TEDxStanford
David Camarillo: Why helmets don't prevent concussions -- and what might
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What is a concussion? Probably not what you think it is. In this talk from the cutting edge of research, bioengineer (and former football player) David Camarillo shows what really happens during a concussion -- and why standard sports helmets don't prevent it. Here's what the future of concussion prevention looks like.
David Camarillo - Bioengineer
David Camarillo's research focuses on understanding and preventing traumatic brain injury. Full bio
David Camarillo's research focuses on understanding and preventing traumatic brain injury. Full bio
Double-click the English transcript below to play the video.
00:12
The word concussion evokes a fear
these days more so than it ever has,
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
what was much worse than that
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was a pair of bike accidents I had
where I suffered concussions,
where I suffered concussions,
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and I'm still dealing with the effects
of the most recent one
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
that a repeated history of concussion
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can lead to early dementia,
such as Alzheimer's,
such as Alzheimer's,
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and chronic traumatic encephalopathy.
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00:54
That was the subject
of the Will Smith movie "Concussion."
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,
and what they see in the military,
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01:02
but you may not know
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that bike riding is the leading cause
of concussion for kids,
of concussion for kids,
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sports-related concussion, that is.
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01:11
And so another thing
that I should tell you
that I should tell you
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01:13
that you may not know
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is that the helmets that are worn
in bicycling and football
in bicycling and football
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01:17
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.
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.
against skull fracture.
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And so I get this question
all the time from parents,
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?"
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.
with any kind of confidence there.
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So I look at that question
from a bit of a different lens,
from a bit of a different lens,
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and I want to know,
how can we prevent concussion?
how can we prevent concussion?
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02:00
Is that even possible?
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02:02
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
of the details around concussion
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so that we can have
a better understanding.
a better understanding.
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02:15
The reason we're able
to prevent skull fracture with helmets
to prevent skull fracture with helmets
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02:18
is because it's pretty simple.
We know how it works.
We know how it works.
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02:21
Concussion has been
much more of a mystery.
much more of a mystery.
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02:24
So to give you a sense of what might
be happening in a concussion,
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.
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.
into the other side of the skull.
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And what you'll notice is highlighted
in this video from the CDC,
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,
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.
so it's on the outer surface of the brain.
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03:11
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,
some aspects that are probably right,
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indicative of what the scientists
think happens with concussion,
think happens with concussion,
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but there's probably more
that's wrong with this video.
that's wrong with this video.
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So one thing that I do agree with,
and I think most experts would,
and I think most experts would,
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is that the brain
does have these dynamics.
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.
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
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,
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,
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.
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,
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,
substances in your body,
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and you can think of it
kind of like jello.
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,
and turning and contorting,
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and the tissue is getting stretched.
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04:18
And so most experts, I think, would agree
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that concussion is not likely
to be something that's happening
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
that's much deeper
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towards the center of the brain.
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04:31
Now, the way that we're
approaching this problem
approaching this problem
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to try to understand
the mechanisms of concussion
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
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:
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.
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
possible measurement
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of how the skull moves.
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05:12
People have tried
other approaches, with helmets.
other approaches, with helmets.
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05:14
We've looked at other sensors
that go on your skin,
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
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,
we can go beyond studying cadavers,
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because you can only
learn so much about concussion
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.
and study live humans.
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So where can we find
a group of willing volunteers
a group of willing volunteers
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to go out and smash their heads
into each other on a regular basis
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.
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.
we measured with this device.
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06:00
One of the things that I should point out
is the device has this gyroscope in it,
is the device has this gyroscope in it,
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and that allows you
to measure the rotation of the head.
to measure the rotation of the head.
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Most experts think
that that's the critical factor
that that's the critical factor
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that might start to tell us
what is happening in concussion.
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,
extra people late, but Luck has time,
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and Winslow is crushed.
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I hope he's all right.
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(Audience roars)
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Top of your screen,
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you'll see him come on
just this little post route,
just this little post route,
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get separation, safety.
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Here it comes at you in real speed.
You'll hear this.
You'll hear this.
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The hit delivered by --
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David Camarillo: Sorry, three times
is probably a little excessive there.
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.
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.
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.
in the lower left side of his face mask.
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And so that did something first
that was a little counterintuitive.
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.
to whip back to the right.
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So this left-right motion
was sort of a whiplash-type phenomenon,
was sort of a whiplash-type phenomenon,
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and we think that is probably
what led to the brain injury.
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,
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.
is what's happening inside of the brain.
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So we collaborate with
Svein Kleiven's group in Sweden.
Svein Kleiven's group in Sweden.
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They've developed a finite element
model of the brain.
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,
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.
and contorting as I mentioned.
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So you can see this doesn't
look a lot like the CDC video.
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.
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,
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.
your attention to is this red spot.
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So the red spot is very close
to the center of the brain,
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
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,
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
that a concussion is more likely
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when you're struck and your head
rotates in this direction.
rotates in this direction.
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This is more common
in sports like football,
in sports like football,
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but this seems to be more dangerous.
So what might be happening there?
So what might be happening there?
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Well, one thing that you'll notice
in the human brain
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.
and the left brain.
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And the key thing
to notice in this figure here
to notice in this figure here
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is that right down the center
of the right brain and the left brain
of the right brain and the left brain
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there's a large fissure
that goes deep into the brain.
that goes deep into the brain.
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And in that fissure,
what you can't see in this image,
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,
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
is when you're struck
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and your head rotates
in this left-right direction,
in this left-right direction,
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forces can rapidly transmit
right down to the center of your brain.
right down to the center of your brain.
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Now, what's there
at the bottom of this fissure?
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
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.
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,
mechanisms of concussion,
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and as the forces move down,
they strike the corpus callosum,
they strike the corpus callosum,
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it causes a dissociation
between your right and your left brain
between your right and your left brain
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and could explain some
of the symptoms of concussion.
of the symptoms of concussion.
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This finding is also consistent
of what we've seen
of what we've seen
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in this brain disease that I mentioned,
chronic traumatic encephalopathy.
chronic traumatic encephalopathy.
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So this is an image of a middle-aged
ex-professional football player,
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,
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
the size of a normal corpus callosum
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and the size of the person here
who has chronic traumatic encephalopathy,
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.
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
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.
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.
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,
this mechanism of injury,
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is although there's a rapid transmission
of the forces down this fissure,
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
slow the head down just enough
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so that the brain
does not lag behind the skull
does not lag behind the skull
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but instead it moves
in synchrony with the skull,
in synchrony with the skull,
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then we might be able to prevent
this mechanism of concussion.
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.
but some of you may have seen this.
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This is bubble soccer,
and it's a real sport.
and it's a real sport.
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In fact, I saw some young adults
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playing this sport down the street
from my house the other day,
from my house the other day,
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and as far as I know
there have been no reported concussions.
there have been no reported concussions.
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(Laughter)
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But in all seriousness,
this principle does work,
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.
for bike riding or playing football.
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And so we are collaborating
with a company in Sweden called Hövding.
with a company in Sweden called Hövding.
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Some of you may have seen their work,
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and they're using the same principle
of air to give you some extra space
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,
that are in our mouthguard,
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and it detects when he's likely
to have a fall,
to have a fall,
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and there's an airbag
that explodes and triggers,
that explodes and triggers,
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the same way that an airbag
works in your car, essentially.
works in your car, essentially.
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And in the experiments
we've done in my lab with their device,
we've done in my lab with their device,
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we found that it can greatly reduce
the risk of concussion in some scenarios
the risk of concussion in some scenarios
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compared to a normal bicycle helmet.
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So it's a pretty exciting development.
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But in order for us to actually realize
the benefits of technology
the benefits of technology
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that can prevent concussion,
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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.
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.
there are some not so good reasons.
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Bike helmets are federally regulated.
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The Consumer Product Safety Commission
has been given jurisdiction
has been given jurisdiction
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to approve any bike helmet for sale,
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and this is the test they use.
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This is back to what I was telling you
at the beginning about skull fracture.
at the beginning about skull fracture.
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That's what this test is for.
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And that's an important thing to do.
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It can save your life,
but it's not sufficient, I would say.
but it's not sufficient, I would say.
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So for example, one thing
this test doesn't evaluate
this test doesn't evaluate
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is it doesn't tell you
is that airbag going to trigger
is that airbag going to trigger
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at the right time and place,
and not trigger when it doesn't need to?
and not trigger when it doesn't need to?
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Similarly, it's not going to tell you
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is this helmet likely
to prevent concussion or not?
to prevent concussion or not?
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And if you look at football helmets,
which aren't regulated,
which aren't regulated,
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they still have a very similar test.
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They're not regulated
by the government, anyway.
by the government, anyway.
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They have an industry body,
which is the way most industries work.
which is the way most industries work.
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But this industry body, I can tell you,
has been quite resistant
has been quite resistant
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to updating their standards.
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So in my lab, we are working on not only
the mechanism of concussion,
the mechanism of concussion,
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but we want to understand
how can we have better test standards?
how can we have better test standards?
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And we hope that the government
can use this type of information
can use this type of information
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to encourage innovation
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by letting consumers know
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how protected are you with a given helmet.
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And I want to bring this back finally
to the original question I asked,
to the original question I asked,
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which is, would I feel comfortable
letting my child play football
letting my child play football
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or ride a bicycle?
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And this might be just a result
of my own traumatic experience.
of my own traumatic experience.
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I'm much more nervous
about my daughter, Rose, riding a bicycle.
about my daughter, Rose, riding a bicycle.
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So she's a year and a half old,
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and she's already, well, wants to anyway,
race down the streets of San Francisco.
race down the streets of San Francisco.
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This is the bottom
of one of these streets.
of one of these streets.
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And so my personal goal
is to -- and I believe this is possible --
is to -- and I believe this is possible --
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is to further develop these technologies,
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and in fact, we're working
on something in my lab in particular
on something in my lab in particular
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that really makes optimal use
of the given space of a helmet.
of the given space of a helmet.
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And I am confident
that we will be able to,
that we will be able to,
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before she's ready to ride a two-wheeler,
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have something available
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that can in fact really reduce
the risk of concussion
the risk of concussion
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and comply with regulatory bodies.
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And so what I'd like to do --
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and I know that this is for some of you
of more immediate nature,
of more immediate nature,
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I've got a couple years here --
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is to be able to tell parents
and grandparents when I'm asked,
and grandparents when I'm asked,
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it is safe and healthy for your children
to engage in these activities.
to engage in these activities.
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And I'm very fortunate
to have a wonderful team at Stanford
to have a wonderful team at Stanford
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that's working hard on this.
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So I hope to come back in a few years
with the final story,
with the final story,
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but for now I will tell you,
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please don't just be afraid
when you hear the word concussion.
when you hear the word concussion.
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There is hope.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
David Camarillo - BioengineerDavid Camarillo's research focuses on understanding and preventing traumatic brain injury.
Why you should listen
Dr. David Camarillo, Ph.D., is Assistant Professor of Bioengineering and (by courtesy) Mechanical Engineering at Stanford University. He holds a B.S.E in Mechanical and Aerospace Engineering from Princeton University (2001), a Ph.D. in Mechanical Engineering from Stanford University (2008) and completed his postdoctoral research fellowship in Biophysics at the University of California, San Francisco in 2011.
Camarillo worked in the surgical robotics industry at Intuitive Surgical and Hansen Medical, before launching his laboratory at Stanford in 2012. His current research focuses on designing force measurement devices for multiple clinical and scientific applications including embryo development, brain trauma and cardiac therapy.
Camarillo was recently awarded the Hellman Fellowship for his work in robot-assisted reproduction as well as the Office of Naval Research Young Investigator Program award for his research in brain biomechanics.
David Camarillo | Speaker | TED.com