WEBVTT

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The word concussion evokes a fear
these days more so than it ever has,

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and I know this personally.

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I played 10 years of football,

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was struck in the head thousands of times,

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and I have to tell you, though,
what was much worse than that

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was a pair of bike accidents I had
where I suffered concussions,

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and I'm still dealing with the effects
of the most recent one

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today as I stand in front of you.

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There is a fear around concussion

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that does have some evidence behind it.

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There is information
that a repeated history of concussion

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can lead to early dementia,
such as Alzheimer's,

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and chronic traumatic encephalopathy.

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That was the subject
of the Will Smith movie "Concussion."

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And so everybody is caught up in football
and what they see in the military,

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but you may not know

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that bike riding is the leading cause
of concussion for kids,

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sports-related concussion, that is.

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And so another thing
that I should tell you

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that you may not know

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is that the helmets that are worn
in bicycling and football

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and many activities,

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they're not designed or tested

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for how well they can protect
your children against concussion.

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They're in fact designed and tested

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for their ability to protect
against skull fracture.

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And so I get this question
all the time from parents,

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and they ask me,

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"Would you let your own child
play football?"

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Or, "Should I let my child play soccer?"

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And I think that as a field,

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we're a long way from giving an answer
with any kind of confidence there.

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So I look at that question
from a bit of a different lens,

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and I want to know,
how can we prevent concussion?

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Is that even possible?

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And most experts think that it's not,

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but the work that we're doing in my lab

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is starting to reveal more
of the details around concussion

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so that we can have
a better understanding.

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The reason we're able
to prevent skull fracture with helmets

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is because it's pretty simple.
We know how it works.

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Concussion has been
much more of a mystery.

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So to give you a sense of what might
be happening in a concussion,

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I want to show you the video here

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that you see when you type into Google,

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"What is a concussion?"

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The CDC website comes up,

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and this video essentially
tells the whole story.

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What you see is the head moves forward,

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the brain lags behind,

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then the brain catches up

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and smashes into the skull,

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it rebounds off the skull,

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and then proceeds to run
into the other side of the skull.

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And what you'll notice is highlighted
in this video from the CDC,

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which I'll note was funded by the NFL,

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is that the outer surface of the brain,

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where it was to have
smashed into the skull,

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looks like it's been damaged or injured,
so it's on the outer surface of the brain.

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And what I'd like to do with this video

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is to tell you that there are
some aspects that are probably right,

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indicative of what the scientists
think happens with concussion,

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but there's probably more
that's wrong with this video.

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So one thing that I do agree with,
and I think most experts would,

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is that the brain
does have these dynamics.

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It does lag behind the skull

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and then catch up and move
back and forth and oscillate.

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That we think is true.

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However, the amount of motion
you see in the brain in this video

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is probably not right at all.

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There's very little room
in the cranial vault,

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only a few millimeters,

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and it's filled entirely
with cerebral spinal fluid,

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which acts as a protective layer.

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And so the brain as a whole probably
moves very little inside the skull.

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The other problem with this video

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is that the brain is shown

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as a kind of rigid whole
as it moves around,

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and that's not true either.

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Your brain is one of the softest
substances in your body,

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and you can think of it
kind of like jello.

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So as your head is moving back and forth,

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your brain is twisting
and turning and contorting,

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and the tissue is getting stretched,

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and so most experts I think would agree

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that concussion is not likely
to be something that's happening

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on this outer surface of the brain,

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but rather it's something
that's much deeper

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towards the center of the brain.

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Now, the way that we're
approaching this problem

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to try to understand
the mechanisms of concussion

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and to figure out if we can prevent it

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is we are using a device like this.

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It's a mouthguard.

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It has sensors in it
that are essentially the same

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that are in your cell phone:

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accelerometers, gyroscopes,

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and when someone is struck in the head,

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it can tell you how their head moved

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at a thousand samples per second.

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The principle behind
the mouthguard is this:

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it fits onto your teeth.

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Your teeth are one of the hardest
substances in your body.

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So it rigidly couples to your skull

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and gives you the most precise
possible measurement

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of how the skull moves.

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People have tried
other approaches, with helmets.

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We've looked at other sensors
that go on your skin,

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and they all simply move around too much,

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and so we found that this
is the only reliable way

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to take a good measurement.

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So now that we've got this device,
we can go beyond studying cadavers,

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because you can only
learn so much about concussion

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from studying a cadaver,

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and we want to learn
and study live humans.

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So where can we find
a group of willing volunteers

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to go out and smash their heads
into each other on a regular basis

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and sustain concussion?

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Well, I was one of them,

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and it's your local friendly
Stanford football team.

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So this is our laboratory,

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and I want to show you

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the first concussion
we measured with this device.

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One of the things that I should point out
is the device has this gyroscope in it,

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and that allows you
to measure the rotation of the head.

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Most experts think
that that's the critical factor

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that might start to tell us
what is happening in concussion.

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So please watch this video.

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Announcer: Cougars bring
extra people late, but Luck has time,

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and Winslow is crushed.

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Announcer: I hope he's all right.

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(Audience roars)

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Announcer: Top of your screen,

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you'll see him come on
just this little post route,

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get separation, safety.

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There it comes at you in real speed.
You'll hear this.

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Announcer: The hit delivered by --

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David Camarillo: Sorry, three times
is probably a little excessive there.

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But you get the idea.

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So when you look at just the film here,

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pretty much the only thing you can see
is he got hit really hard and he was hurt.

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But when we extract the data

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out of the mouthguard that he was wearing,

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we can see much more detail,
much richer information.

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And one of the things that we noticed here

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is that he was struck
in the lower left side of his face mask.

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And so that did something first
that was a little counterintuitive.

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His head did not move to the right.

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In fact, it rotated first to the left.

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Then as the neck began to compress,

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the force of the blow caused it
to whip back to the right,

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so this left-right motion
was sort of a whiplash type phenomenon

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and we think that is probably
what led to the brain injury.

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Now, this device is only limited in such
that it can measure the skull motion,

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but what we really want to know
is what's happening inside of the brain.

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So we collaborate with
Svein Kleiven's group in Sweden.

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They've developed a finite element
model of the brain.

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And so this is a simulation

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using the data from our mouthguard
from the injury I just showed you,

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and what you see is the brain --

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this is a cross-section right in the front

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of the brain twisting
and contorting as I mentioned.

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So you can see this doesn't
look a lot like the CDC video.

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Now, the colors that you're looking at

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are how much the brain tissue
is being stretched,

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and so the red is 50 percent.

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That means the brain has been stretched
to 50 percent of its original length,

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the tissue in that particular area.

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And the main thing I want to draw
your attention to is this red spot.

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So the red spot is very close
to the center of the brain,

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and relatively speaking,

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you don't see a lot of colors like that
on the exterior surface

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as the CDC video showed.

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Now, to explain a little more detail

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about how we think
concussion might be happening,

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one thing I should mention

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is that we and others have observed
that a concussion is more likely

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when you're struck and your head
rotates in this direction.

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This is more common
in sports like football,

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but this seems to be more dangerous.
So what might be happening there?

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Well, one thing that you'll notice
in the human brain

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that is different than other animals

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is we have these two very large lobes.

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We have the right brain
and the left brain.

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And the key thing
to notice in this figure here

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is that right down the center
of the right brain and the left brain

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there's a large fissure
that goes deep into the brain.

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And in that fissure,
what you can't see in this image,

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you'll have to trust me,

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there is a fibrous sheet of tissue.

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It's called the falx,

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and it runs from the front of your head
all the way to the back of your head,

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and it's quite stiff.

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And so what that allows for
is when you're struck

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and your head rotates
in this left-right direction,

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forces can rapidly transmit
right down to the center of your brain.

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Now, what's there
at the bottom of this fissure?

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It's the wiring of your brain,

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and in fact this red bundle
here at the bottom of that fissure

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is the single largest fiber bundle

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that is the wiring that connects
the right and left sides of your brain.

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It's called the corpus callosum,

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and we think that this might be

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one of the most common
mechanisms of concussion,

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and as the forces move down,
they strike the corpus callosum,

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it causes a dissociation
between your right and your left brain

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and could explain some
of the symptoms of concussion.

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This finding is also consistent
of what we've seen

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in this brain disease that I mentioned,
chronic traumatic encephalopathy.

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So this is an image of a middle-aged
ex-professional football player,

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and the thing that I want to point out
is if you look at the corpus callosum,

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and I'll page back here so you can see
the size of a normal corpus callosum

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and the size of the person here
who has chronic traumatic encephalopathy,

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it is greatly atrophied.

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And the same goes
for all of the space in the ventricles.

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These ventricles are much larger.

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And so all of this tissue
near the center of the brain

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has died off over time.

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So what we're learning
is indeed consistent.

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Now, there is some good news here,

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and I hope to give you a sense
of hope by the end of this talk.

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One of the things that we've noticed,

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specifically about
this mechanism of injury,

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is although there's a rapid transmission
of the forces down this fissure,

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it still takes a defined amount of time,

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and what we think is that if we can
slow the head down just enough

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so that the brain
does not lag behind the skull

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but instead it moves
in synchrony with the skull,

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then we might be able to prevent
this mechanism of concussion.

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So how can we slow the head down?

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(Laughter)

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A gigantic helmet.

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So with more space, you have more time,

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and this is a bit of a joke,
but some of you may have seen this.

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This is bubble soccer,
and it's a real sport.

00:11:46.760 --> 00:11:48.416
In fact, I saw some young adults

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playing this sport down the street
from my house the other day,

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and as far as I know
there have been no reported concussions.

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(Laughter)

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But in all seriousness,
this principle does work,

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but this has gone too far.

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This isn't something that's practical
for bike riding or playing football,

00:12:06.520 --> 00:12:10.896
and so we are collaborating
with a company in Sweden called Hรถvding.

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Some of you may have seen their work,

00:12:13.280 --> 00:12:17.656
and they're using the same principle
of air to give you some extra space

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to prevent concussion.

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Kids, don't try this at home please.

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This stuntman does not have a helmet.

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He instead has a neck collar,

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and this neck collar has sensors in it,

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the same type of sensors
that are in our mouthguard,

00:12:37.080 --> 00:12:40.216
and it detects when he's likely
to have a fall,

00:12:40.240 --> 00:12:42.576
and there's an airbag
that explodes and triggers,

00:12:42.600 --> 00:12:46.376
the same way that an airbag
works in your car, essentially.

00:12:46.400 --> 00:12:49.336
And in the experiments
we've done in my lab with their device,

00:12:49.360 --> 00:12:53.096
we found that it can greatly reduce
the risk of concussion in some scenarios

00:12:53.120 --> 00:12:55.256
compared to a normal bicycle helmet.

00:12:55.280 --> 00:12:57.120
So it's a pretty exciting development,

00:12:58.120 --> 00:13:02.816
but in order for us to actually realize
the benefits of technology

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that can prevent concussion,

00:13:04.720 --> 00:13:07.656
it needs to meet regulations.

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That's a reality,

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and this device is for sale in Europe

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but is not for sale in the US,
and probably won't be any time soon.

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So I wanted to tell you why.

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There are some good reasons and then
there are some not so good reasons.

00:13:21.640 --> 00:13:23.856
Bike helmets are federally regulated.

00:13:23.880 --> 00:13:27.616
The Consumer Product Safety Commission
has been given jurisdiction

00:13:27.640 --> 00:13:29.496
to approve any bike helmet for sale,

00:13:29.520 --> 00:13:30.976
and this is the test they use.

00:13:31.000 --> 00:13:34.656
This is back to what I was telling you
at the beginning about skull fracture.

00:13:34.680 --> 00:13:36.096
That's what this test is for.

00:13:36.120 --> 00:13:37.856
And that's an important thing to do.

00:13:37.880 --> 00:13:40.736
It can save your life,
but it's not sufficient, I would say.

00:13:40.760 --> 00:13:43.496
So for example, one thing
this test doesn't evaluate

00:13:43.520 --> 00:13:46.336
is it doesn't tell you
is that airbag going to trigger

00:13:46.360 --> 00:13:50.256
at the right time and place,
and not trigger when it doesn't need to?

00:13:50.280 --> 00:13:52.336
Similarly, it's not going to tell you

00:13:52.360 --> 00:13:55.736
is this helmet likely
to prevent concussion or not?

00:13:55.760 --> 00:13:59.496
And if you look at football helmets,
which aren't regulated,

00:13:59.520 --> 00:14:02.481
they still have a very similar test.

00:14:02.520 --> 00:14:04.776
They're not regulated
by the government, anyway.

00:14:04.800 --> 00:14:07.936
They have an industry body,
which is the way most industries work.

00:14:07.960 --> 00:14:10.976
But this industry body, I can tell you,
has been quite resistant

00:14:11.000 --> 00:14:12.376
to updating their standards.

00:14:12.400 --> 00:14:15.656
So in my lab, we are working on not only
the mechanism of concussion,

00:14:15.680 --> 00:14:19.136
but we want to understand
how can we have better test standards?

00:14:19.160 --> 00:14:23.696
And we hope that the government
can use this type of information

00:14:23.720 --> 00:14:25.456
to encourage innovation

00:14:25.480 --> 00:14:27.096
by letting consumers know

00:14:27.120 --> 00:14:30.896
how protected are you with a given helmet.

00:14:30.920 --> 00:14:34.296
And I want to bring this back finally
to the original question I asked,

00:14:34.320 --> 00:14:37.656
which is, would I feel comfortable
letting my child play football

00:14:37.680 --> 00:14:39.416
or ride a bicycle?

00:14:39.440 --> 00:14:42.776
And this might be just a result
of my own traumatic experience.

00:14:42.800 --> 00:14:46.800
I'm much more nervous
about my daughter Rose riding a bicycle.

00:14:47.920 --> 00:14:49.576
So she's a year and a half old,

00:14:49.600 --> 00:14:55.056
and she's already, well, wants to anyway,
race down the streets of San Francisco.

00:14:55.080 --> 00:14:57.416
This is the bottom
of one of these streets.

00:14:57.440 --> 00:15:02.656
And so my personal goal
is to -- and I believe this is possible --

00:15:02.680 --> 00:15:04.736
is to further develop these technologies,

00:15:04.760 --> 00:15:07.736
and in fact, we're working
on something in my lab in particular

00:15:07.760 --> 00:15:10.713
that really makes optimal use
of the given space of the helmet,

00:15:10.737 --> 00:15:13.216
and I am confident
that we will be able to,

00:15:13.240 --> 00:15:16.456
before she's ready to ride a two-wheeler,

00:15:16.480 --> 00:15:17.856
have something available

00:15:17.880 --> 00:15:21.216
that can in fact really reduce
the risk of concussion

00:15:21.240 --> 00:15:24.376
and comply with regulatory bodies.

00:15:24.400 --> 00:15:26.016
And so what I'd like to do --

00:15:26.040 --> 00:15:29.416
and I know that this is for some of you
of more immediate nature,

00:15:29.440 --> 00:15:31.096
I've got a couple years here --

00:15:31.120 --> 00:15:35.256
is to be able to tell parents
and grandparents when I'm asked,

00:15:35.280 --> 00:15:39.696
it is safe and healthy for your children
to engage in these activities.

00:15:39.720 --> 00:15:42.536
And I'm very fortunate
to have a wonderful team at Stanford

00:15:42.560 --> 00:15:44.456
that's working hard on this.

00:15:44.480 --> 00:15:48.576
So I hope to come back in a few years
with the final story,

00:15:48.600 --> 00:15:50.576
but for now I will tell you,

00:15:50.600 --> 00:15:53.536
please don't just be afraid
when you hear the word concussion.

00:15:53.560 --> 00:15:54.776
There is hope.

00:15:54.800 --> 00:15:56.016
Thank you.

00:15:56.040 --> 00:15:58.000
(Applause)