A new game plan for concussions.

Sports-related concussions seem to be in the headlines almost every day, but detecting them remains mysterious — more art than science. They rarely show up on imaging tests. And their symptoms are often hidden by athletes who don’t want to miss a single game. Now Cleveland Clinic in Ohio is using iPad to take the mystery out of concussions with an app that lets trainers monitor symptoms moments after an event occurs. Already players are making safer returns to the field, court and ice.

It’s not just an American football problem.

American football accounts for the highest number of concussions in high school sports in the US. But concussions affect athletes across every sport — even those not considered “full contact”.

American Football




US high school sports-related concussions, 2012-2013.*

“In the past, evaluating a concussed athlete involved a lot of guesswork. iPad and the C3 Logix app have taken that subjectivity out of the process.”

Athletic Trainer Jason Cruickshank

St. Edward High School ice hockey player Mike Duffy has experienced countless collisions and crashes into the boards.

But nothing like the illegal check that rocked him this season. Although he managed to finish the game, his head throbbed and he was falling asleep in class. He didn’t know it at the time, but he had a concussion. A bad one.

According to athletic trainer Jason Cruickshank, Duffy was lucky his concussion was caught. His team are part of a programme that uses iPad with the C3 Logix app to measure and monitor concussion symptoms among all student athletes. “There are obvious and not-so-obvious concussions,” he says. Playing with one puts an athlete at risk of much worse injury. And young athletes are even more vulnerable because their brains are still developing.

In the past, it was easy to miss a concussion because of highly subjective reporting from athletes and errors made during paper-and-pencil data collection. But with iPad and the app, Cruickshank can make injury assessments based on precise measurements. “Using iPad with C3 Logix, we get hard, factual data that we can put in front of the athlete and say, ‘Look, this is where you should be.’”


Types of concussion

A sudden impact to the head causes the brain to slam against the inside of the skull, creating a coup injury. The brain can then rebound and strike the skull on the opposite side, causing a contrecoup concussion.

Mapping an unseen injury with iPad.

Even before the season is under way, Cruickshank gets a jump on managing potential injuries. It begins with using iPad and the app to take baseline measurements of athletes in normal states. When a possible concussion occurs during a practice or game, he examines the athlete and then takes him to the changing room for a post-injury retest. By comparing those results with the baseline, Cruickshank can easily spot a drop in performance that might indicate concussion.

Pre-concussion results

12 January 2014

Baseline assessment

Post-concussion results

12 February 2014

Incident report

A concussion isn’t like a broken arm. It doesn’t show up in an X-ray or even an MRI. So to accurately monitor the injury, you need to visualise its effect on a person’s cognitive and motor performance. The C3 Logix app uses a hexagon-shaped graph to represent the multiple symptoms associated with concussion. The athlete’s normal level of function is shown on the perimeter, with post-injury results inside. During recovery, the inner graph moves out towards the perimeter.

“We needed an accelerometer, a gyroscope and a great display to be able to objectively test balance, vision and reaction time. iPad gave us all of that in a single device.”

Athletic Trainer Jason Cruickshank

Getting back in the game.

There is no typical recovery from concussion. And it’s not always clear when a full recovery has occurred. So as injured athletes progress, trainers like Cruickshank are with them every step of the way, monitoring their performance with C3 Logix on iPad. Typically, he tests them every five to six days. Because all the data collected on iPad is stored by the app, Cruickshank can share a complete picture of the athletes’ progress with doctors, parents and coaches. That makes it much easier to judge when it’s safe for an athlete to return to action. St. Edward ice hockey coach Troy Gray says that seeing the persuasive test data is making his athletes more likely to cooperate with treatment and requested breaks from play.

Given the significance of his injury, Mike Duffy’s return to school and ice hockey was surprisingly smooth. After a month of rest, rehab and weekly testing, he was cleared to return to finish the season. “iPad let me judge my own progress,” he says. “I’m feeling fine now, and I’m back to my game. This recovery is 100 per cent.”

“As a coach, nothing matters more than player safety. With iPad and C3 Logix, I know for sure when an athlete is ready to return to play.”

Coach Troy Gray