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Central Piloting Concussion Diagnosis Tool Testing

Featured: Central Piloting Concussion Diagnosis Tool Testing

December 21, 2017

Taking on a lead role in attacking an issue that’s shrouded in fear, Central College’s exercise science department is partnering with a Michigan medical device maker and Henry Ford Hospital in exploring new technologies to enhance the safety of athletes evaluated for concussions.

Central is the first college or university in the U.S.  to serve as a pilot program for the testing tool, developed by Safety in Motion, Inc. (SiM) of Northville, Mich., a company launched by former Ford Motor Company executive and retired attorney Walter Borda.

“It’s exciting to be part of a study like this, especially getting our students involved,” said head athletic trainer Frank Neu. “This gives them real-life experience.”

Borda is determined to take the guesswork out of concussion evaluation, which would better ensure an athlete’s safety when playing decisions are made. The Balance Error Scoring System, better known as the BESS test, is the current standard testing protocol for diagnosing concussions and mild traumatic brain injuries on site. But it has limitations.

“The BESS test is subjective,” said Dan Wright, SiM director of sales. “If four people all monitored the same athlete as they’re going through the test, you could get four different answers.”

When a doctor with the Sports Medicine Department at Henry Ford Health System shared similar concerns, Borda told him he had an answer.

“We can eliminate most of the problems you recited through the application of electronic and automotive technologies, as well as appropriate algorithms,” Borda said. “You can eliminate the subjectivity, you can eliminate the inconsistency, you can improve the accuracy, the reliability and the repeatability.”

 

Guided by medical experts at Henry Ford Health System, a team of former automotive engineers transformed Borda’s idea and developed the SiM-1000 portable force plate (www.sim-technologies.com). The team includes former General Motors Corvette chief engineer Tom Wallace, former Ford safety technical fellow Priya Prasad, former CEO of the largest crash dummy company Dave Stein, and Dr. Brett Martin, former sports medicine physician with North Ottawa Medical Group and former director of the Sports Concussion Clinic with Henry Ford Health System, now serving in private practice. Dr. Vasilios Moutzouros, orthopedic surgeon and chief of sports medicine with Henry Ford Health System, has joined the team and is sponsoring the research within the hospital and with Central, with the objective of publishing the findings in a professional medical journal.

The force plate utilizes auto air bag sensors in a small, portable device intended to take the subjectivity out of concussion evaluation through data-based balance testing. It’s powerful, yet small enough to use on a playing-field sideline.

“It will facilitate the ability to measure the athlete’s condition through balance evaluation,” Borda said. “Balance is one of the pathways that is used in the concussion diagnostic process.”

While the force plate was given a trial run with a handful of athletes, it had never gone through more broad-based testing–until Central partnered with SiM.

Borda and a team of SiM staff members journeyed to Pella in August to conduct baseline testing for more than 140 Central football players. Central’s Neu and associate professor of exercise science Leslie Duinink organized the testing, relying on the assistance of several athletic training students. Central’s staff members followed with testing of the women’s soccer team.

“Only the accumulation of data like Central College is going to provide for us is going to give us the capacity to look at other options and to be able to do more development in the future,” said Wright.

Central’s athletic training staff utilized the equipment throughout the fall season, testing student-athletes more than 100 times in diagnosing potential concussions and determining when it was safe to return to play. Then Borda’s crew returned to campus Nov. 15, following the season, and retested the football squad.

Meanwhile, Duinink and senior athletic training students Kelsi Griffiths (Lisbon, Iowa) and Hunter Howe (Elmer, Mo.) studied video of each of the preseason tests and independently scored them each manually in the traditional subjective fashion. Those scores will then be compared with those recorded by the force plate for the SiM team to analyze.

“I think we’ve given them the numbers they need,” Duinink said.

The pilot program is providing Central’s exercise science students with a front-line opportunity to experience real-world clinical research. That’s unusual at the undergraduate level.

“It’s neat to be involved in testing a diagnostic tool that could soon spread out over America,” Griffiths said.

“I think it’s exciting,” Howe said. “I get to see first-hand how the results are going to be used.”

Howe said the work is also revealing postgraduate paths he hadn’t previously considered.

“I really like research,” he said. “We’re talking about an evidence-based practice, which ties in to a lot of our classes. That really interests me.”

Duinink said the SiM project integrates seamlessly into Central students’ work.

“It’s an opportunity for them to participate in real research,” Duinink said. “It’s not just reading a textbook. They’re putting something into practice to help with a problem that’s very real.”

Such forms of integrated learning are a Central education hallmark, and something Griffiths values.

“I like how we’re given the freedom to work with athletes one-on-one, but if you get stuck, (faculty members) are there to help you,” said Griffiths, who is considering a physical therapy career. “Central gets you out in the community and you work with hospitals and physical therapy clinics. You work with professionals and can ask them questions.”

Howe is a fan as well.

“I really like our program,” he said. “It’s very practice-based. You can learn something in the classroom and then come down to the athletic training room and use it that day. It really helps me get a better grasp of the knowledge. And having our professors in the room, you develop really close relationships.”

It’s all part of a wide range of experiences Howe has taken advantage of at Central.

“I’ve been able to be a (track and field) student-athlete and spent a semester in Bangor, Wales,” said Howe, who will attend graduate school next year and is thinking about becoming a physician assistant. “I’ve also made so many connections. It’s crazy how many connections Central has. During your sophomore year, you can go on rotations and meet doctors in different fields, like dentists, orthopedists and chiropractors. You’re able to make personal connections with them.”

A scary subject—but easy to ignore

Duinink, who previously served as Central’s head athletic trainer, earlier conducted concussion research, made presentations for the Iowa Department of Public Health Brain Injury Alliance and provided guidance on best practices for Iowa K-12 educators. She’s collected data for a national research project through the University of Georgia and has also partnered with associate professor of sociology Dawn Reece in studying attitudes and behaviors regarding concussions.

For much of America, it’s a topic to avoid, she said.

“People are still very dismissive of it while some are overly reactive to it,” she said.

Part of the problem is concussions are hard to diagnose and even harder to understand.

“You can’t see them,” Duinink said. “So we (as a society) encourage kids to shake it off and keep going.”

In interviewing athletes and parents, she found that’s a common mindset.

“People are conditioned to ignore symptoms, not only with concussions, but injuries in general,” she said. “There’s an expectation that they participate whether they’re hurt or not.”

The SiM force plate is designed to help determine when that’s safe.

“I’ve coached kids a lot,” said Rob Davis, SiM director of programming, sales and marketing. “It is difficult. A kid bumps their head. Do you pull them out on a suspicion because I’m not qualified to make that decision? Their parents probably aren’t qualified to make that decision, either.

“If we have a reliable way to detect a probable concussion or head trauma, I can feel a lot safer as a parent knowing that something can tell us very easily and quickly if the player should be out.”

Yet even parents sometimes are fearful of the answer and find it easier to ignore the issue.

“The challenge is making people willing to find out if their kid has a concussion or not and be willing to deal with the consequences if they do,” Davis said.

Some fans and leaders think those involved in concussion research are either headline-seekers or trying to destroy football. But Borda argues that the only way concussions will destroy football is if the issue is ignored. He’s not trying to end the sport, he’s trying to save it.

“I love football,” said Borda, who is a former player. “The last thing I would want to do is kill football.”

And, he notes, too many assume football is the only sport that deals with concussions, which is why Central’s women’s soccer team was part of this fall’s pilot program and why the college’s athletic training staff continues using the SiM device for athletes in other sports.

“It’s a contact-sport problem,” Borda said. “And anyone who thinks a sport like soccer or basketball isn’t a contact sport hasn’t watched very much of it.”

Athlete safety is the overriding goal.

Yet many leaders remain fearful.

“A lot of other institutions we’ve gone to don’t want to hear from us,” Borda said. “They aren’t interested in opening the door to see what could be behind it and how the circumstances can be improved. We’ve been to large universities that are unwilling to cut the potential risks their students are exposed to. They simply don’t want to know.”

Borda and his team believed the SiM force plate can begin to unlock the puzzle, but they needed data from large-scale testing to determine if they were right, and for the device to be taken seriously enough to be effectively evaluated by the medical community.

“We’d love to get data on seeing what happens when kids do get head trauma,” Davis said. “See how they recover, how quickly they recover. I think that could be very useful for knowing what to expect from an athlete at a certain age, in a certain sport, at a certain level.

Facilitating that large-scale testing proved almost as challenging as developing the technology. Fear led to roadblocks. Many university athletics departments showed initial interest but then higher-level administrators nervously backed off, Borda said. Talks with NFL officials dragged on without results.

Then on a sultry afternoon last July, Jason Vines was on a boat in the Atlantic Ocean near his Wilmington, N.C. home and had an idea. Vines, a former Ford and Chrysler communications vice president now working as a political communications consultant in Washington, D.C., said he donates his time to SiM Technologies because he wants to make a difference.

“I’d been working with Walter Borda and the team for four years on the device and it was frustrating,” Vines said. “We have a solution here and it seemed like a lot of these groups didn’t want to know the answer. But you can’t avoid it. You cannot open a newspaper without seeing a story about concussions.”

A 1982 Central and Pella native, Vines knew his alma mater had a highly regarded exercise science program, not to mention an NCAA Division III athletics program that is a traditional powerhouse. He talked to a friend at the college about serving as a pilot program and the answer came swiftly.

“We asked for help from Central and they turned it around in a week or two and got it all organized,” Borda said. “It was amazing.”

Central leaders saw a cutting-edge research opportunity for its exercise science students and an opportunity to partner with Henry Ford Health System, as well a project with a potential life-saving impact.

“No other school is doing this,” Neu said. “We’re the ones who stepped up and we’re happy to do so. Concussion research is a hot topic.”

“Central College’s staff has bent over backwards to help us in our research,” Borda said. “Central is clearly in a leadership position in this kind of research, based on our experience.”

Vines is thrilled.

“My alma mater, of which I’m very proud, embraced this and said, ‘We want to make a difference. We care about our student-athletes’ health,’” Vines said. “That is kind of awe-inspiring to me.”

Problems and progress

Duinink said that Central’s students are learning that part of serving as a pilot program is discovering that there are often more failures than successes in developing new technologies. But the testing also serves to generate ideas for improvements.

“I’ve learned that technology has its benefits and flaws,” Griffiths said. “It’s made me a little more interested in using their technology and taking it forward.”

Borda said suggestions from Central’s staff are helping his team learn as well.

“We’re looking at some specific changes and improvements to the SiM device as a direct result of their ideas,” he said.

Modifications could be made to the device or how it’s implemented, and the research could even lead to discussion about changes to the BESS test, Borda speculated.

After her experience with the SiM force plate, Duinink said it may prove even more beneficial in areas beyond concussion evaluation, particularly with older patients. She’s not alone, according to Borda. Nationally recognized neurological surgeon Dr. Steven Kalkanis is co-director of the Henry Ford Neuroscience Institute as well as medical director of the Henry Ford Cancer Institute and participated in former U.S. vice president Joe Biden’s Cancer Moonshot Initiative.

“Steve Kalkanis believes this device has the capability and the sensitivity to not only diagnose a potential concussion but also to help in the diagnostic process for Parkinson’s Disease and determining fall risk for patients in nursing homes and things like that,” Borda said.

But the early consensus at Central is that the device shows promise.

“I never would have thought to make a machine that could do this,” Griffiths said. “It’s a good idea. They have the right science behind it. They’re on the right track.”

Duinink agreed.

“It’s a potentially valuable tool,” Duinink said. “It’s always good to have another tool in the tool box in evaluating the health of our young people.”

Next steps

Much of the data is now being reviewed by Jason Meldau,, who is doing research work for the sports medicine department with Henry Ford Health System along with Montzouros and other concussion experts there. The initial feedback is favorable, said Borda, who anticipates extensive conversations between the medical team and Central’s staff.

Borda is delighted with the results thus far.

“I think it proves the machine works, it proves that it’s a wonderful diagnostic aid and the hard numbers show it,” Borda said.

Initial results also indicate Central players’ core balance capability actually improved throughout the season. Borda credits the college’s highly regarded strength and conditioning program. More investigation is needed.

For Central, results matter. But so does the process. Simply being part of the research makes it a winner for students, Duinink said.

“Any time you get to do data collection, it shows what the perils and pitfalls of testing are,” she said. “How do you logistically do this with a large group of people? That’s the kind of thing they get to experience on a bigger scale than they’ve ever seen.”

Howe found it’s not a simple undertaking.

“It takes a small army to do a research program,” he said. “It’s a complicated process. It shows the importance of organization. But I think we did a good job.”

And it’s an experience few undergraduates receive.

“I don’t know of many other colleges doing a lot of this,” Duinink said. “It’s an opportunity to participate in research in a field that’s rapidly expanding. And I think we’re showing that our students know what they’re doing. They’re providing quality data.”

The benefits are numerous.

“It shows they have some practical research background and might give them an opportunity to get into a graduate program they might not otherwise receive. They can showcase what they’ve been able to do and it makes them a more desirable candidate.”

Borda marveled at the efficiency of Central’s operation during the SiM team’s campus visits, and the abilities of the college’s exercise science students, as well as the athletes’ cooperation.

“We figured it was going to take us two days to get through testing 150 players,” Borda said. “It was so well-organized we did it in about half a day. It was fantastic. Leslie (Duinink) and Frank (Neu) and the students did a terrific job.”

Borda applauds Central for making athlete safety a priority.

“Central is providing continuous health monitoring, unlike many universities that don’t,” he said. “And Central is one of only a handful of schools in the country actively engaged in any kind of ongoing concussion research.”

The search for answers is ongoing, as is SiM’s research, which will continue at Central, Borda said.

“I’m committed to it,” he said.

For Borda, the work follows a successful auto industry career and his motivation now is not financial. It’s about safety of American’s youth, and preserving the sports he loves.

“Our interest is in facilitating the ability to play contact sports safely and without excessive damage or harm,” he said.

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