Back on the gridiron: VR helps athletes safely return to play following concussion

Returning to sports too soon after a concussion or other traumatic brain injury (TBI) can increase the risk of an even more serious injury and long-term brain damage. Johns Hopkins biomedical engineering students have developed a new virtual reality (VR) game that provides athletes with objective data to guide return-to-play (RTP) decisions after a concussion, offering a more reliable alternative to current protocols that rely heavily on subjective inputs like self-reported questionnaires from the athlete.   

“Our technology provides clinicians and athletic trainers with valuable insights into TBI recovery currently not captured by conventional tools,” said Shalika Subramanian, a fourth-year biomedical engineering student and team lead for the project. “The system transforms the usual clinical tests into an engaging game environment that generates objective, quantifiable and personalized recovery metrics.”  

Subramanian and teammates Betania Arce, Arya Kazemnia, Issac Kim, Aditya Kondepudi, Divyansh (Dev) Lalwani, Pratibha Pradeep, and Edmund Tsou will present their work on Tuesday, April 29, at the Johns Hopkins Engineering Design Day—the annual year-end event showcasing students’ solutions to real-world problems. 

The device works like this: An athlete wears the VR headset and runs through a series of mini-games that test eye-tracking, balance, motor skills, and cognition — all brain functions typically impaired after a TBI. For example, one such game includes tracking a randomly generated ball that moves across the landscape that the athlete must follow with their eyes. If they accurately track it, the ball will disappear for a second before reappearing in a new spot and repeating until the test is complete. 

Comprehensive recovery data captured by the headset is securely uploaded onto a cloud-based platform, giving clinicians and trainers access to objective measurements that enable more data-driven RTP decisions rather than relying solely on patients’ reported symptoms.  

The new game-based assessment is needed, the students say, because almost half of athletes with TBIs are given the green light to return to play too early.

Their data-driven approach also overcomes a flaw in conventional assessments —the tendency of athletes to deliberately hide or downplay their concussion symptoms in their eagerness to return to competition. 

Much of the team’s energy was spent turning current concussion tests into games that athletes will actually enjoy playing.  

“Through the process, one of our biggest takeaways has been the importance of designing with the athlete’s experience in mind,” said team members Arce and Lalwani. “We know that an intuitive and immersive experience will encourage athletes to use the system consistently. Our goal is to create an experience where the gameplay naturally facilitates evaluation, allowing for a more authentic and effective recovery assessment.” 

Currently, the team is testing the VR with clinic patients at Johns Hopkins Hospital to validate the health metrics collected by the games. Next steps include working with the university’s head football coach Daniel Wodicka, Engr ’14, who has been advising the students, and his team to further test and refine their invention; players and staff will provide concrete feedback about what does and does not work about the technology, and how it could be integrated into treatment plans, said Kazemnia.  

Because concussions are common and aren’t just an issue for athletes, the team expects that the technology has the potential to expand into broader markets, including to help veterans, military personnel, and older adults with TBIs. 

In addition to Wodicka, advisors for the team include Jonathan Browne, a resident physician of neurology; Kemar Green, a neuro-ophthalmologist; and Michelle Zwernemann, director of the Department of Biomedical Engineering’s Undergraduate Design Program.