Brain injuries have a somewhat of a tainted history as far as dealing with their severity and identifying them effectively goes. However, recently, especially in the world of sports, there has been some serious movement and headway made in not only dealing with the plethora of cases of brain injuries but also detecting them correctly. In a multitude of instances, when an individual sustains a brain injury, the blanket term “concussion” is used to deem this a true injury, but with the brain being a vital component of everyday function, it begs the following questions: What exactly is a concussion? How does it come about? And what exactly does it mean to the individual who has sustained this injury?
To answer these preliminary questions and set the stage for the text to come, information regarding concussions and their effects will be drawn from the work of Elizabeth Sandel MD, who authored Shaken Brain, a piece of research writing that looks into the science behind concussions. According to Sandel, “A concussion, also known as a mild traumatic brain injury (mTBI), is an injury to the brain caused by a blow or jolt to the head — or a blow to the body that causes the head to move and the brain to shift rapidly inside the skull — that disrupts normal brain functioning.”
Sandel explains that symptoms of a concussion can range widely from sensitivity to light, sound and or movement to severe headaches, lapses in memory, irritability, and hormonal changes. The severity and length of time that one will experience these symptoms depends on the grade of their concussion. It is a general medical practice that concussions are graded on a three-level tier with level one being a low-grade or mild concussion, level two being mid-grade to moderate and level three being high-grade to severe. Concussions are a prevalent injury that affects individuals on all levels. According to a study conducted by the Sports Medical Council of Alberta, on average each year, around 200,000 people in Canada are diagnosed with a concussion and about 20 per cent of all concussions reported are sustained by athletes, with young adults having the highest rate. Hockey, football, and rugby are the sports with the highest concussion report incident rates.
These statistics show that any individual playing high-contact sports is at a higher risk of sustaining a concussion. Kyle Dawdy, a former member of the varsity men’s football team, shared, “Before we report for our first day of camp, we need to do a concussion baseline test — we are not allowed to participate in any team events until we do this test.” He is referring to the King-Devick test, which measures ocular, motor, visual, and cognitive function for concussion evaluation. “We just have to read a bunch of numbers that are on a sheet of paper. There are different levels and pages, and the numbers are ordered randomly across the pages,” Dawdy said. “As we read, we are encouraged to go as fast as we can without making any mistakes, we are timed and then the time is recorded by the athletic therapists.”
Breanna Hendrick, head athletic therapist for the UW’s varsity football team, shared that the issue of concussions in football is much more prevalent than in other sports. “Throughout a season, I will deal with multiple instances of suspected concussions,” she said. “When an athlete comes to me with concussion-like symptoms, or the athlete has sustained a severe blow to the head, I take them to a private, quiet area to perform a SCAT 6 test. Upon completion of the test, we will analyze the results, and the athlete will also perform a King-Devick test. We will then compare the results of this with their initial baseline test conducted before the season, combining these two assessment tools with our professional judgement, we will then decide on whether the athlete can return to play.”
The SCAT 6 test is a comprehensive sports concussion assessment tool that can be used to test an athlete for a concussion up to seven days after the injury. It helps medical professionals evaluate an athlete’s cognitive, physical, and emotional symptoms and assists in making decisions regarding return-to-play protocols. When conducting an assessment using this tool, athletes are asked many questions and are supposed to answer them as effectively and honestly as possible. As discovered through discussion with Hendrick and former varsity football team member Dawdy, the tests used to determine and or diagnose a concussion within varsity athletics here at the UW are entirely reliant on tests and professional judgment, both considered to be quite subjective.
If you are anything like UW alum Andrew Cordssen-David, the idea of having an injury as severe and potentially life-altering as a concussion being determined by subjective means is a compelling problem that needs to be addressed. Cordssen-David and his team are actively working to resolve this critical gap in the market for concussion detection. Cordssen-David’s passion for entrepreneurship led him to enroll in the master of business, entrepreneurship, and technology (MBET) program at UW. Through the support of the MBET program, he assembled a team, including members affiliated with the UW, to develop a solution that provides athletes and athletic therapists with objective results to help in the detection of a concussion occurring following a head-related incident.
Cordssen-David shared that dealing with concussions is something he is very familiar with. He played hockey for various years at a professional level, including with the Quebec Maritimes Junior Hockey League (QMJHL), the British Columbia Hockey League (BCHL), and the Ontario Junior Hockey League (OJHL), until finally wrapping up his career with the Waterloo Warriors as a member of the varsity hockey team from 2018-2023. Cordssen-David shared that “concussions largely affected [his] hockey career,” citing multiple occurrences where he experienced having to go through these subjective tests. He further explored this topic in an interview with CTV where he shared that in his exposure to concussions, “less than a handful were documented and [he]’d say probably around the same undocumented.”
Although Cordssen-David did not directly relate these undocumented/untreated concussions to the reliability of these subjective tests, it is fair to assume that with subjective concussion testing being the only true widely available and accepted testing mechanisms, they have failed him and many other athletes leading to their concussions to go undiagnosed.. This, combined with other factors, pushed him to explore a more objective route to determine if an individual has sustained a concussion.
Through the assistance of MBET, Cordssen-David was able to build connections and a research team to look into the possibility of creating objective measures to determine if one has sustained a concussion. Through research, he and his team discovered that after a severe blow to the head or a traumatic brain injury, specific biomarkers in an individual’s saliva show a significant spike. In understanding this, the next task was for the team to come up with a product that could be used to identify if this spike has occurred. This led to the creation of the company HeadFirst Inc.
Cordssen-David shared that the testing mechanism that he and his team came up with is very similar to the COVID-19 rapid tests that were prevalent during the pandemic. He explained, “When an athlete is suspected of having a concussion or exhibits concussion-like symptoms, they will undergo a saliva test. After the saliva is collected and applied to the device, it will provide a result: one line indicates a negative reading, while two lines signify that the individual’s biomarkers have spiked, indicating a possible concussion.”
Cordssen-David highlighted that a significant challenge in concussion testing in athletics is that due to their competitive nature, athletes may sometimes mislead athletic therapists to expedite their return to play. By introducing objective measures alongside the subjective concussion testing tools that have been used for decades, the likelihood of athletes returning to play prematurely could potentially be reduced. He added, “The goal of this product is not to completely replace subjective tests, as they still hold value, but rather to serve as an additional tool for healthcare professionals to make more informed decisions about whether a concussion has occurred.”
Moreover, professionals in the athletic therapy field are enthusiastic about the idea of an objective measure to help identify a concussion. In the discussion with Hendrick, she shared, “Although the tests being used require a high level of professional judgement, they are still subjective in nature, having a product like HeadFirst saliva testing providing objective results will make concussion detection and return to play a much more robust and results-based process.” This leads one to believe that the HeadFirst concussion detection product will not only assist athletic therapists and other healthcare professionals in their practice, it will also work to protect athletes from themselves.
HeadFirst is currently in the early stages of testing and attempting to receive approval for its product to hit the market. UW’s athletics department is currently collaborating with HeadFirst on a study involving athletes from all sports to assess the feasibility of this approach. Cordssen-David said that moving forward, his goal is to not only have this product widely available to athletes but also have it as a tool available to anyone who is suspected of sustaining a concussion or traumatic brain injury. Although this product is only in its early stages of development, it so far seems as if Cordssen-David and his team at HeadFirst are on the brink of being one of the many innovative and game-changing products to come out of the Velocity incubator here at UW.
