AI and smart mouthguards: the new frontline in fight against brain injuries

<span>Photograph: Kin Cheung/AP</span>
Photograph: Kin Cheung/AP

There was a hidden spectator of the NFL match between the Baltimore Ravens and Tennessee Titans in London on Sunday: artificial intelligence. As crazy as it may sound, computers have now been taught to identify on-field head impacts in the NFL automatically, using multiple video angles and machine learning. So a process that would take 12 hours – for each game – is now done in minutes. The result? After every weekend, teams are sent a breakdown of which players got hit, and how often.

Related: World Rugby keen to introduce hi-tech mouthguards at all levels of the game

This tech wizardry, naturally, has a deeper purpose. Over breakfast the NFL’s chief medical officer, Allen Sills, explained how it was helping to reduce head impacts, and drive equipment innovation.

Players who experience high numbers can, for instance, be taught better techniques. Meanwhile, nine NFL quarterbacks and 17 offensive linemen are wearing position-specific helmets, which have significantly more padding in the areas where they experience more impacts.

What may be next? Getting accurate sensors in helmets, so the force of each tackle can also be estimated, is one area of interest. As is using biomarkers, such as saliva and blood, to better understand when to bring injured players back to action.

If that’s not impressive enough, this weekend rugby union became the first sport to adopt smart mouthguard technology, which flags big “hits” in real time. From January, whenever an elite player experiences an impact in a tackle or ruck that exceeds a certain threshold, they will automatically be taken off for a head injury assessment by a doctor.

No wonder Dr Eanna Falvey, World Rugby’s chief medical officer, calls it a “gamechanger” in potentially identifying many of the 18% of concussions that now come to light only after a match.

Smart mouthguards. AI. Biomarkers. This the new frontline in the fight against brain injuries in sport. Such technology is born of a medical, ethical and legal necessity, especially when you hear the awful stories of former players and see lawsuits the NFL and World Rugby have faced. But they also lead us towards an interesting thought experiment: what may they mean for sport in the next decade or two?

Take boxing. If a smart mouthguard can flag that a fighter has been hit with a punch so hard it has a 90% chance of causing a concussion, shouldn’t that bout be stopped immediately? If not, why not? Sure, boxers know the risks of stepping into the ring. But such technology would add a totally different dynamic – for the fighter and a sanctioning body. Could the status quo really hold when an independent doctor is alerted to a possible brain injury in real time during a fight?

However, one thing becomes clear chatting to Dr Ross Tucker, a science and research consultant for World Rugby: we are still only scratching the surface when it comes to how smart mouthguards and other technologies could make sports safer.

As things stand, World Rugby is adding the G-force and rotational acceleration of a hit to determine when to automatically take a player off for an HIA. Over the next couple of years, it wants to improve its ability to identify the impacts with clinical meaning – which will also mean looking at other factors, such as the duration and direction of the impact, as well.

“Imagine in the future, we could work out that four impacts above 40G creates the same risk of an injury as one above 90G,” Tucker says. “Or that three within 15 minutes at any magnitude increases risk the same way that one at 70G does. There are so many questions we can start asking.”

Then there is the ability to use the smart mouthguard to track load over time. “It’s one thing to assist to identify concussions,” he says. “It’s another entirely to say it’s going to allow coaches and players to track exactly how many significant head impacts they have in a career – especially with all the focus on long-term health risks. If they can manage that load, particularly in training, that has performance and welfare benefits.”

New Zealand’s Rieko Ioane (centre) tackles Ireland’s James Lowe (second left) during their Rugby World Cup quarter-final.
World Rugby is adding the G-force and rotational acceleration of a hit to determine when to automatically take a player off for an HIA. Photograph: Anne-Christine Poujoulat/AFP/Getty Images

Meanwhile, new research into boxing from the University of Exeter’s Head Impact, Brain Injury and Trauma research group again hints at the dangers – and difficulties – for combat and collision sports.

Their academics got 18 amateur boxers to compete in a series of trials – including three rounds of boxing and an equivalent bout of time hitting pads and sitting, and then looked at what happened to each boxer’s brain blood flow after each trial. While none of the fighters sustained a concussion, the results were still worrying.

Related: World Rugby to adopt ‘gamechanging’ G-force tech to flag major head impacts

As Dr Bert Bond, who led the research, says: “There was an alteration in the ability to regulate brain blood flow – even in healthy boxers – and the magnitude of this change was associated with the number of times the boxer was hit in the head.”

In other words, even though the fighters felt fine, and had not absorbed heavy blows, their neurophysiology had changed because of subconcussive hits. “It shows that if we don’t cross that concussive threshold, it doesn’t mean that things are OK,” says Bond, who has previously researched heading in women’s football for Uefa.

Bonds, incidentally, spends his time researching lifestyle exposures that will increase someone’s risk of dementia. “And one of those exposures involves how many times you get hit in the head over your lifespan,” he says.

It is a blunt message, especially for those of us who enjoy sports whose dangers are more evident now than a decade ago. But, while those risks will never disappear, there is a tentative hope that this emerging technology will at least mitigate them.