Hanover Startup Tackles Concussion Protocol With ‘SmartResponse’

  • SmartResponse CEO James Perkins reaches out to those involved in a conference call where they are checking on the progress of SmartResponse's software development at the Dartmouth Entrepreneurial Network office in Hanover, N.H., on Nov. 30, 2017. Perkins, of Corinth, Vt., is leading a group of medical experts and software engineers in the construction of the software that hopes to do for athletic department concussion response training what online driver education programs do for student drivers. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • SmartResponse CEO James Perkins listens to feedback from those part of a conference call checking on the progress of SmartResponse's software development at the Dartmouth Entrepreneurial Network office in Hanover, N.H., on Nov. 30, 2017. Perkins, of Corinth, Vt., is leading a group of medical experts and software engineers in the construction of the software that provides users with an “immersive” interactive experience similar to playing a video game in response to concussions. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Business Writer
Sunday, December 03, 2017

Hanover — James Perkins calls it “driver’s ed for institutional liability insurance.”

It may not exactly evoke the frisson of getting your driver’s license, but that’s how Perkins describes his new tech startup, which aims to provide online training for athletic department personnel in how to properly handle concussions suffered by team players on the field.

That kind of workplace training, according to Perkins, is not only critical in itself but will also help mitigate against a school’s or college’s liability insurance premiums, which can be substantial.

The Brain Trust, Perkins’ small Hanover company, is designing game software called SmartResponse that provides users with an “immersive” interactive experience similar to playing a video game. But instead of shooting at enemy warplanes or role-playing in a fantasy world, a person playing SmartResponse — a coach or athletic department staffer — is taught the correct protocols for dealing with sports concussions.

“We call it a digital delivery platform for best practices,” Perkins said from an office he uses at the Dartmouth Entrepreneurial Network co-working space on Currier Place in Hanover. “This kind of immersive learning is more effective than other learning modalities,” he believes, adding that so-called “serious gaming” is being adopted by the military and other institutions for training purposes.

SmartResponse has been developed in response to concussion training and management requirements from state and local governments as well as athletic governing bodies that have become prevalent in recent years. A person’s performance in playing the interactive training program is scored and a passing mark would earn certification, which could hold down insurance premiums, Perkins said.

Managing the effects of sports concussions has become a priority for schools and colleges since Washington state adopted in 2009 what became known the Zackery Lystedt Law, which prohibits a player suspected of sustaining a concussion from returning to practice or a game without first getting a licensed health care provider’s written approval. All 50 states have subsequently enacted some version of the law.

An interactive training video game that illustrates best practices in concussion response “can bend the curve by being of tremendous assistance to states, schools, districts, boards, administrators and coaches in terms of awareness and minimizing latent injuries from concussions,” said Nathaniel Fick, a Baltimore attorney who specializes in traumatic brain injury cases and is advising SmartResponse.

Fick notes that insurers discount premiums for liability coverage when enrollees certify they’ve participated in continuing education programs that address risk factors in their profession. “The more they can reduce risk the more profitable they are,” he said. “There’s a rationale to these things.”

Perkins expects to have a half-hour “preview” edition of SmartResponse available for review by schools and colleges soon and a full-scale, multi-hour edition ready for commercial release by the second quarter of 2018. New England College in Henneker, N.H., where SmartResponse recently held a public education seminar on concussion management, will participate as a beta test site.

Meet ‘Brandi’

Like a video game, Perkin’s concussion response training program has created its own fictional world, this one set in Janesville High School, which stars a sophomore soccer player named Brandi Chase; her coach, Laurie Jones; Director of Athletics Bill Hightower; 10th-grade history teacher Naomi DeMott; and a cast of bit players, including high school classmates, Brandi’s parents and a man in the bleachers who claims to be a “doctor” but is merely an argumentative bystander.

At various “decision points” throughout the video game questions are posed about how the coach should respond to a concussion injury and multiple answers are proposed that the game player can select. Each answer sends the video’s storyline in a different direction, although there is only one correct answer. The “experiential” learning method is supposed to reinforce the correct course of action, Perkins said.

The more that athletic and school staff can be trained in the correct protocols in handling student athlete concussions, the more favorably insurance companies may view it when assessing a school’s risk profile and calculating premium rates, said Hank James, former director of risk management at Dartmouth College and now an associate vice chancellor for risk management at the University of North Carolina who is advising SmartResponse.

“Concussions are a big deal in sports these days. Insurance companies want to see if schools and colleges have mechanisms in place to prevent any claims and address problems,” said James. “Any risk management tool that could be used to assist students with some kind of brain injury or concussion helps to mitigate that risk and change the risk profile of the institution.”

“Brandi” was the brainchild of Dr. Corey Burchman, a Dartmouth-Hitchcock Medical Center anesthesiologist and assistant professor of anesthesiology at Dartmouth’s Geisel School of Medicine, who has been working with Perkins on developing the prototype. He sketched out a handwritten synopsis of the opening scene and dialogue in which Brandi knocks heads with another soccer player and the various steps and options the coach faces in evaluating and responding to a concussion

“I went on the Centers for Disease Control (and Prevention) website that has online videos to familiarize people with the vagaries of head injuries and I thought we could do a better in engaging a learner with a game experience rather than with a passive PowerPoint presentation or listening to an online lecture,” Burchman said.

A Micro-Budget Production

Perkins said he assembled a micro-budget production team comprised of student interns from Dartmouth and elsewhere to produce the animation. He brought aboard Jim Murtha, an education industry adviser and former chief operating officer of The New School in New York, to work on the project and provide guidance.

Through Murtha the team was able to enlist the help of student actors to do the voice-over of the animated characters, which were recorded and mixed at New School studios and at Dartmouth’s Black Family Center for Visual Arts in Hanover.

“We are a startup company,” Perkins said. “We do things with a Band-Aid and bubble gum.”

To be sure, the animated characters in the video have the stilted look of early-generation computer animation and the narrative and dialogue are rough by Hollywood production standards. But using live actors would be prohibitively expensive given the number of scenes and potential storylines posed by the multiple question-and-answer format required in the training program, Perkins said.

Perkins, who lives in Corinth and who has worked with various technology startups over the years, said he and his partners have to date invested less than $100,000 in developing SmartResponse. The company’s work setting is typical of tech startups: anywhere a table with seats around it can be grabbed.

“We’ve had a lot of meetings at Salt hill Pub, Four Aces Diner and Lou’s,” Perkins said.

To bring experts into the project, Perkins has assembled a team of physicians and consultants in head injury medicine and science that also includes Morris Levin, a former clinical professor at Geisel and now chief of the Division of Headache Medicine and director of the Headache Center at University of California San Francisco Medical Center; and Robert Cantu, medical director and namesake of the Dr. Robert C. Cantu Concussion Center at Emerson Hospital in Concord, Mass. Both are considered leaders in the field.

Back to Class

Although the vast majority of high schools and colleges report having protocols in place for how to respond to concussions suffered by student players on the field, less prevalent is training for teachers in meeting the challenges of students in a classroom “return to learn” setting. After all, it is frequently in the classroom where the student may manifest latent signs of the consequences of the injury.

SmartResponse takes this into account in the prototype video, in which the trainee assumes the role of Brandi’s high school history teacher and is then presented with different classroom scenarios involving Brandi’s post-concussion adverse reactions to light, noise and learning tasks.

In one scene, for example, Brandi walks into the classroom wearing sunglasses because her concussion has caused her to have a sensitivity to light. But it is “against school policy” for students to wear sunglasses in class. The question is posed: What is the proper response for the teacher — should she tell Brandi to remove the glasses or should she be allowed to wear them? Brandi’s sensitivity to noise presents a challenge when assigning her to a project workgroup — how should the teacher rearrange the workgroup to minimize the noise for Brandi? (We won’t give away the answers).

Perkins plans to use the half-hour preview version of SmartResponse as a prototype to attract investors. He estimates he needs about $500,000 to produce the first commercially releasable product, which would take a learner between an hour to two hours to play, depending on his or her proficiency in responding to various scenarios and questions.

The program would be cloud-based and participating schools and colleges would pay a quarterly subscription fee gauged to their size and staff. There may even be a free version for use at home by parents, he said.

Education and training are key to dealing with the challenge of concussions, said Burchman, the DHMC anesthesiologist — and that’s where SmartResponse will come into play.

“You can’t prevent the first concussion,” Burchman said, “but you can do a lot to prevent the damage that might be caused as a result of it.”

John Lippman can be reached at jlippman@vnews.com.