Human Performance, Performance | Jul 11, 2016
Stanford's Director of Athletic Training on Brain Performance

Scott Anderson, Director of Athletic Training for Stanford University, on brain performance, the concussion dilemma and the impact of technology.

As a leader in the sports medicine profession, I’ve seen and been a part of many exciting events, individual and team accolades, and various scientific breakthroughs with application to sport. Also, I live and work in the epicentre of the tech world! A world where anything seems possible and discovery is as common as your daily Starbucks order. There is so much potential here to change everything. I’ve heard that word used over and over again – potential – usually when the most highly anticipated gadget arrives promising to disrupt your way of going about life. Sadly, aside from the occasional Google or Tesla, many tech companies lack hard science supporting their claims, and as a result many fail to deliver on that promise – even those used today in elite sport.

So I remain sceptical, not about the impact of technology in sport, but in those who can actually carry it across the finish line. In my world, it doesn’t take someone special to discover something novel, but it does if they plan to see it through all the way to its full – you guessed it – potential. That is the true essence of disruption.

Not coincidental to start-up life in the Silicon Valley is how narrow the gap between winning and losing in sport has become. A play made here, a foul not committed there, or even a ref’s inexplicable mistake are all part of the acknowledged and accepted equation that defines success and failure these days. I think we can all agree that the most minuscule detail can be the difference between a champion and a pretender. Can legitimate technological advancements influence this? Perhaps, because let’s face it – isn’t that what we are all after? That 1 per cent edge that differentiates us, and makes me better than you.

Despite my scepticism, I believe in potential. And here’s why.

What is Brain Performance?

What if I told you there was a way to unlock a number of ‘secret’ access levels and rewards on your gaming console based solely on your ability to finely tune your vision to the screen?

How would productivity improve if employers were able to monitor how much time an employee spends focused on their daily duties?

Would you believe me if I said that the quality of one’s eye movements will be a determining factor in achieving elite athletic performance?

The brain operates by planning 2.5 seconds into the future. It is constantly assessing its environment, in anticipation of what is about to happen. This predictive brain function is critical to attention, in order to synchronise incoming information from the outside world with one’s actions. It is required for simple tasks such as driving a car, riding a bike, etc but also for complex sensorimotor tasks often seen in sport. For example, if I throw a ball to you, you don’t see it in real time – your brain is predicting the speed and trajectory and anticipating the point at which it will arrive, and coordinates receiving the ball with the motor system. This sequence is a highly coordinated effort that results in a fluid output of cognitive operations, based on the ability to predict. This state of orientation, known as ‘paying attention’ is the byproduct of the brain operating in the future.

How is this predictive state of timing achieved? As a visual task is initiated, the cerebellum is activated and temporarily inhibits the forward response (similar to the breaks on a car), allowing for the synchronisation of the sensorimotor responses to be timed perfectly with the actual task in real time. People who excel at this are highly coordinated, move efficiently, and acquire skill through repetition with ease. Those that are not adept at this exhibit poor coordination and are injury prone.

Paying attention, or the ability to maintain focus, is a common link that bonds many elite athletes today. At times it is the difference between the minor leagues and the majors, the amateur circuit and the pro tour, and a job or no job. The ability to concentrate so as to avoid mistakes is a common element seen in most sports, and some of the world’s elite athletes have fine-tuned this skill to the highest level. The measurement of ability in this regard is a function of Brain Performance, however it may not simply be reserved for recreational tasks and elite sport anymore. Today, we can now measure the quality of brain performance in all humans, leading us to a seemingly endless road of applications. Identifying increased injury risk in athletes training under stress? Using ocular-motor analytics to determine the quality of synchronisation in hi-level performers? Objectively measuring improvement in attention with specific training?  All seem possible in the new frontier that is Brain Performance.

 A Window into the Brain

The eyes are the most directly accessible motor component of the brain. The brain uses the eyes to orient itself in time and space, and since visual tracking and attention share similar neural networks we can perform assessments on the eyes to determine the quality of Brain Performance. Using normative data derived from military and athletic studies, we can measure variability in eye movements and determine a deviation in the quality of attention focus. This is the signature used in identifying how well the brain is performing in real time.

– How well does this athlete concentrate?

– Can he maintain his focus well or does he get distracted easily?

– Can he shift his attention rapidly from one aspect of the field to another, and back again?

We can answer each of these questions in a reliable way by assessing the quality of eye movements.

The Concussion Dilemma

A wise person once told me that ‘speculation is the enemy of calm’ – we’ve entered a chaotic time regarding concussion because of one fundamental reason. We don’t know enough about concussion to properly understand what it is!  We’ve reached a tipping point that has led to public confusion, frightened parents, and an industry arms race. Each has been perpetuated because we lack the science to deliver the objective tests needed (similar to those used in imaging of musculoskeletal injuries) that lead us to proper diagnosis. Thus, recovery from concussion is unknown. Despite these challenges, the potential remains.

Concussion was recently redefined as a change in brain function that should be measured by neurological or cognitive changes (among other criteria). However, in many cases today we continue to rely on the reporting of subjective symptoms as our basis for diagnosis. In cases of concussion where attention is measured, we see large variability in Brain Performance, as evidence by large forward eye movements, known as saccades (see chart below). These specific eye movements confirm to us that visual attention is impaired. The predictive brain plan, operating 2.5 seconds ahead of real time, is no longer inhibited properly by the cerebellum (the brakes on the car are no longer working), causing the eye movements to jump ahead in incorrect anticipation.

Insight - Stanford in Article Image - Featured Article

Obviously, poor performance recovery due to sleep deprivation is a common issue in athlete management today. This fatigue metric associated with decreased Brain Performance has tremendous implications, not just in sport, but for daily life events as well.  Those with poor spatial attention exhibit similar sport risk profiles as those with concussion. Under these conditions, it is obvious to even non-medical personnel that the athlete is not ready for competition, and one could argue it is not safe for them to participate in sport until recovery improves – usually with more productive sleep habits.

Tomorrow’s Discoveries are Yesterday’s Future

As leaders, it is our responsibility to question the status quo, drive innovation, and integrate disruptive applications to drive performance improvements. This is the methodology for identifying the 1 per cent difference we are all seeking. There remain many unanswered questions, but with today’s emphasis on fitness, sport, and injury prevention, we continue to chip away at the iceberg. We can remain sceptical but still believe in the impact of technology. Without it, we may miss our chance at transcending physical preparedness and medicine forever.


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