On the athletic field, injuries happen.
Some injuries are unavoidable thanks to the circumstances: Think of a football quarterback taking a hit from the blind side. He never saw it coming.
Collision sports such as football, soccer, rugby, hockey and lacrosse constantly have athletes making contact with one another, frequently at high rates of speed.
But many injuries are preventable, Gary Wilkerson said, and it all starts at the top.
Wilkerson, a University of Tennessee at Chattanooga professor in graduate-level athletic training and a researcher in the field for more than 30 years, said he started trying to understand the connection between the brain and injuries 12 to 15 years ago.
“We began to see more knee and ankle injuries occurring after concussions compared to people who’d never had one,” he said, “and then the question becomes, ‘Why is having a concussion causing more knee and ankle injuries?’ That’s where we began to try to understand it.”
It’s all about the reaction time.
“Reaction time is telling us how efficiently messages are being conveyed from one part of the brain to the other,” said Wilkerson, who has taught at UTC since 1999 and has received the designation of National Athletic Trainers’ Association (NATA) Fellow. He was inducted into the NATA Hall of Fame in 2016 and was awarded the NATA Foundation Medal for Distinguished Research in 2019.
“There’s a long-held misconception that specific parts of the brain perform specific functions. That’s not true at all,” he said. “Specific parts of the brain perform a function based on its connections with other areas. It’s the interactions among these areas; you’ve got messages going from back to front, front to back, back to side, and across side to side. They’re like a pinball machine. These messages are going everywhere.
“How efficiently those messages are being routed, processed and generating another message will be reflected in your reaction time.”
Several years ago, Wilkerson helped create a mobile phone application to capture cognitive response speed and accuracy. The app, a series of images on the phone prompting the user to tilt it left or right, tests cognitive processing efficiency through reaction times and accuracy—which reflects an athlete’s ability to detect, react and respond to environmental changes.
But the data told only part of the story.
‘The combination of the speed and the accuracy tells us a great deal about how efficiently the brain is processing that information,” he said. “That’s a really good test and we’ve learned a lot of things from that, but it’s static because those arrows just sit there on the screen.
“One of the things that we know is critical for athletes—and for military personnel, law enforcement, anybody who is engaged in activities that require you to take in information from the environment and process that quickly—is to make accurate decisions. We know that very specific parts of the brain respond to motion in the environment.”
A collaboration that Wilkerson has been a research partner in for the last year is going next level.
Wilkerson and the Boston-based REACT Neuro group—led by neuroscientist Shaun Patel; Dr. Rudy Tanzi, the vice chair of neurology at Massachusetts General Hospital; and Dr. Brian Nahed, associate professor of neurosurgery at Massachusetts General Hospital and Harvard Medical School—are using virtual reality technology to test response efficiency.
“They’re the guys who originated the company, which was actually a commercialization of a project they started at Harvard,” Wilkerson said, “The CEO, Shaun Patel, was a faculty member in neuroscience at Harvard before he left to run this company, so we’re talking about heavy hitters in the world of neurology.
“Their work was pretty much being done with senior adults and trying to detect early- onset cognitive decline. They realized that there are lots of parallels between the effects of concussions and repetitive head impacts in young adults and what we’re seeing in terms of degenerative changes in older adults. They talked to me about, ‘How can we take what we’re already doing and adapt that to get the most precise information that we can from young athletes?’”
Inside the virtual reality headset, instead of a flashing visual stimulus that elicits a response, there’s movement you have to respond to with body movements.
“Stand with your shoulders parallel to the red line on the ground,” said the headset’s voice. “Look forward. Assume a “T” pose with arms out as far to your sides as you can reach. While holding the “T” pose, pull both triggers on your controllers to calibrate. For this task, you should assume a crouched ready position, feet shoulder-width apart, knees bent, hands in front of your chest, head looking forward at the cross in the center.
“In this task, you have to lunge to reach the target spheres to your left and right. When you hit a target, your controller will vibrate. Try lunging left or right to touch a sphere now. You will see circles move across your field of view. The circles will appear in the center and move to another direction or come in from your peripheral vision. When you see a filled circle move across the screen, hit the target in the same direction as the circle is moving. Try that now.”
It sounds like a cool game—and in a way, it is—but trying to prevent injuries is not a game.
“One of the things we know through training, and there’s no doubt about this, is we can expand the range of the visual field,” Wilkerson said. “There’s a really interesting phenomenon here in the visual system.”
As he explained, people have foveal vision—the central part of your eyes where you have a high degree of acuity in picking up details, but it’s a little bit blurrier in the periphery of your eyes.
“Your peripheral vision is well adapted to detect moving things in the environment,” he said, “and if we can improve the balance between the central vision and the peripheral vision, the range of that vision will get wider.
“The wider that peripheral vision, the quicker you’re going to pick up something coming from the periphery.”
For an athlete, the faster the reaction time, the better the chance to protect yourself, reducing the chance of injury.
The VR technology combines a physically exerting whole-body movement response with cognitive decision-making.
“The main reason we’ve moved to the VR is that you’ve got total control over what goes on inside that visual environment,” he said, “and there’s a very precise measurement of the responses. I’ve never had anything before that I could measure eye responses with so precisely.”
The research is not just athlete-focused. Consider what increasing reaction times would do for military personnel.
“If you’re in the military, you certainly want to see the enemy first,” he said. “Every millisecond you can gain—and where you have to make quick decisions right or left—can have enormous consequences.”
As he’s learned from working with ROTC, many of the cadets were high school athletes, “and a lot of them had high school concussions. We still see the effects,” Wilkerson said.
“A lot of the work that I’ve done with Olympic athletes, with high-level football players, with ROTC, we can see in our test results lingering effects of concussions that occurred six, seven, eight years earlier. The point here is that we want to try to intervene and manage those effects.”
This summer, Wilkerson and UTC athletic training program members, including Associate Professor and Athletic Training Program Director Shellie Acocello and Assistant Professor and Athletic Training Clinical Education Coordinator Lynette Carlson, performed VR testing with Chattanooga-area high school athletes. He also presented his findings, titled “Relevance of Functional Connectivity among Brain Networks to Level of Sport-Related Injury Risk,” at NATA’s July national conference in Philadelphia.
“From my perspective, this research is foundational. It’s critical,” Wilkerson said. “You can have continuing injury problems that aren’t getting resolved because you haven’t gotten to the core driver of the ability to effectively protect the joint, and that’s definitely in the brain. We have to understand it and know what to do about it.
“We don’t have all the answers about how to manage these things yet, but you can’t treat anything that you don’t first detect. What we’ve really been focused on is being able to detect these very subtle indicators that almost certainly make you vulnerable to more problems developing down the line.”
Can those effects be eliminated? That question can’t be answered yet.
But, through training, can those adverse effects be less problematic?
“There’s some pretty good evidence that we can improve the efficiency of those rapid eye movements to take in more information in the environment,” Wilkerson said. “I’m a big believer in objectively measuring whatever we can measure. If we’ve measured it and we’re persuaded it’s there, we can intervene and do something about it instead of just hoping for the best.
“The sky is the limit. The possibilities for what we can learn are endless.”