Updated November 12, 2013
One way for athletes, coaches, parents, officials, support staff and medical personnel to become educated about concussions is by downloading concussion "apps" on their mobile devices. Because of their widespread use, portability and wireless connectivity, mobile phones are, in the words of a 2013 study,  "uniquely placed," to address the "significant" gap in concussion education.
While there are, as of yet, no studies investigating the use of mobile devices for sports concussion education, diagnosis or management, the authors of the 2013 study identified two key advantages of mobile phone apps as educational tools: first, that they give the user the opportunity to download educational materials quickly, and, second, they possess operating systems that support engaging and interactive solutions to learning.
The study identifies a need for smartphone apps to organize information on injury demographics, symptom timing, recovery milestones, and medical appointments, in order to provide licensed health care professionals diagnostic screening tools, such as the Sport Concussion Assessment Tool (SCAT2/3), that are easily accessible across computing platforms. But, the authors note, of the eleven applications they identified as being assessment tools, only four described the intended audience as health care professionals.
Concerned that use by parents and other non-medical personnel might carry significant legal liability, the authors of the study say "care should be taken to ensure that assessment tools are used exclusively by licensed health care providers."
There are currently 20 smartphone apps on sports concussions (including apps from the maker of the Shockbox helmet sensor, and the mobile version of the King-Devick test). Seven provide educational materials intended for use by parents and athletes, two of which are designed specifically for educating children (Hockey Canada Concussion Awareness for Kids, and Barrow Brainball). Most, however, are designed for use by medical professionals, such as athletic trainers or team doctors, not by parents or coaches.
Here are our reviews
1. Concussion Recognition and Response (CRR) ($.99).
An excellent smart phone application developed by two top concussion experts, Gerard A. Gioia, PhD, a pediatric neuropsychologist and the Chief of the Division of Pediatric Neuropsychology at Children's National Medical Center, where he directs the Safe Concussion Outcome, Recovery & Education (SCORE) program, and Jason Mihalik, PhD, CAT(C), ATC, Assistant Professor in the Department of Exercise and Sports Science at the University of North Carolina, and co-director of the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center.
The CRR app allows parents and coaches to capture and retain data on concussion incidents for a particular athlete and determining whether concussion is suspected by responding to a series of screen prompts:
- asking whether there was a blow to the head or body, the cause of injury, and how powerful the blow was;
- marking yes or no on a list of concussion signs (observed by parent or coach), including whether any seizures immediately following injury;
- instructing user to call 911 (with link) or go to nearest emergency room right away if athlete displays any of the warning signs of a more serious brain injury; and
- interviewing athlete and marking yes or no on list of concussion symptoms (experienced by athlete).
In case of suspected concussion, the app prompts parents and coaches to remove the athlete from the game or practice right away and provides recommendations for follow-up care and management, including:
- informing parent/guardian of suspected concussion
- recommending further medical evaluation
- giving parent ACE Post-Concussion Home/School instructions (while the instructions are provided, they are so small as to be essentially unreadable as formatted unless enlarged).
- observing athlete over next 24 hours, including not leaving him or her alone (the app includes a helpful checklist for use in home monitoring to record observations)
- instructing parents to review and record symptoms every 1-2 hours and observe for danger signs
- no return to play until athlete symptom free and been cleared by health professional for gradual return.
The app also includes helpful answers to concussions FAQs, with separate general FAQs and ones geared to coaches and parents.
This is an excellent and helpful concussion app, easy to navigate, and it puts at the fingertips of a coach, or parent or parent-coach most of the essential information they need for identifying a possible sports concussion and what parents need to do - and not do - in the first, critical 24 to 72 hours after suspected concussion. It is, in the view of MomsTEAM editors, the best concussion application for parents currently on the market.
Note: Before this application loads, the following box appears on the screen: "This application is not intended to replace seeking help from a trained medical professional. If the youth has lost consciousness, even briefly, call 911 immediately. Refer to the FAQs section for the complete disclaimer related to the application." The FAQs contain the standard legal disclaimer that the app is for "information and educational purposes only."
2. Concussion App from Sports Safety Labs LLC (free/$4.99),
The free version of this application:
- provides basic information on concussion signs and symptoms;
- allows a user to call an ambulance via 911,
- helps a user locate the nearest hospital and provides driving directions, and
- allows the user to send location coordinates via email to emergency contacts and rescue personnel.
An optional concussion diagnostic module, available via in-app purchase for $4.99, allows the user to capture and store for individual athletes the results of 11 tests based on the SCAT2 test to assist in the evaluation of the physiological and neurocognitive status of pre-concussion (baseline) and post-concussion (injured) athletes. The standardized presentation of the report and its data can be emailed from the user's smartphone to a physician to support their diagnostic interpretation of the athlete's condition. Physician's post-injury reports may be forwarded via email from the smartphone to a child's club or league if the user chooses to do so for rapid documentation and approval for return-to-play status.
The application provides a personal baseline testing program which compares the athlete's own post-injury results versus their own pre-injury results rather than to "norms" or population samples of other athletes who have also taken the test, and is designed to help the athlete and their doctor make accurate, personalized comparisons for return-to-play decision.
Pop-up prompts at various points during the testing indicate that the app is designed for use by medical professionals, not by parents.
In the opinion of the MomsTEAM editors, the free version might be worth a download for parents, if for no other reason than to utilize the Call 911 and Locating the Nearest Hospital features, but the one for $4.99 is really not designed for parents, so there is no point in shelling out five bucks for a test that isn't meant for a parent to use, and, as the 2013 study reviewing smartphone apps pointed out, shouldn't be used except by qualified health care professionals.
Free version: recommended.
$4.99 version: not recommended.
3. Play It Safe (free)
This free smartphone application from Concussion Health, LLC includes a 22-part test, including:
- a simplified symptom checklist
- the so-called "Maddocks" questions used to determine if the athlete is oriented to time and space;
- a word recall test to test memory
- a number reversal test;
- some simple balance tests; and
- a vision test.
Once the test is completed, the app provides a result summary (red flag,yellow flag, green flag).
The application is unwieldy, as it doesn't include an explanation of why the 22 items are tested with the individual test modules, requiring the user to access the application's "Help" section to obtain such explanations. While the app says the tests can be performed by coaches, parents or other individuals involved in the athlete's care, it doesn't seem designed with any particular type of user in mind; the test modules are only loosely based on the SCAT2 test, and hence of questionable utility by a clinician in diagnosing a suspected concussion.