast progress in the field is to make data available to people um along with in an Ideal World video footage and labels regarding uh what actually occurred in the data and what was the outcome of those impacts um because there’s going to be a lot of complex relationships to investigate between um
The sort of number of impacts the types of impacts the accumulation of impacts and those things before we can start really getting um uh those sort of outcomes from the mouth guards like those insights that people sort of Hope for of looking for concussion detection
And those kind of things so yeah in In Sum it’s just as with a lot of things more more data is required yeah I I completely agree I think more data is needed and that’s one thing that world rugby is going to get from that mandate
No matter what they’re going to get tons and tons of data so that’s going to help um I think the one one thing as well is that even if concussions are common they’re not that common so collecting like head impacts from instrumen in mouthguards that actually lead to
Concussions takes a long time because and mouthguards are not cheap either so it takes a lot of money as well so there’s a lot of like logistical issues to getting more data I think think one of the thing that we need to do if we want to use instrument in m to identify
Concussion is understand how concussions happen and we have a lot of ground to cover there um but so I I I would personally like to see more research on like the cumulative effect of head impact because right now we usually look at concussions in terms of like one big
Impact that makes the player show clear signs of concussion but we don’t really understand still how all these little impacts that a player sustain before actually influence that big impact and so we think that concussions is a result of like smaller impacts and big impacts and like anything in between but we
Don’t really understand it yet and in addition to all of those things there’s so many other variables so what we’re doing currently what we’re trying to do and this is really I want this is really hard to integrate all these different data sources so we are doing this project with with University
Liel women’s rugby looking at how does Net strength affect relate relate to the impacts that you see on the field how does what we wanted to look at was how menstrual cycle affects a how you get injured and B how you respond to that
But we had to take that out um we were asked to take that out which is incredibly disappointing but we’re also looking at not just the scat six for neurocognitive responses but a series of more bespoke neurocognitive tests that are being that part of it’s being led by
Dr jev Williams from exitor so our aim with this was to have really clear develop try to develop really clear correlations between the actual cumulative um you know head impact exposure that we’re measuring through these mouth guards throughout the you know week Game season and how these neurocognitive responses changed over
That time but in able to get that data you need full by in from everybody involved and of course everybody’s got their own lives and these players aren’t professional they don’t their Medics aren’t fulltime you know so it’s been it’s it’s been a real challenge to coordinate all of these data strands
Together um it remains a big challenge so that I mean ultimately when need to have this cross-pollination of you research designs need to include the neurology side um the you know neurocognitive experts in that area along with the biomechanist looking at the the impacts as you know we’re trying
To but also you know with female athletes having having to take out the menstrual cycle monitoring was a hugely disappointing part of our state we don’t really know how the the changes on the hormonal profile affect these concussions cuz there’s been one or two studies one in 2014 that that found that
Having a concussion in the Lal phase of your menstrual cycle was correlated with longer and more severe postconcussion symptoms but it’s so hard to gather that data you really need people that know what they’re doing with the whole change in hormonal profile um you need those
People you need to write that into your study design and you need the funding which is really hard to get because you know it’s periods women people tend not to people with money tend not to really understand the importance of that see it’s it is we’re found it quite
Difficult to get to get funding to even look at it um so we well we’ve got so far to go um and understanding even even just those individual parts of it let alone how all of these all of these components into relate and how they how
One thing affects the other as you say with the one thing they’re definitely going to to get at least at the elite level is lots of data by mandating it are there any legal consequences or what are the kind of moral ethical concerns around I guess the use of players data
And do players have any say in what data can and can’t be used for or is that a bit of a controversial question I can only speak for our for the study that I’ve directly involved in and not the the data is only only accessible to the researchers named on
Our ethics document there’ be nobody looking at that until it’s in a generalized form for publication where there won’t be any identifiable features we can only report you know this this a stand standard thing in the Pro leagues I really don’t know I’m not involved in that part of
It I don’t know about like in legal um uh consequences of it but I know it’s a bit different here in the US whether whe if you obtain funding that comes from the government so from the National Institute of Health or the Department of Defense for example that are funding a
Lot of concussion related studies um you have to make your data publicly available not available for like like members of the general public but available to researchers that have a specific research questions that could potentially be answered by those data so we we have to make some of that like
Some of those results and some of those data available which I think is a great thing to move the field forward do we think all of this is coming to many more Sports as well now if we talk about how World rugby have taken up the mandated
Use of instrumented mouth guards do we think similar things are likely to be coming for other sports or are there lessons here that other sports can learn from rugby I think it’s actually very funny because like this whole field started as Lizzie said before with American football and with ice hockey and other
Like helmeted sports because that was what the technology allowed and then since instrumen mards like rugby took over and like they’ve been really like I think leading the field and they’ve like studied some like very very big studies compared to what has been seen here in the US where it’s mostly like like
Little research teams that do research on their local football college team while rug rugby has like refunded like large massive studies that I think are taking everything forward I think a lot of sports might want to wait to see what world rby comes with and like what are the results and
How the MS are like used and maybe validated and accepted by all of the stakeholders before going forward but I think it was like like the first like never seen before kind of mandate um from what be in Nora do you know so I’ve read a few years ago
And this this might not still be the case that there was only one insurance company in the whole of the US who would actually insure American football so Pop Warner NCAA and the NFL do you know if that’s still the case because if we’re being really transparent about the kinds
Of impact forces and the accumulative impact forces that people so in the case of professional players that employes are sustaining do you think that’s going to have any implications for particular leagues being able to get insurance I honestly have no idea um I I don’t think I’ve been in the states long
Enough to know that and that’s not something that we’ve had that we came across in my studies here um one thing that I can tell you related to insurance and the way that it like the health system works in the US is that the number of concussion is definitely like
Underestimated like I know we have a lot of like I work with combat sport athletes and we have several people that do not have insurance and even if they are like clearly concussed after a fight they will not want to to go to the doctor because they can’t pay for it but
That’s that’s really the only thing that I know about the whole health insurance thing here and I know we’re coming to a close in terms of time but if anyone listening to this is really interested in this area of either concussions instrumented mouth guards impact related Sports Etc
Is there anywh you can recommend that people can find out either more about your own research or more about this topic in general I know I like if people want to find more about my work U I am a little bit active on X or Twitter uh so
People can find me there I’m also like more than happy to like answer question via email um if people want to David’s published a really promising exciting paper from his PhD his PhD vior is actually tomorrow and there’s two more papers coming out of that PhD in
The in the I’m like looking at them going yes they will be won’t they um in the short term so David do you want to talk about those a little bit papers because this is really where the where the future of this field needs to go yeah I can I can
Give a quick um a quick overview um so just um on on the topics of the thesis we mainly been looking at improving the reliability and functionality of instrumented math cards um because there’s been a lot of focus with the use of math cards sort of the the pentacle
Of sports where they have much greater resources than most users would be able to access um so part of it been to try and create tools that you know could be usable to researchers at any level of the game so um allowing you to verify your own
Impacts if you have less resources like cameras and stuff available to yourself and trying to make the um predictions from the mouth guards as accurate as possible because um one consideration we found with the mouth guard data is that um it’s always it’s the report of the
Magnitude AR thepoke to the wearer which is something that could factor into the the magnitude um so using the fil filtering the impacts for danger by magnitude uh we did a study where we found that these could vary by about 20% greater than 20% per person so you could
See the exact same impact uh when translated to a point of Interest say in the brain for someone so that magnitude you’re then reporting as like your know impact size could could vary by 20% from one person to another person so that impact which is reported at 59g for one
Person um and therefore not an impact of Interest could actually be a 71 72 mg impact in another person when translated to that correct location um and yeah the rest of the work is then um TR trying to extract more information um which I hope
Would be a useful tool as well going in the future so looking at what uh What mechanisms are actually C causing head acceleration so using machine learning albums to try and predict the action that a person was conducting whether it’s was a tackle or a carry or um the
Actual impact type of direct contact ahead or indirect contact ahead to try and sort of continually provide extra data richness which I believe could then be used to in further analytics down the line in terms of um finding where impacts are coming from or finding yeah the source of impacts and therefore you
Could yeah expand that out to find out the source of injury as well I suppose you can tell you’re prepared for your vior with a nice succinct summary of the last three years or however many years of research um yeah thanks for that Anora and Lizzy massive thank you
For showing all of your knowledge David thank you for sharing yours and a massive good luck for your PhD VI tomorrow hopefully by the time this comes out and people are actually listening that will all have gone well and yeah it might be Dr pal by that
Point um yeah massive good look and thanks again to everyone thanks for listening to the experts in sport podcast if you’d like to get in touch then please contact me Martin Foster at m. Foster al. ac.uk thanks for listening see you next time