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Details on New Jersey’s concussion detection protocol tests

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Traumatic brain injury is one of the biggest dangers facing MMA athletes today, but some commissions are trying to minimize the danger. Iain Kidd investigates.

Courtesy of Dr. Michael Kelly

I recently had the chance to speak to Dr. Michael Kelly, the author of Fight Medicine and New Jersey ringside physician, about the state’s recent trial of a new concussion detection protocol, and what it could mean for the health and safety of athletes going forward.

You can listen to the entire interview on the Three Amigos Podcast, which goes into more detail and covers more potential uses.

Dr Kelly: Over the past several years, we’ve seen more and more evidence that you can detect concussions earlier using changes in eye movement. They found that eye doctors could diagnose a concussion with 98% accuracy by examining the eyes of someone who had suffered a concussion, even when they had no other information on the patient.

One of the biggest indicators is an inability for the eyes to follow across the horizontal field of vision. The ability to follow across the horizontal plane requires four different parts of the brain to function simultaneously. The end result is people have “abnormal smooth pursuits” or abnormal saccades. When the eyes try to follow something they pop back and forth, almost like they are vibrating on the horizontal plane. It’s very hard to detect this unless you’re watching closely and you’re a trained physician. It’s also hard to quantify how much of the movement is abnormal.

What the Eyeguide Focus entails is having a person follow a small white dot on a computer screen, while a camera focuses on the retina and takes pictures of the eye movement at 70 frames per second. The computer then calculates how smooth or erratic the eye movements are.

The studies are looking at both concussive and subconcussive blows. If we can get a baseline and follow a fighter for a number of years, we can measure any slow, chronic development of an impairment. A lot of this is very early and the studies are ongoing, but there are a number of universities and medical centers in the US which are studying the effects of both acute, traumatic brain injury, and chronic brain injury from subconcussive blows.

Trial results

The initial trial took place in February 2017.

Dr Kelly: The trial went very well. There was a 90 percent correlation between the changes predicted by the ringside physician, and the changes detected by the machine. Even fighters who won, but sustained heavy blows, showed some changes.

Another really interesting finding is from one fight in particular where the fighter had massive facial trauma, and he had taken a number of blows, but a lot of those blows were on the ground, where his head wasn’t moving much. So, although he had facial trauma and possibly injury to the bones, that fighter was very lucid and his speed was very quick. He was acting very normal, despite how his face looked, and when we tested him the machine correlated with that [and didn’t show a concussion].

The testing went relatively smoothly, in part because it’s so fast. It’s a ten-second test. All of the fighters involved were very helpful and willing to participate in the study, which I’m very thankful for.

Potential Issues

Dr Kelly: At first, we were testing fighters immediately after they came out of the ring, but what we didn’t do was take their heart rate and try to correlate whether or not that affected the findings. The test involves their head sitting on a device, so if their adrenaline is flowing, their heart rate is up and their blood pressure is up, they might be having slight oscillations that might affect the outcome of the test. We’re going to look at adjusting the protocol to get the resting heart rate before the fight, and perform the test once they are back down to their normal heart rate.


Dr Kelly: The price hasn’t really been worked out yet, because they’re still developing ways to manufacture the system more efficiently. The latest change i know of is they switched to 3-D printing to make the units much more cost-effective. At this point it’s someone in the range of $2,500 for the device. I have seen similar devices in the $10,000 range, but I think the price for them all will come down as their use becomes more widespread.

Operation of the Machine

Dr Kelly: The hardest part of using the device is taking a few minutes to get the head set up, and to calibrate the machine to the patient’s pupil, but that only takes a few seconds. From what I’ve seen, the machine is almost idiot-proof. Someone can learn how to use it in about a minute.

Right now, the results are broken down into score bands for the baseline, and results of either impaired or not impaired from the test. That is determined based on the results from around 4,000 samples. If it works well, the machine will be able to tell you if a person is impaired or not impaired, and how many standard deviations a fighter’s results are below their baseline results.

The idea is to make the system as easy as possible for non-medically trained professionals to get the results from the machine, and a physician can actually look at the numbers to see how they correlate. You would also have a physician evaluate any other medical conditions that could affect what we’re seeing.

The Future of Concussion Detection

The NJSACB plan to test the machine further at a boxing event in May, which should provide even more data since KOs are more common in boxing. Dr Kelly is already using the device in his own private practice.

New Jersey isn’t the only state taking steps to improve its concussion detection. The California state athletic commission under Andy Foster is also running a trial on a new concussion protocol, that one based around the C3 Logix system developed by doctors at the Cleveland Clinic.

Although the C3 Logix system doesn’t have the quick testing time that allows the Eyeguide Focus to be used on all fighters post fight, it’s a more comprehensive protocol. I suspect it’s only a matter of time until the most diligent commissions are utilizing a system that is capable of immediate post-fight testing as well as a comprehensive whole body test for more sensitive diagnoses.

Traumatic brain injury is a serious time-bomb for MMA, and it’s good to see the better commissions already taking steps to try to protect athletes and minimize the risk of a fighter training or competing with an undiagnosed injury that could be exacerbated.

There will always be detrimental health effects in mixed martial arts. We’re all going to have to come to terms with the fact that our sporting heroes are sacrificing their long-term well-being for our entertainment, but the aim should always be to minimize those consequences, and these concussion detection protocols are a step in the right direction.