The Case for Prevention: A New Way to Assess Concussion Risk
By the time a concussion is diagnosed, the opportunity for prevention has already passed. We can diagnose a head injury after it happens. We can manage recovery. But when it comes to reducing risk before the next hit, the next fall, the next collision– too often, the tools are either incomplete or impractical.
At the University of North Carolina Wilmington at the College of Health and Human Sciences, that gap has become the focus of two athletic trainers who have spent their careers thinking upstream. For Dr. Lindsey H. Schroeder, Associate Professor, Exercise Science and Dr. Alex McDaniel, Associate Professor, Athletic Training, prevention isn’t a buzzword– it’s the core of their profession. “Athletic trainers have a very niche job within the healthcare realm, and it’s prevention,” Schroeder explained. “We’re with our patients before they’re actually our patients… we’re afforded the ability to prevent certain things or attempt to prevent certain things.”
It’s also why concussions became impossible to ignore.
When Schroeder and McDaniel were both junior faculty, they were still figuring out what kind of research they wanted to build their careers around. They knew they wanted it to be rooted in prevention– and they knew concussions were “such… an overwhelmingly large portion of an athletic trainer’s job,” especially in sports like football. The question became: what could they tackle that might actually help clinicians and athletes before injury occurs?
A key early moment came when McDaniel attended a strength and conditioning conference and saw a device marketed as improving neck strength to help prevent concussions. It was a bold claim, and it sparked an obvious next question: how would you know if anything actually changed?
Schroeder put it simply: “Anytime you do any sort of program… you need to be able to measure at baseline, and at least at baseline and post.” But when they looked for a practical way to assess neck strength before and after training, they ran into a problem– nothing on the market fit their needs. The options were “way too expensive,” required “large physical space,” and weren’t realistic for new faculty without labs or major funding. “We had no lab space whatsoever,” Schroeder said.
So they did what clinicians often learn to do in the real world: they built what they needed.
“If something doesn’t exist, [we] just create it,” Schroeder said. She drew from her experience in a high school setting, where limited resources demand creativity: “I had 750 athletes and a $1,500 budget. You got to try to find a way to make things stretch.” Working within those constraints had taught her how to repurpose what was available—and how to stay focused on what mattered most.
Together, Schroeder and McDaniel used “off the shelf items” to create an early prototype capable of measuring neck strength isometrically– static strength in four directions. It gave them what they didn’t have before: a way to capture baseline and then measure change after an intervention. The project gained momentum as they iterated, learned, and refined.
But over time, they began to realize that the most important part of the story might not be strength alone.
“Neck strengthening is kind of a misnomer,” McDaniel explained. “It’s not just the strength of the muscle. It’s the ability of the muscle to contract fast and quickly.” In other words: if the goal is to reduce concussion risk, it’s not enough to build a stronger neck. The body also needs the ability to respond rapidly when force hits—so the head and neck can stabilize fast enough to reduce sudden movement.
McDaniel offered an analogy most people can immediately grasp training for size (hypertrophy) and strength is different from training for speed and power. “If the goal is I need to reduce concussions,” he said, “then just getting the neck stronger is not going to do much… The goal should be, I need to get the twitch of my muscle faster.”
That distinction became central to how they thought about prevention. Impacts and collisions happen quickly– too quickly for strength alone to matter if the neuromuscular system can’t react in time. Their aim became not just measuring how much force a person can produce, but how quickly their neck can respond and attenuate force when an impact occurs.
McDaniel described it in physical, everyday terms: in a sudden event like a car crash, the head can snap forward and back. “The amount of displacement, and the time that it takes… and the time that it takes for the muscles to contract and try and realign the neck,” he said, “that all affects the brain moving around inside the skull.” If the neck can react faster– shortening what he called the “latency period”– the head may move less, and the brain may experience less abrupt motion.
That’s the gap they believe existing approaches often miss: many tools and programs focus on strength, but not on the speed of response.
Today, with support from NCInnovation, Schroeder and McDaniel are advancing Prototype 3A– a system designed to capture both static strength and a dynamic assessment tied to reaction time and adaptation. The goal is to create a quick, usable assessment that fits into real settings, not just controlled environments.
The experience begins with a baseline. Schroeder described the static portion as measuring in four directions– flexion, extension, and left and right lateral flexion– using a head harness connected by a cable to the device, and another cable attached to a fixed structure. “Anything that’s fixed,” she noted. A mobile app provides a countdown, and the person pulls against the device while the measurement is recorded. The process repeats across all four directions.
That baseline then informs the dynamic portion of Prototype 3A. The system applies a pull calibrated to the individual’s own measured capability, and the assessment focuses on how the person responds– both when they can brace and when the pull is not anticipated. The intention is to quantify reaction time and adaptation under conditions that better resemble real-life forces, without requiring a long or burdensome test.
Just as important as the science is the learning curve of translation– moving from a strong clinical concept to something that could be used widely and responsibly. Schroeder didn’t sugarcoat how different that journey has been. “Ninety percent of it is the learning moment,” she said. “We are clinicians.” The business and development side– patents, customer discovery, understanding the pathway from prototype to product– wasn’t part of their original training. “We know nothing about business, patent process, customer process,” she said, describing how they would leave meetings and “have to go home and do homework.”
NCInnovation’s role, they emphasized, has been to help remove barriers that exist outside the lab– supporting connections, strategy, and the practical steps that make it possible to move from an early build to a tool with real-world potential. Along the way, their work has also benefited from input and expertise from colleagues across disciplines who can help strengthen the technology and its analytical foundation.
The team has also taken initial steps to protect the innovation, with a patent issued, and they see a longer runway ahead. Future possibilities– such as refining the algorithm over time through data collection and pursuing larger validation efforts– are aspirations they intend to work toward as the tool matures and evidence builds.
For Schroeder, the “why” keeps coming back to the people behind the injuries. “When you practice clinically,” she said, “you’ve got patients that you can think of [who] sustained serious concussions or traumatic brain injury (TBI)… and you see the behavior change, and you see the impact that it has on not just them, but their families.” Prevention, she added, isn’t about promises that nothing will ever happen. “There’s no way that you can prevent everything,” she said. But if you could reduce even a fraction of injuries– or even a portion of cumulative damage over time– “I think that ultimately is why Alex and I started doing this.”
