Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: A Single-Participant Report

Abstract

Objective: Challenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player's readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play.

Methods: The participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep).

Results: The university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]).

Conclusion: The concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols.

Impact: Digital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions.

Lay summary: Inertia-based wearable technologies (eg, accelerometers) may be useful to help augment traditional, self-report approaches to sports-related concussion assessment and management by better informing return-to-play protocols.

Keywords: Brain Concussion; Return to Play; Rugby; Sports Medicine; Wearable Technologies.

Figure 1

Use of the fifth version of the Sports Concussion Assessment Tool (SCAT5) before sports-related concussion (SRC), immediately after SRC, and >2 months later. Green/bold data indicate that the player returned to baseline levels. Yellow (bold or italic) data indicate abnormal findings. Red/italic data indicate that the player scored worse than at baseline. Assessments before and after SRC were performed by different physical therapists. ^*A lower score was better (more normal). ^**A higher score was better (more normal). Neuro Exam = neurological examination; RTP = returned to play.

Figure 2

Gait assessment. (A) Supervised (laboratory) gait assessment (2-minute walk test) for step time before sports-related concussion (SRC), after SRC, and after return to play. (B) Remote gait assessment for step time.

Figure 3

Sleep analysis (general nocturnal movement for 6 h) after sports-related concussion (A) and after return to play (B).

Figure 4

Traditional (fifth version of the Sports Concussion Assessment Tool) vs enhanced assessment for return to play, with additional metrics, such as gait, balance, and sleep analysis.