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Tooby J, Till K, Gardner A, Stokes K, Tierney G, Weaving D, Rowson S, Ghajari M, Emery C, Bussey MD, Jones B. When to Pull the Trigger: Conceptual Considerations for Approximating Head Acceleration Events Using Instrumented Mouthguards. Sports Med 2024:10.1007/s40279-024-02012-5. [PMID: 38460080 DOI: 10.1007/s40279-024-02012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.
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Affiliation(s)
- James Tooby
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Leeds Rhinos Rugby League Club, Leeds, UK
| | - Andrew Gardner
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Keith Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
- Medical Services, Rugby Football Union, Twickenham, UK
| | - Gregory Tierney
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Sport and Exercise Sciences Research Institute, School of Sport, Ulster University, Belfast, UK
| | - Daniel Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Steve Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
- Leeds Beckett University, Leeds, UK
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie Dawn Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and Sports Science Institute of South Africa, Cape Town, South Africa
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
- Rugby Football League, England Performance Unit, Red Hall, Leeds, UK
- Premiership Rugby, London, UK
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2
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Bussey MD, Salmon D, Romanchuk J, Nanai B, Davidson P, Tucker R, Falvey E. Head Acceleration Events in Male Community Rugby Players: An Observational Cohort Study across Four Playing Grades, from Under-13 to Senior Men. Sports Med 2024; 54:517-530. [PMID: 37676621 PMCID: PMC10933157 DOI: 10.1007/s40279-023-01923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The aim of this study was to examine the cumulative head acceleration event (HAE) exposure in male rugby players from the Under-13 (U13) to senior club level over 4 weeks of matches and training during the 2021 community rugby season. METHODS This prospective, observational cohort study involved 328 male rugby players. Players were representative of four playing grades: U13 (N = 60, age 12.5 ± 0.6 years), U15 (N = 100, age 14.8 ± 0.9 years), U19 (N = 78, age 16.9 ± 0.7 years) and Premier senior men (N = 97, age 22.5 ± 3.1 years). HAE exposure was tracked across 48 matches and 113 training sessions. HAEs were recorded using boil-and-bite instrumented mouthguards (iMGs). The study assessed the incidence and prevalence of HAEs by ages, playing positions, and session types (match or training). RESULTS For all age grades, weekly match HAE incidence was highest at lower magnitudes (10-29 g). Proportionally, younger players experienced higher weekly incidence rates during training. The U19 players had 1.36 times the risk of high-magnitude (> 30 g) events during matches, while the U13 players had the lowest risk compared with all other grades. Tackles and rucks accounted for the largest HAE burden during matches, with forwards having 1.67 times the risk of > 30 g HAEs in rucks compared with backs. CONCLUSIONS This study provides novel data on head accelerations during rugby matches and training. The findings have important implications for identifying populations at greatest risk of high cumulative and acute head acceleration. Findings may guide training load management and teaching of skill execution in high-risk activities, particularly for younger players who may be exposed to proportionally more contact during training and for older players during matches.
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Affiliation(s)
- Melanie D Bussey
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand.
| | | | - Janelle Romanchuk
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
- New Zealand Rugby, Wellington, New Zealand
| | - Bridie Nanai
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Peter Davidson
- School of Physical Education, Sports and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Ross Tucker
- Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
- World Rugby, Dublin, Ireland
| | - Eanna Falvey
- World Rugby, Dublin, Ireland
- School of Medicine & Health, University College Cork, Cork, Ireland
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Luke D, Kenny R, Bondi D, Clansey AC, Wu LC. On-field instrumented mouthguard coupling. J Biomech 2024; 162:111889. [PMID: 38071791 DOI: 10.1016/j.jbiomech.2023.111889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
Instrumented mouthguard (iMG) sensors have been developed to measure sports head acceleration events (HAE) in brain injury research. Laboratory validation studies show that effective coupling of iMGs with the human skull is crucial for accurate head kinematics measurements. However, iMG-skull coupling has not been investigated in on-field sports settings. The objective of this study was to assess on-field iMG coupling using infrared proximity sensing and to investigate coupling effects on kinematics signal characteristics. Forty-two university-level men's ice hockey (n = 21) and women's rugby (n = 21) athletes participated in the study, wearing iMGs during 6-7 month in-season periods. Proximity data classified video-verified HAE recordings into four main iMG coupling categories: coupled (on-teeth), decoupling (on-teeth to off-teeth), recoupling (off-teeth to on-teeth) and decoupled (off-teeth). Poorly-coupled HAEs showed significantly higher peak angular acceleration amplitudes and greater signal power in medium-high frequency bands compared with well-coupled HAEs, indicating potential iMG movements independent of the skull. Further, even video-verified true positives included poorly-coupled HAEs, and iMG coupling patterns varied between the men's hockey and women's rugby teams. Our findings show the potential of using proximity sensing in iMGs to identify poorly-coupled HAEs. Utilizing this data screening process in conjunction with video review may mitigate a key source of sensor noise and enhance the overall quality of on-field sports HAE datasets.
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Affiliation(s)
- David Luke
- School of Biomedical Engineering, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC V6T 2B9, Canada; Department of Mechanical Engineering, The University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC V6T 1Z4, Canada
| | - Rebecca Kenny
- Department of Mechanical Engineering, The University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC V6T 1Z4, Canada
| | - Daniel Bondi
- Department of Mechanical Engineering, The University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC V6T 1Z4, Canada
| | - Adam C Clansey
- Department of Mechanical Engineering, The University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC V6T 1Z4, Canada
| | - Lyndia C Wu
- School of Biomedical Engineering, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC V6T 2B9, Canada; Department of Mechanical Engineering, The University of British Columbia, 6250 Applied Science Ln Room 2054, Vancouver, BC V6T 1Z4, Canada.
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Smith CR, Onate JA, Edwards NA, Hagen JA, Kolba C, Paur S, Walters J, Caccese JB. Characterizing Head Acceleration Events in Law Enforcement Cadets During Subject Control Technique Training. Ann Biomed Eng 2023:10.1007/s10439-023-03382-z. [PMID: 37847420 DOI: 10.1007/s10439-023-03382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Law enforcement cadets (LECs) complete weeks of subject control technique training. Similar sport-related combat training has been shown to expose participants to head acceleration events (HAEs) that have potential to result in short- and long-term impairments. The purpose of this study was to describe the number and magnitude of HAEs in LECs throughout their training. 37 LECs (7 females; age = 30.6 ± 8.8 years; BMI = 30.0 ± 6.0) were recruited from a law enforcement organization. Participants wore instrumented mouthguards, which recorded all HAEs exceeding a resultant 5 g threshold for training sessions with the potential for HAEs. Participants completed three defensive tactics (DT) training sessions, a DT skill assessment (DTA), and three boxing sessions. Outcome measures included the number of HAEs, peak linear acceleration (PLA), and peak rotational velocity (PRV). There were 2758 true-positive HAEs recorded across the duration of the study. Boxing sessions accounted for 63.7% of all true-positive HAEs, while DT accounted for 31.4% and DTA accounted for 4.9%. Boxing sessions resulted in a higher number of HAEs per session (F2,28 = 48.588, p < 0.001, ηp2 = 0.776), and higher median PLA (F2,28 = 8.609, p = 0.001, ηp2 = 0.381) and median PRV (F2,28 = 11.297, p < 0.001, ηp2 = 0.447) than DT and DTA. The LECs experience a high number of HAEs, particularly during boxing sessions. Although this training is necessary for job duties, HAE monitoring may lead to modifications in training structure to improve participant safety and enhance recovery.
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Affiliation(s)
- Carly R Smith
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- Human Performance Collaborative, The Ohio State University, Columbus, OH, USA
| | - Nathan A Edwards
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- Human Performance Collaborative, The Ohio State University, Columbus, OH, USA
| | - Joshua A Hagen
- Human Performance Collaborative, The Ohio State University, Columbus, OH, USA
| | - Chris Kolba
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Scott Paur
- Franklin County Sheriff's Office, Columbus, OH, USA
| | | | - Jaclyn B Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA.
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Filben TM, Tomblin BT, Pritchard NS, Bullock GS, Hemmen JM, Neri KE, Krug V, Miles CM, Stitzel JD, Urban JE. Assessing the association between on-field heading technique and head impact kinematics in a cohort of female youth soccer players. SCI MED FOOTBALL 2023:1-10. [PMID: 37753837 DOI: 10.1080/24733938.2023.2264272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
There is concern that exposure to soccer headers may be associated with neurological sequelae. Training proper heading technique represents a coachable intervention that may reduce head acceleration exposure. The objective was to assess relationships between heading technique and head kinematics in female youth soccer players. Fourteen players (mean age = 14.4 years) wore instrumented mouthpieces during practices and games. Headers were reviewed by three raters to assign a technique score. Mixed models and LASSO regression evaluated associations of technique with peak linear acceleration (PLA), rotational acceleration (PRA), rotational velocity (PRV), and head impact power ratio (HIP Ratio) while adjusting for session type and ball delivery. Two hundred eighty-nine headers (n = 212 standing, n = 77 jumping) were analyzed. Technique score (p = 0.043) and the technique score - session type interaction (p = 0.004) were associated with PRA of standing headers, whereby each 10-unit increase in technique score was associated with an 8.6% decrease in PRA during games but a 5.1% increase in PRA during practices. Technique was not significantly associated with any other kinematic metrics; however, peak kinematics tended to decrease as technique score increased. LASSO regression identified back extension and shoulder/hip alignment as important predictors of peak kinematics. Additional research on heading technique and head acceleration is recommended.
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Affiliation(s)
- Tanner M Filben
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Brian T Tomblin
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Garrett S Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jordan M Hemmen
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristina E Neri
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Victoria Krug
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
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Holcomb TD, Marks ME, Stewart Pritchard N, Miller L, Espeland MA, Miles CM, Moore JB, Foley KL, Stitzel JD, Urban JE. Characterization of Head Acceleration Exposure During Youth Football Practice Drills. J Appl Biomech 2023; 39:157-168. [PMID: 37105545 PMCID: PMC10809728 DOI: 10.1123/jab.2022-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023]
Abstract
Many head acceleration events (HAEs) observed in youth football emanate from a practice environment. This study aimed to evaluate HAEs in youth football practice drills using a mouthpiece-based sensor, differentiating between inertial and direct HAEs. Head acceleration data were collected from athletes participating on 2 youth football teams (ages 11-13 y) using an instrumented mouthpiece-based sensor during all practice sessions in a single season. Video was recorded and analyzed to verify and assign HAEs to specific practice drill characteristics, including drill intensity, drill classification, and drill type. HAEs were quantified in terms of HAEs per athlete per minute and peak linear and rotational acceleration and rotational velocity. Mixed-effects models were used to evaluate the differences in kinematics, and generalized linear models were used to assess differences in HAE frequency between drill categories. A total of 3237 HAEs were verified and evaluated from 29 football athletes enrolled in this study. Head kinematics varied significantly between drill categorizations. HAEs collected at higher intensities resulted in significantly greater kinematics than lower-intensity drills. The results of this study add to the growing body of evidence informing evidence-based strategies to reduce head impact exposure and concussion risk in youth football practices.
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Affiliation(s)
- Ty D. Holcomb
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Madison E. Marks
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - N. Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Logan Miller
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Mark A. Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kristie L. Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC
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7
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Norris C. Annals of Biomedical Engineering 2022 Year in Review. Ann Biomed Eng 2023; 51:865-867. [PMID: 37010647 DOI: 10.1007/s10439-023-03191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Carly Norris
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24060, USA.
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8
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Arbogast KB, Funk JR, Solomon G, Crandall J. Measuring Head Acceleration Like a CHAMP. J Athl Train 2023; 58:283-284. [PMID: 36521167 PMCID: PMC11215641 DOI: 10.4085/1062-6050-0516.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Gary Solomon
- Player Health and Safety Department, National Football League, New York, NY
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Powell DRL, Petrie FJ, Docherty PD, Arora H, Williams EMP. Development of a Head Acceleration Event Classification Algorithm for Female Rugby Union. Ann Biomed Eng 2023; 51:1322-1330. [PMID: 36757631 PMCID: PMC10172216 DOI: 10.1007/s10439-023-03138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/25/2022] [Indexed: 02/10/2023]
Abstract
Instrumented mouthguards have been used to detect head accelerations and record kinematic data in numerous sports. Each recording requires validation through time-consuming video verification. Classification algorithms have been posed to automatically categorise head acceleration events and spurious events. However, classification algorithms must be designed and/or validated for each combination of sport, sex and mouthguard system. This study provides the first algorithm to classify head acceleration data from exclusively female rugby union players. Mouthguards instrumented with kinematic sensors were given to 25 participants for six competitive rugby union matches in an inter-university league. Across all instrumented players, 214 impacts were recorded from 460 match-minutes. Matches were video recorded to enable retrospective labelling of genuine and spurious events. Four machine learning algorithms were trained on five matches to predict these labels, then tested on the sixth match. Of the four classifiers, the support vector machine achieved the best results, with area under the receiver operator curve (AUROC) and area under the precision recall curve (AUPRC) scores of 0.92 and 0.85 respectively, on the test data. These findings represent an important development for head impact telemetry in female sport, contributing to the safer participation and improving the reliability of head impact data collection within female contact sport.
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Affiliation(s)
- David R L Powell
- ZCCE, Faculty of Science and Engineering, Swansea University, Wales, UK.,Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Freja J Petrie
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Paul D Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.,Institute for Technical Medicine (ITeM), Furtwangen University, Villingen Schwenningen, Germany
| | - Hari Arora
- ZCCE, Faculty of Science and Engineering, Swansea University, Wales, UK
| | - Elisabeth M P Williams
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK.
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