04.12.2022

MailOnline tests ‘smart’ mouthguard that could reduce concussions in rugby

Concussion rates in elite English rugby have hit their highest levels since records began, and now account for 28 per cent of injuries. In an effort to comabt the rise, Rugby Football Union (RFU) has started to roll out its ‘smart’ mouthguard programme. 

The mouthguards are developed by Prevent Biometrices and can monitor the frequency and magnitude of head contacts. Ahead of their rollout across the women’s Rugby World Cup in New Zealand later this year, MailOnline’s Shivali Best visited Cheshunt Rugby Club to see how they work in practice.

The mouthguards are developed by Prevent Biometrices and can monitor the frequency and magnitude of head contacts

Having had a mouthguard fitted, Shivali took part in a training session with players from Cheshunt Rugby Club

How do the mouthguards work?

At first glance, the mouthguard looks like any other, but it actually has clever technology embedded within it.

Drew Goodger, Vice President of Customer Success at Prevent Biometrics, explained: ‘The mouthguards, from a structural standpoint, are really no different to your typical off-the-shelf mouthguard.

‘What they do have are an accelerometer and a gyroscope, which essentially measure the movement of your head, both from contact and non-contact scenarios.

‘You also have little components like batteries and Bluetooth transmitters that can capture that information and project it in real time to an iOS app.’

The mouthguards collect and wirelessly transmit count, load, location, direction, linear and rotational motion every time there is a collision.

Dr Falvey said: ‘The speed of head movement is taken as a proxy for a head impact — if your head is hit, your head moves quickly.’

In June, the RFU published its audit of the 2020-21 rugby season and showed that concussion was the most reported injury for the tenth year running, accounting for 28 per cent of injuries.

Speaking to MailOnline, Dr Éanna Falvey, Chief Medical Officer of World Rugby, explained that this is likely a result of better diagnosis.

‘We have spent a long time educating and making the diagnosis of concussion correctly,’ he said.

‘As we’ve seen the concussion rates rise, we’ve seen the rates of other contact injuries like shoulder dislocation and fractures stay the same.

‘So in reality, what we’re probably looking at now is the rate that was always there, but we’re actually seeing it properly.’

While the diagnosis of concussion has improved, the challenge is now reducing the rate, according to Dr Falvey.

‘Our job now is to start bringing that rate down by introducing measures to the game to make it safer, and limit the number of head injuries, impacts and concussions that occur,’ he said.

So far, several measures have been put in place to bring down the rate of concussion, including a new Head Contact Process, which was introduced last year.

‘If a player makes contact in an illegal manner with another player’s head, they may get a red card and be removed from the game,’ Dr Falvey explained.

Efforts are also being made to educate players and coaches on the dangers of head concussions.

‘Most of the time it’s not foul play, but we want players to understand that the best way to stop players having head impact events and concussions is to stop them being hit in the head. That’s the most basic one,’ Dr Falvey said.

The mouthguards contain an accelerometer and a gyroscope, which measure the movement of your head, both from contact and non-contact scenarios

The mouthguards collect and wirelessly transmit count, load, location, direction, linear and rotational motion every time there is a collision

The mouthguards connect to an iOS app, where coaches can see information on any head contacts in real time

WHAT ARE THE SYMPTOMS OF A CONCUSSION?

Signs of a concussion usually appear within a few minutes or hours of a head injury.

But occasionally they may not be obvious for a few days, so it’s important to look out for any problems in the days following a head injury.

Symptoms include:

• a headache that does not go away or is not relieved with painkillers

• dizziness

• feeling or being sick

• memory loss – you may not remember what happened before or after the injury

• clumsiness or trouble with balance

• unusual behaviour – you may become irritated easily or have sudden mood swings

• feeling stunned, dazed or confused

• changes in your vision – such as blurred vision, double vision or ‘seeing stars’

• being knocked out or struggling to stay awake

World Rugby has teamed up with Prevent Biometrics on a ‘smart’ mouthguard that it hopes could help to reduce concussions in rugby.

At first glance, the mouthguard looks like any other, but actually has clever technology embedded within it.

Speaking to MailOnline, Drew Goodger, Vice President of Customer Success at Prevent Biometrics, explained: ‘The mouthguards, from a structural standpoint, are really no different to your typical off-the-shelf mouthguard.

‘What they do have, from a technology standpoint, are an accelerometer and a gyroscope, which essentially measure the movement of your head, both from contact and non-contact scenarios.

‘You also have little components like batteries and Bluetooth transmitters that can capture that information and project it in real time to an iOS app.’

MailOnline’s Shivali Best was fitted with a mouthguard at Cheshunt Rugby Club, and the entire process took just minutes.

‘It’s really no different from a boil and bite standpoint than what you see at a community level on a daily basis,’ Mr Goodger explained.

‘We place the mouthguard in boiling water for 20 seconds, you fit it, and within 60 seconds you have your mouthguard.

‘It then takes 10-15 minutes to set up the software and you’re up and running and ready to go for the season.’

Having had a mouthguard fitted, Shivali took part in a training session with players from Cheshunt Rugby Club.

The mouthguard collected count, load, location, direction, linear and rotational motion every time Shivali was involved in a collision.

Following the training session, Shivali was shown her results on an iPhone app, with the strongest collision resulting in 9Gs (G-force).

Dr Falvey said: ‘The speed of head movement is taken as a proxy for a head impact — if your head is hit, your head moves quickly.’

‘It’s really no different from a boil and bite standpoint than what you see at a community level on a daily basis,’ Mr Goodger explained

The mouthguard was placed in boiling water for 20 seconds before being fitted to Shivali’s teeth ahead of her training session

So far, the mouthguards have been tested with several teams including the Harlequins men, Bristol Bears women, Northampton Saints (pictured) and the Red Roses

Former players call for more to be done to reduce concussion

Several former rugby players have called for more to be done to reduce concussions in rugby in recent years.

Ryan Jones, former Wales captain, is representing 185 rugby union players in a concussion lawsuit against the game’s governing bodies, and warned of a ‘ticking time bomb’ of early-onset dementia diagnoses and other neurological impairments in the sport.

Jones is suffering with both early-onset dementia and probable chronic traumatic encephalopathy (CTE) at the age of 41.

He believes rugby is ‘walking headlong with its eyes closed into a catastrophic situation’ as it continues to battle the impact of head injuries suffered by its players.

‘I feel like my world is falling apart,’ Jones, who won 75 Welsh caps and led his country on 33 occasions, told The Sunday Times. ‘I am really scared.’

England’s 2003 World Cup-winning hooker Steve Thompson and ex-Wales back row Alix Popham are among the former players who have been diagnosed with the same brain injuries as Jones.

While Shivali’s data was simply for demonstration, data collected from real rugby players can be used to assist with the development of more precise contact guidelines for use at both a community and a professional level.

‘Last year we launched Contact Guidelines for the game, which is the amount of contact a player should have in their training week, in the lead up to a game,’ Dr Falvey said.

‘And we’re going to use the data from the mouthguards to inform that and further refine it, so we limit any unnecessary events that occur.’

So far, the mouthguards have been tested with several teams including the Harlequins men, Bristol Bears women, Northampton Saints and the Red Roses

They’ll also be rolled out across the women’s Rugby World Cup in New Zealand later this year, while all professional English teams will also be offered the mouthguards in the upcoming season.

While the data collected is currently being used to help develop contact guidelines, Dr Falvey believes the mouthguards could be used in the future to flag potential concussions as they happen in real-time during games.

‘We have a scenario where if there’s a large impact event, we can set a threshold,’ he explained.

‘Someone could be on the side of the pitch with an iPhone and get a message that says: «Player 15 has just had an impact even that’s above a set threshold».

‘We’re hopeful over the next few seasons we can find a level that’s indicative of someone that we want to have a look at.’

One of the main issues stopping World Rugby from rolling the mouthguards out more widely is price.

Currently, the mouthguards range in price from £200-£300 — signifantly more expensive than off-the-shelf options.

‘Our goal long term is to drive the price down as much as possible to make it more affordable at a community level,’ Mr Goodger concluded.

‘As a company, our ultimate goal is to get it out to the masses by making it scalable, easy to use, but also affordable to your everyday rugby player.’

Several former rugby players have called for more to be done to reduce concussions in rugby in recent years.

Ryan Jones, former Wales captain, is representing 185 rugby union players in a concussion lawsuit against the game’s governing bodies, and warned of a ‘ticking time bomb’ of early-onset dementia diagnoses and other neurological impairments in the sport.

Jones is suffering with both early-onset dementia and probable chronic traumatic encephalopathy (CTE) at the age of 41.

He believes rugby is ‘walking headlong with its eyes closed into a catastrophic situation’ as it continues to battle the impact of head injuries suffered by its players.

‘I feel like my world is falling apart,’ Jones, who won 75 Welsh caps and led his country on 33 occasions, told The Sunday Times. ‘I am really scared.’

England’s 2003 World Cup-winning hooker Steve Thompson and ex-Wales back row Alix Popham are among the former players who have been diagnosed with the same brain injuries as Jones.

BRAIN INJURIES IN SPORTS: FAST FACTS ABOUT CTE RISKS, TESTS, SYMPTOMS AND RESEARCH

As athletes of all sports speak out about their brain injury fears, we run through the need-to-know facts about risks, symptoms, tests and research.

1. Concussion is a red herring: Big hits are not the problem, ALL head hits cause damage

All sports insist they are doing more to prevent concussions in athletes to protect their brain health.

However, Boston University (the leading center on this topic) published a groundbreaking study in January to demolish the obsession with concussions.

Concussions, they found, are the red herring: it is not a ‘big hit’ that triggers the beginning of a neurodegenerative brain disease. Nor does a ‘big hit’ makes it more likely.

In fact, it is the experience of repeated subconcussive hits over time that increases the likelihood of brain disease.

In a nutshell: any tackle or header in a game — or even in practice — increases the risk of a player developing a brain disease.

2. What is the feared disease CTE?

Head hits can cause various brain injuries, including ALS (the disease Stephen Hawking had), Parkinson’s, and dementia.

But CTE is one that seems to be particularly associated with blows to the head (while the others occur commonly in non-athletes).

CTE (chronic traumatic encephalopathy) is a degenerative brain disease that is caused by repeated hits to the head.

It is very similar to Alzheimer’s in the way that it starts with inflammation and a build-up of tau proteins in the brain.

These clumps of tau protein built up in the frontal lobe, which controls emotional expression and judgment (similar to dementia).

This interrupts normal functioning and blood flow in the brain, disrupting and killing nerve cells.

Gradually, these proteins multiply and spread, slowly killing other cells in the brain. Over time, this process starts to trigger symptoms in the sufferer, including confusion, depression and dementia.

By the later stages (there are four stages of pathology), the tau deposits expand from the frontal lobe (at the top) to the temporal lobe (on the sides). This affects the amygdala and the hippocampus, which controls emotion and memory.

3. What are the symptoms?

Sufferers and their families have described them turning into ‘ghosts’.

CTE affects emotion, memory, spatial awareness, and anger control.

Symptoms include:

Suicidal thoughts
Uncontrollable rage
Irritability
Forgetting names, people, things (like dementia)
Refusal to eat or talk

4. Can sufferers be diagnosed during life?

No. While a person may suffer from clear CTE symptoms, the only way to diagnose their CTE is in a post-mortem examination.

More than 3,000 former athletes and military veterans have pledged to donate their brains to the Concussion Legacy Foundation for CTE research.

Meanwhile, there are various studies on current and former players to identify biomarkers that could detect CTE.

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