Wednesday June 15th, 2016

New research suggests that our approach to head protection might need to be turned inside out. Helmets first appeared in football back in 1893, and although they have been beefed up over time, the basic principle has remained the same since then: wrap a player’s skull in a tough external shell. But while helmets have significantly reduced lacerations and skull fractures, their ability to prevent brain injury is limited.

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A person’s brain is a delicate mass of neurons—roughly the consistency of Jell-O—that sits in a bath of cerebrospinal fluid inside the skull. When the head is subjected to impact, the brain can shift and twist within the skull cavity, putting strain on the tissue and its internal connections. Those strains are suspected to be behind both short-term functional injuries such as concussion and longer-term damage such as chronic traumatic encephalopathy.

Though helmets can help reduce the sizes of impact forces, they cannot prevent the brain from moving within the skull. A device called the Q-Collar made by Connecticut-based company Q30 Innovations uses a radical approach to attempt to do just that. Lightly clamping down on a person’s jugular veins, the collar causes the brain to swell and fit more snugly within the skull.

“Basically you’re putting a kink in the hose on the outflow,” says Gregory Myer, Director of Research for the Division of Sports Medicine at Cincinnati Children’s Hospital Medical Center. “What that immediately does is create a backfill in the brain and increase that blood volume.” According to Myer, the effect is similar to the increase in brain blood volume a person would experience when lying down.

A preliminary study performed by Myer of 15 youth hockey players through half a season of play published in the journal Frontiers in Neurology on Jun. 6 showed no statistically significant structural changes in the brains of those using the Q-Collar. In contrast, changes were found between pre-season and mid-season tests in those who did not use the collar. A larger follow-up study by Myer of 42 high-school football players published online on Wednesday in the British Journal of Sports Medicine, showed similar results over the course of an entire season.

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Q30 Innovations funded the two studies and Q-Collar co-inventor David Smith, a visiting scientist at Cincinnati Children’s, is listed as an author of both.

The studies used helmet accelerometers to count the number of hits each player sustained with an acceleration greater than 20g. Structural changes in players’ brains were detected by using magnetic resonance imaging to measure the diffusivity of water in different parts of the brain before and after the study period.

“Changes indicate alterations in the tissue and the axons that could represent brain injury,” Myers says. “What we saw was that those boys that wore the collar did not have significant changes in the structural component of their brain, whereas those that didn’t wear the collar, we did see a significant change.”

The participants chosen for the football study included 21 players from St. Xavier High (Cincinnati) and the same number from nearby Moeller High. The St. Xavier Bombers were Ohio High School Athletic Association champions in 2005 and ’07, and rival Moeller Crusaders have nine state titles, including back-to-back wins in 2012 and ’13. Bombers players, who received 16,983 recorded impacts over their season, were fitted with the Q-Collar, while Crusaders players, with 17,750 hits, were not.

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The Q-Collar has not yet received Food and Drug Administration approval, and Myer says that more research is still needed. His team has functional MRI and electroencephalogram data from the football study that is still being evaluated, and further plans to investigate the effect of the collar on non-helmeted athletes and female athletes.           

But Myer sees promise in current results.

“Instead of adding external shells to the head,” he says, “maybe we should be working at coming up with a better solution that protects it from the inside.”

Beyond athletics, the Q-Collar, or technologies like it, could have application anywhere that head injury is a significant risk, from automobile accidents to military operations.

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