XT Guardian Caps do not reduce the risk of sport-related concussions in high school football players (11/6/25 Newsletter)
In this newsletter: Opportunities, Concussion Advocate Training Webinar, Sports, What’s New with Us, Older Adults, & Women’s Health
Writers: Anni Yurcisin, Ella Webster, and Emily Sugg
Editors: Conor Gormally, Malayka Gormally, & Zoe Marquis
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Opportunities
Tuesday, November 11, 6 pm ET: A free webinar, Concussion in Women, presented by Dr. Carmela Tartaglia, hosted by the Canadian Concussion Centre. Register in advance.
Thursday, November 13, 11 am PT: A free class, Ways to Support Long Term Brain Health, presented by Larissa Del Piero, PhD, hosted by Brain Northwest. No registration necessary; the Zoom link is here.
Tuesday, November 18, 7 pm ET: A free online session, Principles of Getting Back to School and Work, the first of three in an evening series for medical providers working with pediatric patients, hosted by University Health Network ECHO Medical Education. Register in advance.
Thursday, November 20, 1 pm PT: A free class, Embodiment For Recovery Part Two: A Guided Practice Workshop, presented by Zena Watson, LCSW, hosted by Brain Northwest. No registration necessary; the Zoom link is here.
Friday, November 21, 8 am PT: A free webinar, Enhancing School Psychologists’ Capacity to Identify and Support Students with Traumatic Brain Injury (TBI) from Early Childhood to School Age, presented by Cadice Campo, EdS and Cuong Hoang, EdS, hosted by The Center for Brain Injury Research and Training. Register in advance.
Tuesday, November 25, 6 pm ET: A free webinar, Post-Concussion Optometry, presented by Dr. Kristine Dalton, hosted by the Canadian Concussion Centre. Register in advance.
Call for paid study participants: If your child has had a traumatic brain injury, including a concussion, in the past 1-12 months and is 8-16 years old, they may be eligible to join a remote study that can be done from home. Families receive compensation for their time and feedback on their child’s progress. Contact the study team at engagetbi@ucsf.edu or call/text (415) 993-1048 for more information.
In this UCSF study, your child plays a video game, then you and your child complete assessments and surveys to measure cognition. To learn more, see the flyer, visit this study page, or contact the study team, engagetbi@ucsf.edu or call/text (415) 993-1048.
Concussion Advocate Training Workshop: a remote educational webinar (11/6)
Thursday, November 6th, 1-2 PM PST
Please join us for a free, one-hour Zoom workshop with Concussion Alliance Co-Founders Conor Gormally and Malayka Gormally. During this session, you will become a trained concussion advocate for your workplace, family, and community. You will learn about common causes of concussion, myths, and current evidence-based best practices for self-care and navigating the healthcare system. We’ll also show you how you can use our Navigating Your Recovery quick guide to help your community make sure they’re doing the right things in the initial days and weeks after a concussion– and who to go to if symptoms persist. There will be time for a Q&A.
Register in advance for this webinar:
https://us02web.zoom.us/webinar/register/WN_jwGwO5rTT-OCQsD4Of8yKg
After registering, you will receive a confirmation email containing information about joining the webinar.
Sports
XT Guardian Caps do not reduce the risk of sport-related concussions in high school football players
In the East Bay in California, high school football players are suffering too many concussions. A single game can be responsible for multiple players leaving the field with a brain injury, and, recently, one player had to be wheeled off on a stretcher. Parents are struggling as they watch their kids get injured and are looking for a lifeline to prevent concussions. This lifeline has become Guardian Caps, and although they haven’t been proven to reduce concussions in high school football players, parents have been raising money to buy one for every player.
A recent study in the British Journal of Sports Medicine found that Guardian Caps (GCs), an add-on padded “shell device” that goes atop a helmet, do not reduce the risk of sport-related concussions (SRCs) in high school football players. Across more than 2600 high school football players, GC use during practice was not associated with decreased SRC risk in practices or in games, including when accounting for the increased risk factor of having sustained an SRC in the past. While laboratory experiments have shown that extra padding, such as GCs, can limit simulated head impact forces, and previous data from the NFL have shown a decrease in preseason concussions with GC use, no previous studies have looked at the real-world efficacy of high school GCs, which, notably, are a different model from those used in the NFL. The GCs worn in the NFL (the NXT model) weigh approximately 357 grams and are approximately 2.5 cm thick, while those worn by high schoolers (the XT model) weigh approximately 220 grams and are approximately 1.5 cm thick. Because of this difference, NFL studies cannot be extrapolated to high school athletes. This study illustrates that there is no evidence to suggest that the XT model GCs used by high school athletes reduce SRCs. Importantly, as Dr. Erin Hammer told the UW-Madison School of Medicine and Public Health, “... using these devices may provide false reassurance to players and their parents who are hoping to reduce their kids’ risk of concussion.”
Of the 180 SRCs recorded throughout the year by athletic trainers, 64 occurred during practice and 116 occurred during games. The number of SRCs occurring in practice was remarkably similar between GC-wearing and non-GC-wearing athletes; 33 of the practice-related concussions were in athletes wearing GCs, while 31 practice-related concussions were in athletes not wearing GCs. In what is standard practice among football players who wear GCs, athletes who wore GCs during practices did not wear them during games. Of the 116 game-related concussions, 68 occurred in athletes who wear GCs at practice, and 48 occurred in those who do not.
The authors urge sport-related institutions to implement evidence-based changes to reduce SRCs rather than pursuing new technologies that haven’t been proven to reduce SRCs in non-laboratory settings, such as GCs. They highlight three changes that have been connected to a reduction in SRCs: policies aimed at limiting contact in football practices (which reduced the rate of practice-related SRCs by 64%), coach participation in a comprehensive football safety training program (which reduced the rate of practice and game-related SRCs by 50%), and modifications to helmets with increased padding in targeted areas (which were associated with a 31% lower rate of SRC). These changes, while less flashy than technologies like GCs, have been proven to decrease the risk of SRC and should be the targets for high school leagues to improve the cognitive health of their athletes.
New with Us: Women in Global Health publishes Concussion Alliance Co-Founder Malayka Gormally’s story
This past June, Women in Global Health invited its chapter leaders in 65 countries to identify women “who are leading meaningful change in health at every level.” They were looking for stories of women who “Lead change in health at the grassroots level…[and] have stories that inspire community action.” WGH planned to publish the strongest 20 stories from around the world; this October, they published Concussion Alliance Co-founder and COO Malayka Gormally’s story about the founding and growth of Concussion Alliance! Malayka’s story was just one of two stories from the United States.
Older Adults
Standard assessment tools often miss the long-term burden of concussion on older adults
A recent systematic review by Lucas Tze Peng Tan and colleagues found that recovery after a mild traumatic brain injury (mTBI) is often incomplete and longer-lasting for older adults, with ongoing symptoms frequently missed by standard assessment tools. To better understand how recovery differs for older adults, the authors systematically reviewed studies examining physical, psychological, and cognitive outcomes in adults aged 65 and older following mTBI. Their review, published in European Geriatric Medicine, included 18 studies with a total of 3,549 participants. Those 18 studies reported that up to 66% of older adults had persistent impairments in activity and participation at six months post-injury. Approximately 24% experienced at least mild depression, and about 9% had moderate-to-severe anxiety. Cognitive recovery was varied, with ongoing deficits in processing speed, memory, and executive function. In these studies, global outcome measures, such as the Glasgow Outcome Scale–Extended, often fail to capture these domain-specific impairments.
The authors searched for publications in Medline/PubMed, Embase, and Cochrane Library through October 6, 2024, to select observational studies that reported recovery outcomes in adults 65 and older after mTBI. They assessed study quality using the QUIPS tool, a standardized framework used to assess risk of bias in prognostic studies (studies that examine the influence of specific predictive or risk factors on an outcome).
In older adults, “mild” TBI is not often truly mild. Many patients face prolonged and incomplete recovery across physical, cognitive, and psychological domains. Traditional outcome measures used by the studies in this systematic review may substantially underestimate this burden in the geriatric population. Future research should include adults 80 years and older, use multidimensional outcome measures tailored to geriatric cohorts, and extend follow-up beyond one year to guide more customised rehabilitation strategies.
Women’s Health
Gender differences found in concussion assessment; push for a more gender-specific approach
A study published in Neurotrauma identified key gender differences in sport-related concussion (SRC) not captured by standard unidimensional assessment tools––in this case, the Sport Concussion Assessment Tool (SCAT). Lead researcher Rachel Edelstein and her colleagues employed a systematic statistical approach to analyze data from 1,021 National Collegiate Athletic Association (NCAA) athletes (379 females and 642 males), who completed a Symptom Severity Checklist 3.0 (SCAT3) within 48 hours of sustaining a concussion. The researchers found that male athletes tended to be more conservative when reporting symptoms, and female athletes tended to more readily endorse emotional and physical symptoms, such as emotional distress, drowsiness, and sadness. The net effect of these observed trends was that female athletes’ average self-reported symptom severity was 21.6% higher than their male counterparts (30.06 vs. 24.71).
Edelstein et al. suggest that the SCAT incorporate a section specific to female athletes with items that assess menstrual cycle changes, mood changes, sleep disturbances related to hormonal fluctuations, migraine-like symptoms, and neck pain. The authors say that “by adopting a more nuanced, multidimensional approach, athletic training staff and healthcare providers can ensure more precise diagnosis and tailored interventions, ultimately improving outcomes for all athletes.”
In their analysis, the researchers found that the symptoms listed in the SCAT3 fell into four subcategories: neurocognitive, neurophysiological, neurosensory, and neuropsychiatric. The SCAT3 provides a single, composite score intended to capture the overall severity of concussion symptoms. However, combined with the gender differences the researchers found, these results suggest that a more nuanced, multidimensional scale would better reflect the range of experiences that athletes have with SRC.
This study has a few key limitations. First, although Edelstein et al. discuss the possibility that cultural influences may play a role in male underreporting, they acknowledge that their study does not account for psychological or social factors that might impede symptom reporting, and that further research is needed in this area. They also restricted their analysis to investigating differences based on biological sex rather than gender identity, using only “male” and “female” labels and excluding transgender and nonbinary athletes from the study. Finally, the authors mention that the uneven distribution of male and female athletes in their study has the potential to skew their results. However, they were able to verify that this imbalance was not affecting their results by performing additional statistical tests.
The authors note that males tended to try to exhibit “toughness” to conform to social norms of masculinity. This cultural norm may contribute to their findings of lower total self-reported symptom severity in male athletes, and the authors hypothesize that males are more likely to report symptoms only when they perceive them as severe enough to warrant concern.
In conclusion, this study emphasizes the need to modify standard concussion assessment tools, such as the SCAT, to incorporate gender-specific measures. While the SCAT3 effectively generalizes symptoms with a brief checklist, it fails to capture a full spectrum of symptoms that are often present in female athletes. Discrepancies in male reporting underscore the need to refine the SCAT3 assessment tools to more effectively capture underreporting among males, thereby avoiding the potential for overlooking symptom severity. Ultimately, this research provides a strong foundation for future adaptations for the SCAT. Clinicians need to understand the gender-specific responses to concussed athletes to enhance their diagnosis process and recovery. Edelstein et al. also recommend adding neuropsychological tests alongside the SCAT to better capture subtle or hidden symptoms, though they admit that this addition is not essential.
You Can Support Concussion Patients
Join our community of monthly donors committed to improving how concussions are prevented, managed, and treated, thereby supporting long-term brain health for all. Learn more.
You can also make an impact with a one-time gift or tax-friendly options such as Donor Advised Funds (DAFs), IRA Charitable Rollovers, and Planned Giving: leave a gift in your will. Learn more.