Chapel Hill Researcher Directing National Conversations About Concussions

The most important piece of equipment the University of North Carolina at Chapel Hill’s football players will wear this season might not be the helmets, shoulder pads or spikes they’ll lace up when they open the 2015 season.

Instead, Carolina players may end up getting more long-term health benefits from six dime-sized sensors inside their helmets called accelerometers, devices that measure the impact, angle and severity of a hit to the head.

Data collected by these devices has been used to develop procedures in evaluating and treating concussions, which could have major implications for an athlete’s short-term and long-term health.

Tar Heel football players have used the devices since 2004 and now other Carolina sports which may be high-risk for head trauma – including soccer, lacrosse and field hockey – are in various stages for their players to use accelerometers as well.

While the sensors don’t actually diagnose if a player has sustained a concussion, they do measure the impact of a hit and can provide data as to how a concussion should be treated.

“Concussions are like snowflakes – no two are exactly alike,” said Kevin Guskiewicz, considered one of the nation’s leading researchers on concussions.

Guskiewicz serves as a Kenan Distinguished Professor and is co-director of the Matthew Gfeller Sports-Related Traumatic Brain Injury Research Center in the Department of Exercise and Sports Science. He’s part of a 15-person research team: four faculty, eight graduate students, and three study/clinical coordinators.

Guskiewicz has been in the forefront of the fight to understand and ultimately try to limit concussions sustained in sports. In fact, his work is so pioneering that he now consults with the United States military about head injuries sustained by soldiers in combat areas or during training.

“We’re part of this study that’s being funded by the Department of Defense and the NCAA,” he said. “The military is leaning on sports medicine researchers, sports concussion researchers because blast injuries are similar, in some ways, to what we see in sports injuries. The difference is, for many years, (the military) didn’t have baseline measures before the injury to know what to expect and what return to baseline should look like.”

It isn’t difficult to see why both the NCAA and NFL have worked with Guskiewicz on learning more about the effects of concussions on players. After all, he was awarded a $500,000 MacArthur Fellowship commonly known as the “genius grant,” in 2011 for his research.

Guskiewicz, 49, came to Chapel Hill 21 years ago after completing his doctoral work at the University of Virginia. He had first become interested in how concussions were treated in the NFL while working as an assistant athletic trainer for the Pittsburgh Steelers as he finished his master’s degree at the University of Pittsburgh.

“I was always perplexed by the way in which we would return players following a concussion, in a very arbitrary way and oftentimes with very little evidence or objective data to make that return-to-play decision,” he said. “Yet, someone with a knee injury or a shoulder injury, they would go through all these tests. (I was) thinking to myself, ‘You can’t tell me the knee or shoulder is more important than the brain.’ ”

The situation inspired Guskiewicz to study how to make better return-to-play decisions. As part of his doctoral research, he worked on developing balance tests for athletes who had sustained injuries such as ankle sprains before deciding to apply the same tests for those diagnosed with a concussion.

Guskiewicz said the research “just took off from there” after his dissertation was published. He mulled through a couple of job offers, but said he fell in love with Chapel Hill during his first interview there.





Photo on left: Veterans Administration Secretary Eric Shinseki, left, and UNC President Tom Ross, center, examine a helmet held by Kevin Guskiewicz, right, fitted with sensors to record data from head area impacts of players on the field. Photo by Dan Sears. Photo on right: Kevin Guskiewicz, director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research center at the University of North Carolina at Chapel Hill.

Friendly Environment

Guskiewicz said one of the main advantages during his time in Chapel Hill has been the cooperation of the athletics department and medical staff while conducting his research.

“I found myself in an environment here where our medical staff, our coaches, our administrators were eager to become leaders in this area of how to make a better return-to-play decision following a concussion, to take the guesswork out of concussion management,” he said. “So, we built a program starting in 1995 that was really first in the country that conducted baseline testing for student-athletes.”

Guskiewicz’s team introduced a multi-faceted baseline testing program for student-athletes that included both cognitive and balance testing.  Today, this approach is considered the standard of care for concussion management at all levels of play. 

Guskiewicz and his staff take baseline readings on all of the athletes competing in football, soccer, lacrosse and wrestling before the season started to have something with which to compare results in case a player sustains a head injury.

Guskiewicz said the partnership with the Tar Heel athletes is a two-way street – team physicians have used the data to help them decide when to clear a player to return to his or her sport, and the research center accumulates more data about the nature of concussions.

“It helped us advance the science around concussions so that we were able to fine-tune these assessment tools to say ‘this one works, this one doesn’t,’ … to the point that after five or six years, we had a really solid baseline testing platform that other schools around the country began to adopt,” he said.

Director of Sports Medicine Dr. Mario Ciocca said the campus has emerged as a national leader in concussion research and treatment, with other sports programs following Chapel Hill’s lead.

“(The program) has had a tremendous impact in helping to guide us in the treatment of concussions, dating back to the mid-‘90s,” he said. “We’re doing things that are now being done across the country. We’ve been a national leader in this area. It’s a nice collaboration – we’re able to use (Guskiewicz’s) expertise, while he can use the research for clinical reference.”

Ciocca said that as more data is collected, the process in which he and the rest of the Chapel Hill medical staff analyze and treat concussions, including the tools used to evaluate concussions, continues to evolve.

“I think things have changed a lot, even in the last five or 10 years,” he said. “We’ve been way ahead in the way we treat things. … It used to be, we put (the players) back in the game. Now, we see, do they get better after 15 minutes? Maybe we put them back in, or maybe not. Every (player evaluation) has different guidelines.”

Tar Heel Head Football Coach Larry Fedora said players’ safety is paramount.

“Kevin is a great asset to the University and to the football program,” he said. “He has helped shape the way college football evaluates and thinks about concussions.  We meet yearly to determine any changes we need to make to our protocols in working with student-athletes that may suffer a concussion.  I’m always going to be in favor of anything we can do to make the game safer and I believe Kevin’s work has done that.”

The Gfeller Center’s work with the accelerometers allows the research team and the medical staff to determine the force of a head impact, the location, and the overall frequency of impacts for a given athlete. It is important data that already has had an impact on improving sports safety.

That impact likely also will be a game-changer for the military as the center’s co-director, Dr. Jason Mihalik, conducts similar research on soldiers.






Rule Changes 

Guskiewicz gave a presentation about a year ago to representatives from all of the UNC campuses, outlining a “best practices” strategy for each program to deal with analyzing concussions among its athletes.

The program follows a graduated return to play progression, in which players with concussions follow several stages before returning to contact drills. For example, once an athlete is back to his or her baseline measures, the athlete will then start light jogging and weightlifting to see if the symptoms return. As the players progress, they will do drills that simulate what might happen on the field of play, but without contact. Assuming those drills go well, players may be cleared to resume full activity provided the symptoms don’t recur.

Guskiewicz said that many times, lawsuits against NCAA programs and the organization itself over concussions have come about because there wasn’t a previously documented routine that helped the athletes gradually return to action.

The ACC is taking concussions very seriously, to the point of instituting a new rule this season in which each member team must provide medical spotters in the press box to monitor players for any kind of signs of brain trauma.

Guskiewicz is now the ACC’s representative on the Concussion Autonomy Committee for the NCAA’s five largest conferences.

“Over the past four months, we have evaluated all 65 universities that are a part of the big five conferences,” he said. “We have looked at their concussion management protocols and standard operating procedures for how to manage a concussion. There’s now a link on the NCAA’s website that shows all 65 university’s protocols, all of which have been deemed in compliance. This is clearly a step in the right direction, to holding schools accountable for carefully managing concussions and putting things in place ahead of time with carefully planned emergency action plans.  Another emphasis of our committee’s efforts is to have a plan for how to best return the student athlete to the classroom, not just the playing field.”

Over the past 15 years, Guskiewicz said, the terminology used to grade concussions has changed. No longer are athletes said to have a “mild” or “minor” concussion.

“We’ve gotten away from calling them mild or minor TBIs – traumatic brain injuries,” he said. “And coaches need to hear that.  Athletic directors need to hear that. Parents and players need to hear that because we can’t trivialize this injury because a concussion that goes mismanaged can become catastrophic, and certainly, a catastrophic injury that results in a permanent disability certainly can’t be classified as ‘mild.’ ”

Guskiewicz said that as more data become widely known as to the effects of concussions, it’s helped reduce the “gladiator mentality” of playing through pain, which is especially true in football.

“We’ve even begun to discuss the foolishness of such (an attitude),” he said. “We have to take care of our teammates. A teammate noticing someone else looks confused, it’s their responsibility to report this, it’s the athletes’ responsibility to report it themselves and it’s the coaches’ responsibility to push it up the chain to the athletic trainer and the physician to be properly managed. We’ve made some progress in this area, but we’ve still got some work to do.”

In 2011, the NFL – using data provided by Guskiewicz’s team – decided to move kickoffs up by five yards up to the 35-yard line and reduce the running start by teams kicking off from 10 yards to five. The result was a 33 percent reduction in the number of returned kickoffs, thanks to an increased number of touchbacks, in which the receiving team doesn’t return the kick. Because of the fewer returns, concussions on that one type of play was reduced by 42 percent from the previous season.

“That’s an example of when science becomes a game-changer,” he said.

The NCAA adopted a similar rule change on kickoffs the following year, and the results were even better – a 50 percent reduction of concussions during kickoffs.

Making Sports Safer Through Innovative Science: Kevin Guskiewicz at TEDxUNC

Other Applications 

Guskiewicz and his colleagues have worked with other programs at Chapel Hill besides football. Currently, he and Mihalik are starting a new study with the women’s lacrosse team. Because that sport doesn’t use helmets – players wear only goggles for protection – the data has the potential to yield some interesting results. According to a recent study, the incidence of concussions in women’s lacrosse is higher than most non-contact sports.

The Gfeller Center team is helping to develop a new accelerometer device that will attach to their goggles and eventually be worn by Tar Heel lacrosse players.

 “The debate has been going on for years – if you put helmets on the women lacrosse players, will it become a more aggressive game? In other words, would it become more like the men’s game, which is way more aggressive,” he said. “They’ve kept the helmets off for that reason.”

Guskiewicz said the sport is also adding a shot clock this upcoming season, which change how aggressive the sport is. Before the shot clock, teams that were losing were much more aggressive in trying to regain possession of the ball. However, Tar Heels coach Jenny Levy said that with the shot clock, there will be more shots taken, which could also lead to injuries.

“Obviously, we’re very excited to be a part of a study that impacts the greater good,” she said. “Sports unfortunately puts kids at risk. I’m not sure what the study is going to show us, but if we uncover more questions and answers about concussions, obviously I’m on board with that. … Ultimately, we want to make sure the players are safe and free from injury.”














Story by Phillip Ramati
Photos contributed by UNC-Chapel Hill