The Concussion Blog

I find myself in a peculiar situation in regards to the Vector Mouthguard; I have indeed benefited from the relationship as mentioned in the first post about this product. However, I have also been honest and blunt with them while dealing with the product. I have made every attempt to be as objective and neutral on any product or research on this blog, in cases where my integrity may have been perceptually challenged I have noted such.

However, I have looked at many blogs about various products and come to the conclusion that this post is going to be an in-depth product review with my honest feedback. You, the reader, will have to trust – hopefully based on my track record – that it is an unbiased assessment. Heck this is just like the YouTube toy reviews that my and your kids watch constantly, minus the video and my ugly mug.

Enough with the mental hand-wringing and on to the after-season report on the Vector Mouthguard (you can catch up from previous posts with “It’s Actually Happening…“, “Day 1“, “Seeing Is…“, “Practical Application…” and “Ready for Primetime“). The last post about the mouthguard was prior to the first game and our team went on to play 10 games so there were a lot of happenings in regards to the Vector, I could write 3000 5000 words on it but no one would read all of it. I will try to bullet the ups and downs as well as noteworthy case uses. At the end I will attempt to address the common questions I had about this from other professionals, parents, coaches and kids. In advance, thanks for your time and if you have further questions hit up the comment section or my inbox.

Immediately the system had media attention about what we were doing for player safety at the high school as the “strange-looking” mouthguards were on the kids as well as a radar looking device on the sideline. Still in the quasi-euphoric/excitement stage of the process there was this interview that I did (completely independent) and captured the first three weeks of the regular season.

During that time we did have some individual mouthguards that were not functioning as planned/expected and some charging issues with the base units. Through conversations with the tech team at i1biometrics we were able to get everything going that was outside the norm. This is a key piece to note; the customer service was unbelievable and agile. Granted there were not thousands of systems in use and none of them had a loud-mouthed blogger running them, it was still what I can see this company continuing to provide for anyone with this product. A lot of the service could be done remotely or via mail. The grasp of the system and the actual engineers that are part of the solution team make it what it is.

As mentioned I didn’t quite know how or if this was going to change how I “did” things as an athletic trainer. Upon the month-long reflection and review after the season I noticed that I did change what I did. I started using the information provided to put a watchful eye on certain players and to confirm what I did see with my eyes. Or in one case I used it to see what happened to a player that I did not witness but my coaches told me about happening in a game. The system had started to provide me eyes that I don’t have but I never really relied on those eyes, but was happy they were there.

During games I started to check at quarters and halftime when I wasn’t busy with other injuries/players. It never became a priority because I have so many other things going on. The system never sent out a notification or upon review during breaks during games did it resulted in a concussion assessment. This system and its reports were mainly used by me for after-action assessments.

I did have three cases of concussion in that occurred in the mouthguards (remember we were limited and I spread out the devices). In each one of those instances I saw the insult that caused the concussion and didn’t need it to tell me. However, I did look at the data after to see what it was saying, more for my information.

What I found became important to me was the actual number of hits a player was taking. Mainly on a weekly basis but at times during tough games I would look at total impacts that registered. I started to use the system, with the coach, to identify players that had a very high volume of hits in a given week, and season as the games started to pile up.

Before I get into some numbers I would like to say that our head coach loved the reports and even expected a weekly wrap up of not only number of hits but where they were on the head. As he and I used the system to make some technique changes to our biggest head droppers. I would say it was successful as the players did modify – this was mainly the RB’s and LB’s dropping head at impact, as well as getting the lineman to get their head up to avoid contact if possible and probably more important see who they were blocking, tackling and avoiding.

The season was a grind and we had our fair share of injuries but this system was never cumbersome or a pain in the ass for me to set up, use or apply. In fact I felt naked without it at practices when there was inclement weather or I had forgotten to charge the computer. Could I function without it in the future, sure, but would I like to have it again, absolutely. This is why…

40 players had this initially but due to injuries, incompatibility, malfunction and compliance there were 37 players that had this for the season (some only a few games due to injury). I will address some of the issues later. For the following data there were 20 varsity only players that had them on for a simple collection point.

Total Impacts Entire Season:

• 10,220 hits reported
• 4,430 hits in practices
• 41 days of practice where any type of hitting took place
• No more than 60 minutes per week of thud drills and no full-contact drills after preseason.
• 5,124 hits registered in varsity contests (10) for all players
• 4,333 hits registered in varsity contests for varsity only players
• 2,962 hits registered in practice for varsity only players

Player Hit Notes:

• 913 total hits was most by any one player (MLB)
  • 539 for games
• 49 total hits was least for a varsity only player (WR)
  • 39 for games

Position Hit Notes (games/prax average):

• MLB – 53.9/34.0
• OLB – 34.4/9.6
• DL – 26.3/15.8
• OL – 23.3/21.0
• DB – 15.1/5.2
• RB – 13.2/11.4
• SLOT – 9.7/14.2
• QB – 8.7/1.8
• WR – 3.9/0.9

Notes on above data: I am looking to get this data stripped of identifying data so I can send it off for research… Compliance was very good for games and just good for practices… We had some key players in positions that missed significant time due to injury that would have probably increased numbers as their reserves did not all have the Vector… In one game the one player had more hits register (93) than they were on the field for (72) this notes the cases of multiple impacts on the same play – overlooked by me until seeing this… Blowout games obviously had significantly less impacts… Not every single play produced a reported hit (system collects 5G or greater)…

As you can see from above this is what I was most in tune to and what this system revealed to me that I am incapable of deciphering on my own. To me this is the most important aspect of this tool. As we moved along in the season the coaches and I started to hold kids from contact practices if they had high numbers in a week or after a game. Of course this was completely unscientific but it is logical. Reduce overall exposure to limit chance of injury. Players would be kept from the thud portions of practices and in some cases players were identified early in the week as candidates to be pulled from the game as soon as possible or even a platoon situation. *The key here being that our coaching staff was willing to work with me.*

Now lets take an honest look at some of the issues that were either resolved or that I think should be addressed.

• Compliance was good, and very good for games but at times it became a pain to make sure all devices were getting charged prior to using and reporting to the system. Sometimes kids just forgot them or didn’t use them in practice because they were not charged. Only one player balked at using in practice due to comfort. So, fit was good and use was generally good but, making sure the system was always optimal was time-consuming. This was addressed later in the season with a firmware upgrade that allowed me to check on the device from my room when it was in their lockers (when they were not in their cars). To me this is a value and repetition issue that will need to be hammered home to athletes as it would lessen that leg work. However, they are high school kids…
• Mouthguards did malfunction often due to grinding and biting on the mouthpieces if saliva/water got into the sensor it basically never shut off and reported any type of movement. We had one player that we found in the middle of the season that had this issue as I noticed all the hits that were being reported but it was not in his mouth during warmups. In his pocket it was going off. Again this was only one player and we fixed and removed from data…
• They are not indestructible as evidenced by my five chompers, this affects the fit and data reporting, we had to remold those guys a few times and each time I “chewed” their butt, but little change on that…
• The data we get is highlighted for linear forces, but it collects rotational info, I found with my three concussions that the linear force was relatively low (under 30G) but the rotation was high. I would like to see more rotational data maybe even some sort of weighting/combination but not quite the HIC. I am obviously not smart enough to figure out how to do it but I can tell you it is good just by looking at it.
• The sideline reporting to the smart phone was not always quick, that is a component that is still in the process of finalizing according to consultation about it. It did work but I often can’t hear or feel my phone in my pocket as I’m on the sideline.
• There was some artifact early on that was attempted to be rectified by better fit but still there were hits that registered at 150G+ and no way that happened in the video review or in some cases when they were out of the play. I chalked that up to cases where the player was yelling/screaming during a play and the MG moving around/lose. After the firmware update and fit adjustments they were less but still occurred.

Here are some other highlights of the system I did not expect or outperformed my expectations.

• For away JV games, which I don’t travel to, each mouthpiece recorded and saved the data so when they got back to range of the system they would drop that info in the computer. This was the same for any inclement weather practices and the system did not go outside. I did not miss an impact when it was being worn whether I was there or not.
• Not one game or practice where the relay system did not work, in fact the rage for the antenna was greater than they told me it would work at.
• The impact direction was very reliable as we noted with our film and this was used greatly by the coaching staff to remind players how to use their head.
• Our video capture system had a time stamp on them that matched the time stamps of the hits in the system so I was able to see every questionable incident and review immediately. Very handy in practices, where drills were filmed, and in games.
• Players that had a concussion and returned to the season were put on hit counts for the week and games, only possible with this system.
• Players returning next year can refit their mouthpieces and use again next year. If they are taken well care of they should work. They are only warranteed for one year but I have been told they, if in proper condition, will work next season.

There was an important case use of the Vector. I had noticed a player that had accumulated a ton of hits (our biggest) and became wary of his health. Not only his possible brain health but body health. Toward the end of the season we tried to keep him from contact where we could but he was not the type to obey all the time and he did not have a viable backup due to injuries. This player started to stray from his expected performance. I did use this information to actually perform concussion tests on him, to which he passed. Coincidentally, he also had a sinus infection later in the season but he was just not quite right. I spent the last two games watching him like a hawk. Although this is purely anecdotal; I believe that the accumulation of hits impacted his performance later in the season, even our second and third biggest reporters were casually noted by coaches as being “off” later in the season. EVERY ONE OF THOSE PLAYERS WERE ASSESSED FOR CONCUSSION. The Vector Mouthguard made this possible.

Conclusion:

The Vector System is useful for me as an athletic trainer. Perhaps it is because I am sensitive to the number of hits? Regardless, this system provides me the ability to monitor this. Yes, the forces are important but as we all know each person is unique and linear force is only a small data point in getting concussed. Surely you are thinking the same with the total number of hits, but logic tells me that more is not good, so this is a universal way and system that I can utilize for monitoring that.

Price is an issue – and the ginormous elephant in the room – it is $199/mouthguard and the system was around $6,000; but getting a buy in from parents to afford this for their players is key. I do know that pricing is going to change, for the better, and as I type i1 is working on this top barrier. There are creative ways one could fund-raise to make this happen; or getting a coach/admin that would shoulder some of the burden. I can announce that this is going to a pricing model that will be a per player cost and WILL INCLUDE THE SYSTEM. I would keep an eye out on i1biometrics to see what the exact pricing will be, but it is less than the $199 noted above from initial reports (I repeat that includes the system).

This not the panacea of sensors or tools for an athletic trainer but this system is versatile as well; if your school has hockey or lacrosse, a helmeted sport, this would be useful there. I prefer this system from the others I have been exposed to as it allows for not only me to use but for the coaches to use. Also, there is not an overt signaling system that would trigger a false-positive from being entered into any sort of protocol. I do wonder about how I will handle any info that may be missed or non-reported like the unfortunate case in California but for the time being this is only a piece of equipment that is complimentary and not relied upon – as no sensor system should be. I am also hesitant to have this information available real-time for the parents to see, or anyone that is uneducated or uninformed about what this is doing.

The fact that the sensors are nearest the center of the head mass and is fixed via the teeth to the skull makes this my choice. As with any tool, it is best used for what is intended for, monitoring the hits one would take and I intend to use this again with some data and observations in my back pocket from this season. I would recommend this to any program that wants to promote and implement better player safety standards.

Feel free to hit me up with more questions.