Of all of the controversies rugby is currently dealing with, the sport's attitude towards tackling concussion is amongst the biggest. With players faster, stronger and more dangerous to one another than ever before, the regularity with which head traumas can occur is staggeringly high.
In the past, before the severity of the injury was fully realised, players would often soldier on while suffering symptoms from a knock to the head, and not take the adequate amount of time off between matches to fully recover. These days, the issue is far more closely scrutinised, and player welfare is a clear priority.
According to the NHS, a concussion is a sudden but short-lived loss of mental function that occurs after a blow to the head. While it's the most common form of brain injury, it's also the least serious. Symptoms can include loss of consciousness, double vision, memory loss, seeing stars or an extended period of confusion.
It might sound more like a description of the average post-fresher's week student than a serious ailment, but the most severe effects can occur when someone experiences the injury multiple times without adequate recovery between incidents.
In the most serious cases, concussion can lead to bleeding or swelling of the brain, either between the skull and the brain itself or more acutely on the surface. Concussion can lead to mood swings, the loss of cerebrospinal fluid through the nose and ears, or issues with basic functions such as speech, reading and writing. Failure to treat concussion properly and in a timely manner can lead to long-term neurological problems, with diseases such as Parkinson's, Alzheimer's and dementia all more likely to occur in those who've suffered in the past.
In recent times, however, rugby has become much more proactive where concussion is concerned, with rules brought in to tackle the issue as well as possible. Players now have to be substituted if a concussion is so much as suspected; rigorous tests are undertaken by a dedicated medical team, and the player is not allowed to return to action until the symptoms have been completely cleared. Teams or players that refuse to adhere to these measures come in for heavy punishment, with fines, docking of points and other penalties acting as deterrents.
But moving forward, there may be more ways to help tackle and manage concussions. Software specially designed to aid medical staff has been extensively trialed throughout the World Cup, and the software is due to be widely released for free after the tournament in app form, making it available for professionals and amateurs alike.
Ed Lodge, CEO of CSx Systems, the company behind the concussion management programme, spoke to us about why he swapped a career in physiotherapy to help launch this pioneering technology.
Hi Ed, so how far along are you in the process of creating hardware and software-based solutions to the issue of concussion in rugby?
We started designing the hardware element a while ago, but the software side of things quickly became it's own being. It's certainly a bigger part of the business at the moment, while we do more hardware research. We've built a sensor already, and it's about the size of a pound coin. It goes behind your ear, and the way we want to use it is to provide instant feedback on unseen events, so doctors can make informed medical decisions depending on what a player has been through during a game.
How do you go about using the software? Have you tested it to a level where you're sure it works as intended?
It's app based, so it can [work] on smartphones and tablets, which is why we're focussed more on software at the moment. That part of the business has already been at the World Cup, and the sensor will come later once we've got enough data to create comprehensive warning systems. We've been speaking to Super Rugby teams and the response is good. Working with them, we're making sure they know that the technology is never going to diagnose a concussion. Because we don't want that – we want to provide the best possible information with which to make an informed decision.
We know you've got a background in physiotherapy, but is anyone is the medical profession part of your team? And will the software only be available to professionals?
We work with around 10 doctors to make sure the figures we're getting will help with making sense of what's happening on the field, and the software should be rolled out after the World Cup across multiple levels. We want to give access to as many people as possible, so all levels of the game. Professionals will obviously already have concussion checks in place that our database will help the process of, but for amateurs, it'll be more about collecting data so that if a problem does arise, you can take that to your doctor and give them a clearer picture of what's gone on.
How much will it cost the average user or amateur team to sign up with the service?
We want it to become available at no cost to the end user, and tie in with some partners to deliver it to the amateur game. I like the word 'partnership' better than sponsorship, but it's a similar sort of deal, because we don't want people to have to worry about paying for it. In the amateur version we'll build in the signs and symptoms so people know what to be looking out for. We can manage the recovery process with the app, so that if someone is still showing systems after a period away from playing, they're not putting themselves at risk before they need to. In the professional game, the software helps contextualise the injury according to each individual player. It differs from person to person. By having a historical database of how each person is effected, the software will help medical teams make more accurate decisions.
How exactly does the software work, then? Will it be easy enough to just download and use straight away?
On the app we've got to achieve a baseline - 'normal' - statistic when a user is healthy, so that when they check during or after matches, there's data available for comparison. The app will have a questionnaire built in to it, with some balance, co-ordination and delayed recall memory testing, which is all recorded in the app, and it only takes around five minutes to do. Any test that user takes subsequently can be referred back to that original reading, and help them make an informed decision. At the World Cup it's currently being used in real time by the match doctors, who aren't the team doctors, so aren't as familiar with the players. This is one of the advantages at the professional level: they don't need to know them. In their hands they'll have access to the players' baseline statistics, so they'll immediately see a difference.
You've mentioned that you're working with the software at the World Cup at the moment. Who else has been helping with the final testing and early usage?
We started working with World Rugby to get involved at the World Cup, where our software has been used at every match, so we supplied each team with a tablet and loaded all of their baseline information on to it for them. Whenever they've performed a concussion test, they've been doing them with our technology. We've done similar previously with the Hurricanes and the Rebels in the Super Rugby, as well as some amateur teams who've been testing it. Doctors love it – they like the fact that it's simple to use and that they can see the relevant information they need to in real time, and it works both on and offline, so there's no wi-fi dependency. A lot of them see this ease of access to information as the way we move forward.
Finally, what's your hope for the software? Do you think it will become a key tool in making concussion less of an issue in rugby at all levels?
It's helping to educate amateur sides, and we've already noticed that people who weren't aware of what they were putting their body through previously are now taking much more care about whether or not they do have a concussion. They're following best practice and the appropriate return to play procedures, so even at a school level it's helping them manage better. There are a few [other types of software] you could call 'competition', but none that are as specific as we are. We're really focussed on rugby across both codes, and football. Rugby is really the only sport with a definitive procedure in place, so the fact that we're already working with World Rugby may count some people out. Some companies have got software, others hardware, but we're the only ones that have worked on both to work together perfectly across multiple sports.