The most important piece of equipment donned by a football player is the helmet. Designed initially to protect against skull fractures, newer versions seek to protect against mild traumatic brain injury (mTBI)/concussion. A long way from leather bonnets, modern football helmets are technologically sophisticated and expensive.

Football helmets, what do you know? True or false?

1. The first football helmet was fashioned by an Army sergeant.

2. There are about 50,000 mTBI/concussions annually in high school football.

3. Only about 47 percent of mTBI/concussions are reported.

Navy Admiral Joseph Mason Reeves was a fierce warrior on the football field. After he sustained a blow to the head that rendered him 'senseless,' he was told by his physician that he could not play in the Army-Navy game because he risked death or “instant insanity. ” The good Admiral was down but not out and visited an Annapolis shoemaker who constructed a leather bonnet. His physician gave him the OK to play and in Fall 1893 the midshipman became the first football player in history to wear a helmet. Navy 6 Army 4.

When there is a concussive force to the head or body, the resultant movement of the head causes a jolt to the brain. This is what happens in a mild traumatic brain injury (mTBI) also called concussion. The familiar dazed look, staggering gait and symptoms of memory loss and confusion occur because the brain is not functioning normally.

Helmet manufacturers have long hoped to design a helmet that would limit brain movement and decrease mTBI/concussion. But how? Xenith, Riddell and other helmet manufacturers are working on this engineering dilemma. Currently, there are no helmets that protect against mTBI/concussion.

In 2008, Xenith unveiled their X1 model, which they touted as offering protection from concussion. The outer shell is familiar but there is an inner cap that Xenith calls a “Shock Bonnet. ” It is designed to fit tight against the scalp when the chin straps are pulled ensuring snug, tailored fit. This Shock Bonnet has 18 discs, which compress upon impact and disperse energy away from the skull. Less movement of the skull means less movement of the brain inside the skull.

Riddell's SpeedFlex helmet boasts a differently designed outer shell which is flexible and moves about 1/4 inch on impact. An inner “InSite Impact Response System” detects the magnitude of force inflicted upon the head and sends this data to a hand-held electronic receiver. Coaches and sideline medical teams can monitor this information to determine if there has been a significant blow to the head or multiple blows that may place the athlete at risk. How many blows are too many? We just don't know. What constitutes a significant blow? We don't know the answer to that question either. However, the University of Arkansas football team may help us get answers. Beginning this season the Razorbacks will don these high tech helmets. There are limited quantities of the SpeedFlex for 2014 with full rollout expected in 2015.

At more than $300 each, the X1 is among the most expensive helmets on the market and the retail price of the SpeedFlex is expected to be higher. The cost for the InSite monitor system will be separate. The SpeedFlex with InSite would cost a college team upwards of $50,000.

Whether the newer helmets protect against mTBI/concussion remains to be seen. Some athletes may become more aggressive and take more risks if they perceive they are invincible.

Necessity is the mother of invention, as Admiral Reeves demonstrated. His idea decreased the rates of skull fractures (and deaths) dramatically. One-hundred twenty-one years later, the high tech helmets just might do the same for mTBI/concussion. We can only hope.

Answers: 1. F; 2. F (68,000); 3. T.

Dr. Lori Boyajian-O’Neill can be contacted at .