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Roby PR, Mozel AE, Grady MF, Master CL, Arbogast KB. Neurovascular Coupling in Acutely Concussed Adolescent Patients. J Neurotrauma 2024. [PMID: 38468544 DOI: 10.1089/neu.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Neurovascular coupling (NVC) uniquely describes cerebrovascular response to neural activation and has demonstrated impairments following concussion in adult patients. It is currently unclear how adolescent patients experience impaired NVC acutely following concussion during this dynamic phase of physiological development. The purpose of this study was to investigate NVC in acutely concussed adolescent patients relative to controls. We recruited patients presenting to a sports medicine practice within 28 days of a concussion or a musculoskeletal injury (controls). Transcranial Doppler ultrasound was used to measure changes in patients' posterior cerebral artery (PCA) velocity in response to two progressively challenging visual tasks: (1) reading and (2) visual search. Each task was presented in five 1-min trials (20 sec eyes closed/40 sec eyes open). Resting PCA velocity data were derived by averaging PCA velocity across a 2-min baseline period that preceded the visual tasks. Filtered task data were converted to time-series curves representing 40 consecutive 1-sec averages for each trial. Curves were then averaged across the five trials and time-aligned to stimulus onset (eyes open) to generate a single ensemble-averaged 40-sec curve representing NVC response for each participant for each task. Independent t tests were used to assess group differences (concussion vs. control) in resting PCA velocity. Separate linear mixed-effects models were used to evaluate group differences (concussion vs. control) in NVC response profiles for both visual tasks and group-by-task interaction. Twenty-one concussion patients (female = 8 [38.1%]; age = 14.4 ± 1.9 years) and 20 controls (female = 7 [35.0%]; age = 14.4 ± 1.9 years) were included in our analysis. Average resting PCA velocity did not significantly differ between concussion patients (36.6 ± 8.0 cm/sec) and controls (39.3 ± 8.5 cm/sec) (t39 = 1.06; p = 0.30). There were no significant group differences in relative NVC response curves during the reading task (F1,1560 = 2.23; p = 0.14) or the visual search task (F1,1521 = 2.04; p = 0.15). In contrast, the differential response to task (e.g., increase from reading task to visual search task) was significantly greater in concussion patients than in controls (p < 0.0001). The NVC response to the visual search task was 7.1% higher than the response to reading in concussion patients relative to being 5.5% higher in controls. Our data indicate that concussed patients present with a significantly greater response to more difficult tasks than do controls, suggesting that concussed adolescents require increased neural resource allocation as task difficulty increases. The study provides insight into the neurophysiological consequences of concussion in adolescent patients.
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Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne E Mozel
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sports Medicine Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sports Medicine Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Fitzgerald B, Bari S, Vike N, Lee TA, Lycke RJ, Auger JD, Leverenz LJ, Nauman E, Goñi J, Talavage TM. Longitudinal changes in resting state fMRI brain self-similarity of asymptomatic high school American football athletes. Sci Rep 2024; 14:1747. [PMID: 38243048 PMCID: PMC10799081 DOI: 10.1038/s41598-024-51688-2] [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: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024] Open
Abstract
American football has become the focus of numerous studies highlighting a growing concern that cumulative exposure to repetitive, sports-related head acceleration events (HAEs) may have negative consequences for brain health, even in the absence of a diagnosed concussion. In this longitudinal study, brain functional connectivity was analyzed in a cohort of high school American football athletes over a single play season and compared against participants in non-collision high school sports. Football athletes underwent four resting-state functional magnetic resonance imaging sessions: once before (pre-season), twice during (in-season), and once 34-80 days after the contact activities play season ended (post-season). For each imaging session, functional connectomes (FCs) were computed for each athlete and compared across sessions using a metric reflecting the (self) similarity between two FCs. HAEs were monitored during all practices and games throughout the season using head-mounted sensors. Relative to the pre-season scan session, football athletes exhibited decreased FC self-similarity at the later in-season session, with apparent recovery of self-similarity by the time of the post-season session. In addition, both within and post-season self-similarity was correlated with cumulative exposure to head acceleration events. These results suggest that repetitive exposure to HAEs produces alterations in functional brain connectivity and highlight the necessity of collision-free recovery periods for football athletes.
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Affiliation(s)
- Bradley Fitzgerald
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA.
| | - Sumra Bari
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Nicole Vike
- Department of Computer Science, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Roy J Lycke
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Joshua D Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Eric Nauman
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Joaquín Goñi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA
| | - Thomas M Talavage
- Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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McIver KG, Lee P, Bucherl S, Talavage TM, Myer GD, Nauman EA. Design Considerations for the Attenuation of Translational and Rotational Accelerations in American Football Helmets. J Biomech Eng 2023; 145:061008. [PMID: 36628996 PMCID: PMC10782865 DOI: 10.1115/1.4056653] [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: 07/07/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
Participants in American football experience repetitive head impacts that induce negative changes in neurocognitive function over the course of a single season. This study aimed to quantify the transfer function connecting the force input to the measured output acceleration of the helmet system to provide a comparison of the impact attenuation of various modern American football helmets. Impact mitigation varied considerably between helmet models and with location for each helmet model. The current data indicate that helmet mass is a key variable driving force attenuation, however flexible helmet shells, helmet shell cutouts, and more compliant padding can improve energy absorption.
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Affiliation(s)
- Kevin G. McIver
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Patrick Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Sean Bucherl
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Thomas M. Talavage
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907
| | - Gregory D. Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA 30542; Emory Sports Medicine Center, Atlanta, GA 30329; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30329; The Micheli Center for Sports Injury Prevention, Waltham, MA 02452
| | - Eric A. Nauman
- Dane A. and Mary Louise Miller Professor Department of Biomedical Engineering, College of Engineering and Applied Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH 45221
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Cheever K, King J, Kawata K. The association between contact sport exposure and cervical sensorimotor dysfunction: a scoping review of implications for future musculoskeletal injury risk. Chiropr Man Therap 2022; 30:50. [PMID: 36434725 PMCID: PMC9701076 DOI: 10.1186/s12998-022-00458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While morphological changes to the cervical spine have been observed for over 40 years in response to contact sport participation, little is known about the secondary effects of the cervical impairment on future musculoskeletal injury and disability. OBJECTIVES AND DESIGN A scoping review was performed to discuss the relationship between contact sport participation and morphological changes to the cervical spine. Moreover, the correlation between morphological changes in the musculoskeletal structures of the cervical spine and resultant deficits in cervical sensorimotor and neuromotor function are discussed. Lastly, how alterations in cervical sensorimotor function may affect overall risk of musculoskeletal injury is discussed. METHODS The scientific literature was searched in PubMed, Sport Discus, and Web of Science pertaining to contact-sport athletes and/or cervical pathology and the cervicocephalic network. The Asksey and O'Malley's framework and PRISMA for Scoping Reviews were used to conduct and report the following review. Included articles were grouped into three categories: (1) Morphological changes to the cervical spine in contact sport athletes. (2) The role of the neuromotor pathways of the cervical spine in maintenance of postural tone and coordination of the extremities. (3) The correlation between altered cervical sensorimotor function and a resultant increase in musculoskeletal injury risk. RESULTS Our search identified 566 documents, of which 405 underwent full-text screening, resulting in 54 eligible studies for the review. Widespread cervical sensorimotor dysfunction was observed in contact sport athletes. Independently, cervical sensorimotor function was demonstrated to play a critical role in postural control and limb coordination. However, limited research exists exploring the interaction between contact sport participation and altered cervical sensorimotor function, as well as an associated increase in musculoskeletal injury risk. CONCLUSIONS Limited evidence exists linking cervical injury and/or observed deficits in cervical sensorimotor and neuromotor function to musculoskeletal injury risk. Longitudinal studies combining imaging measures (e.g., MRI, DEXA), cervical functional test, and prospective injury risk are needed to further explore the correlation between resultant cervical sensorimotor deficits following contact sport impacts and future musculoskeletal injury risk.
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Affiliation(s)
- Kelly Cheever
- Applied Biomechanics Laboratory, Department of Kinesiology, College of Health, Community and Policy, University of Texas at San Antonio, One UTSA Cir, San Antonio, TX, 78429, USA.
| | - Jeffery King
- grid.30760.320000 0001 2111 8460Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI USA
| | - Keisuke Kawata
- grid.411377.70000 0001 0790 959XDepartment of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN USA ,grid.411377.70000 0001 0790 959XProgram in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN USA
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Jack J, Woodgates A, Smail O, Brown F, Lynam K, Lester A, Williams G, Bond B. Cerebral blood flow regulation is not acutely altered after a typical number of headers in women footballers. Front Neurol 2022; 13:1021536. [PMID: 36479047 PMCID: PMC9719992 DOI: 10.3389/fneur.2022.1021536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The repeated act of heading has been implicated in the link between football participation and risk of neurodegenerative disease, and acutely alters cerebrovascular outcomes in men. This study assessed whether exposure to a realistic number of headers acutely influences indices of cerebral blood flow regulation in female footballers. METHODS Nineteen female players completed a heading trial and seated control trial on two separate days. The heading trial involved six headers in 1 h (one every 10 min), with the ball traveling at 40 ± 5 km/h. Cerebrovascular reactivity to hypercapnia and hypocapnia was determined using serial breath holding and hyperventilation attempts. Dynamic cerebral autoregulation (dCA) was assessed by scrutinizing the relationship between cerebral blood flow and mean arterial blood pressure during 5 min of squat stand maneuvers at 0.05 Hz. Neurovascular coupling (NVC) was quantified as the posterior cerebral artery blood velocity response to a visual search task. These outcomes were assessed before and 1 h after the heading or control trial. RESULTS No significant time by trial interaction was present for the hypercapnic (P = 0.48,η p 2 = 0.05) and hypocapnic (P = 0.47,η p 2 = 0.06) challenge. Similarly, no significant interaction effect was present for any metric of dCA (P > 0.12,η p 2 < 0.16 for all) or NVC (P > 0.14,η p 2 < 0.15 for all). CONCLUSION The cerebral blood flow response to changes in carbon dioxide, blood pressure and a visual search task were not altered following six headers in female footballers. Further study is needed to observe whether changes are apparent after more prolonged exposure.
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Affiliation(s)
| | | | | | | | | | | | | | - Bert Bond
- Exeter Head Impacts, Brain Injury and Trauma (ExHIBIT) Research Group, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
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Wilson A, Stevens WD, Sergio L, Wojtowicz M. Altered Brain Functional Connectivity in Female Athletes Over the Course of a Season of Collision or Contact Sports. Neurotrauma Rep 2022; 3:377-387. [PMID: 36204391 PMCID: PMC9531888 DOI: 10.1089/neur.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision (N = 12) and contact (N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe (p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.
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Affiliation(s)
- Alyssia Wilson
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - W. Dale Stevens
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lauren Sergio
- School of Kinesiology, York University, Toronto, Ontario, Canada
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7
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An acute bout of controlled subconcussive impacts can alter dynamic cerebral autoregulation indices: a preliminary investigation. Eur J Appl Physiol 2022; 122:1059-1070. [PMID: 35171333 DOI: 10.1007/s00421-022-04908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There is growing concern repetitive head contacts sustained by soccer players may lead to long-term health ramifications. Therefore, this preliminary investigation examined the impact an acute soccer heading bout has on dynamic cerebral autoregulation (dCA) metrics. METHODS In this preliminary investigation, 40 successful soccer headers were performed in 20 min by 7 male elite soccer players (24.1 ± 1.5 years). Soccer balls were launched at 77.5 ± 3.7 km/h from JUGS soccer machine, located 35 m away from participants. Linear and rotational head accelerations impacts were measured using an accelerometer (xPatch). The SCAT3 indexed concussion symptom score and severity before and after: soccer headers, sham (body contact only), and control conditions. Squat-stand maneuvers were performed at 0.05 Hz and 0.10 Hz to quantity dCA through measures of coherence, phase, and gain. RESULTS Cumulative linear and rotational accelerations during soccer headers were 1574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively. SCAT3 symptom severity was elevated after the soccer heading bout (pre 3.7 ± 3.6, post 9.4 ± 7.6: p = 0.030) and five of the seven participants reported an increase in concussion-like symptoms (pre: 2.6 ± 3.0, post: 6.7 ± 6.2; p = 0.078). Phase at 0.10 Hz was elevated following soccer heading (p = 0.008). No other dCA metric differed following the three conditions. CONCLUSION These preliminary results indicate an acute bout of soccer heading resulted in alterations to dCA metrics. Therefore, future research with larger sample sizes is warranted to fully comprehend short- and long-term physiological changes related to soccer heading.
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Kashyap P, Shenk TE, Svaldi DO, Lycke RJ, Lee TA, Tamer GG, Nauman EA, Talavage TM. Normalized Brain Tissue–Level Evaluation of Volumetric Changes of Youth Athletes Participating in Collision Sports. Neurotrauma Rep 2022; 3:57-69. [PMID: 35112108 PMCID: PMC8804236 DOI: 10.1089/neur.2021.0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Observations of short-term changes in the neural health of youth athletes participating in collision sports (e.g., football and soccer) have highlighted a need to explore potential structural alterations in brain tissue volumes for these persons. Studies have shown biochemical, vascular, functional connectivity, and white matter diffusivity changes in the brain physiology of these athletes that are strongly correlated with repetitive head acceleration exposure. Here, research is presented that highlights regional anatomical volumetric measures that change longitudinally with accrued subconcussive trauma. A novel pipeline is introduced that provides simplified data analysis on standard-space template to quantify group-level longitudinal volumetric changes within these populations. For both sports, results highlight incremental relative regional volumetric changes in the subcortical cerebrospinal fluid that are strongly correlated with head exposure events greater than a 50-G threshold at the short-term post-season assessment. Moreover, longitudinal regional gray matter volumes are observed to decrease with time, only returning to baseline/pre-participation levels after sufficient (5–6 months) rest from collision-based exposure. These temporal structural volumetric alterations are significantly different from normal aging observed in sex- and age-matched controls participating in non-collision sports. Future work involves modeling repetitive head exposure thresholds with multi-modal image analysis and understanding the underlying physiological reason. A possible pathophysiological pathway is presented, highlighting the probable metabolic regulatory mechanisms. Continual participation in collision-based activities may represent a risk wherein recovery cannot occur. Even when present, the degree of the eventual recovery remains to be explored, but has strong implications for the well-being of collision-sport participants.
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Affiliation(s)
- Pratik Kashyap
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Trey E. Shenk
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Diana O. Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Roy J. Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Taylor A. Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Gregory G. Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Eric A. Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Thomas M. Talavage
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
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Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure. Sports Med 2021; 52:481-504. [PMID: 34677820 DOI: 10.1007/s40279-021-01574-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The number and magnitude of head impacts have been assessed in-vivo using inertial sensors to characterise the exposure in various sports and to help understand their potential relationship to concussion. OBJECTIVES We aimed to provide a comprehensive review of the field of in-vivo sensor acceleration event research in sports via the summary of data collection and processing methods, population demographics and factors contributing to an athlete's exposure to sensor acceleration events. METHODS The systematic search resulted in 185 cohort or cross-sectional studies that recorded sensor acceleration events in-vivo during sport participation. RESULTS Approximately 5800 participants were studied in 20 sports using 18 devices that included instrumented helmets, headbands, skin patches, mouthguards and earplugs. Female and youth participants were under-represented and ambiguous results were reported for these populations. The number and magnitude of sensor acceleration events were affected by a variety of contributing factors, suggesting sport-specific analyses are needed. For collision sports, being male, being older, and playing in a game (as opposed to a practice), all contributed to being exposed to more sensor acceleration events. DISCUSSION Several issues were identified across the various sensor technologies, and efforts should focus on harmonising research methods and improving the accuracy of kinematic measurements and impact classification. While the research is more mature for high-school and collegiate male American football players, it is still in its early stages in many other sports and for female and youth populations. The information reported in the summarised work has improved our understanding of the exposure to sport-related head impacts and has enabled the development of prevention strategies, such as rule changes. CONCLUSIONS Head impact research can help improve our understanding of the acute and chronic effects of head impacts on neurological impairments and brain injury. The field is still growing in many sports, but technological improvements and standardisation of processes are needed.
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Blyth RJ, Alcock M, Tumilty DS. Why are female soccer players experiencing a concussion more often than their male counterparts? A scoping review. Phys Ther Sport 2021; 52:54-68. [PMID: 34419893 DOI: 10.1016/j.ptsp.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The risk of concussion is particularly high in female soccer players. There is no consensus as to why female soccer players are at an elevated risk. OBJECTIVE To synthesise current evidence investigating reasons for the increased concussion rate in female soccer players. SOURCES Searching of six databases (MEDLINE, Scopus, CINAHL, SportDiscus, Web of Science and the Cochrane Library) and grey literature was performed between 13/07/2020-31/07/2020. Keywords were concussion-related terms, terms relating to female football/soccer and terms relating to the mechanism/cause. No constraints were placed on publication date and quantitative or exploratory studies meeting inclusion criteria were eligible. Exclusion criteria were studies not published in English and qualitative studies. RESULTS Several hypotheses were identified to explain increased concussion rates in female soccer players, these include, reduced neck strength/anthropometrics, increased head acceleration, increased ball-to-head concussions, differences in hormones and brain structure/function, and reduced visual awareness. CONCLUSION Promising ideas/reasons have been identified for increased concussion rates in female soccer players. Despite hypothesis generation there is scarce high-level evidence which is required to guide injury prevention and/or rule changes to protect female soccer players. The level of evidence for included studies is level 2-3 with most being observational cross-sectional or cohort studies.
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Affiliation(s)
- Rebecca Jane Blyth
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand.
| | - Mark Alcock
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
| | - Dr Steve Tumilty
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
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11
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Marley CJ, Owens TS, Tsukamoto H, Stacey BS, Corkill R, Bailey DM. Impaired cerebral blood flow regulation and cognition in male football players. Scand J Med Sci Sports 2021; 31:1908-1913. [PMID: 34233053 DOI: 10.1111/sms.14018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Football players are at increased risk of neurodegeneration, the likely consequence of repetitive mechanical trauma caused by heading the ball. However, to what extent a history of heading the ball affects cerebral blood flow (CBF) regulation and its potential relationship to cognitive impairment is unknown. To address this, we recruited 16 concussion-free male amateur football players (age: 25 ± 6 y) with a history of heading the ball (18 ± 6 y) and 18 sex, age, education, and activity-matched controls with no prior history of contact sport participation or concussion. Cerebral perfusion was measured at rest and in response to both hyper/hypocapnia to determine cerebrovascular reactivity to carbon dioxide (CVRCO2HYPER/HYPO ) using transcranial Doppler ultrasound and capnography, with the sum reflecting the cerebral vasomotor range. Cognition and visuomotor coordination were assessed using the Montreal cognitive assessment (MoCA) and the Grooved Pegboard Dexterity Test (GPD), respectively. While no differences in cerebral perfusion were observed (p = 0.938), CVRCO2HYPER/HYPO (p = 0.038/p = 0.025), cerebral vasomotor range (p = 0.002), MoCA (p = 0.027), and GPD performance (dominant hand, P ≤ 0.001) were consistently lower in the players compared to controls. These findings are the first to demonstrate that CBF regulation and cognition are collectively impaired in male football players with history of heading the ball, which may contribute to neurodegeneration.
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Affiliation(s)
- Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
| | - Robin Corkill
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences & Education, University of South Wales, Pontypridd, UK
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Lynch CE, Eisenbaum M, Algamal M, Balbi M, Ferguson S, Mouzon B, Saltiel N, Ojo J, Diaz-Arrastia R, Mullan M, Crawford F, Bachmeier C. Impairment of cerebrovascular reactivity in response to hypercapnic challenge in a mouse model of repetitive mild traumatic brain injury. J Cereb Blood Flow Metab 2021; 41:1362-1378. [PMID: 33050825 PMCID: PMC8142124 DOI: 10.1177/0271678x20954015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Incidences of repetitive mild TBI (r-mTBI), like those sustained by contact sports athletes and military personnel, are thought to be a risk factor for development of neurodegenerative disorders. Those suffering from chronic TBI-related illness demonstrate deficits in cerebrovascular reactivity (CVR), the ability of the cerebral vasculature to respond to a vasoactive stimulus. CVR is thus an important measure of traumatic cerebral vascular injury (TCVI), and a possible in vivo endophenotype of TBI-related neuropathogenesis. We combined laser speckle imaging of CVR in response to hypercapnic challenge with neurobehavioral assessment of learning and memory, to investigate if decreased cerebrovascular responsiveness underlies impaired cognitive function in our mouse model of chronic r-mTBI. We demonstrate a profile of blunted hypercapnia-evoked CVR in the cortices of r-mTBI mice like that of human TBI, alongside sustained memory and learning impairment, without biochemical or immunohistopathological signs of cerebral vessel laminar or endothelium constituent loss. Transient decreased expression of alpha smooth muscle actin and platelet-derived growth factor receptor β, indicative of TCVI, is obvious only at the time of the most pronounced CVR deficit. These findings implicate CVR as a valid preclinical measure of TCVI, perhaps useful for developing therapies targeting TCVI after recurrent mild head trauma.
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Affiliation(s)
- Cillian E Lynch
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK.,James A. Haley Veteran's Administration, Tampa, FL, USA.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maxwell Eisenbaum
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK
| | - Moustafa Algamal
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK
| | - Matilde Balbi
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Ferguson
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK
| | - Benoit Mouzon
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK.,James A. Haley Veteran's Administration, Tampa, FL, USA
| | | | - Joseph Ojo
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK.,James A. Haley Veteran's Administration, Tampa, FL, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mike Mullan
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK
| | - Fiona Crawford
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK.,James A. Haley Veteran's Administration, Tampa, FL, USA
| | - Corbin Bachmeier
- The Roskamp Institute, Sarasota, FL, USA.,Department of Life Sciences, The Open University, Milton Keynes, UK.,Bay Pines VA Healthcare System, Bay Pines, FL, USA
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13
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Rao HM, Yuditskaya S, Williamson JR, Vian TR, Lacirignola JJ, Shenk TE, Talavage TM, Heaton KJ, Quatieri TF. Using Oculomotor Features to Predict Changes in Optic Nerve Sheath Diameter and ImPACT Scores From Contact-Sport Athletes. Front Neurol 2021; 12:584684. [PMID: 33746869 PMCID: PMC7969804 DOI: 10.3389/fneur.2021.584684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
There is mounting evidence linking the cumulative effects of repetitive head impacts to neuro-degenerative conditions. Robust clinical assessment tools to identify mild traumatic brain injuries are needed to assist with timely diagnosis for return-to-field decisions and appropriately guide rehabilitation. The focus of the present study is to investigate the potential for oculomotor features to complement existing diagnostic tools, such as measurements of Optic Nerve Sheath Diameter (ONSD) and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Given the high risk of repetitive head impacts associated with both soccer and football, our hypotheses were that (1) ONSD and ImPACT scores would worsen through the season and (2) oculomotor features would effectively capture both neurophysiological changes reflected by ONSD and neuro-functional status assessed via ImPACT. Oculomotor features were used as input to Linear Mixed-Effects Regression models to predict ONSD and ImPACT scores as outcomes. Prediction accuracy was evaluated to identify explicit relationships between eye movements, ONSD, and ImPACT scores. Significant Pearson correlations were observed between predicted and actual outcomes for ONSD (Raw = 0.70; Normalized = 0.45) and for ImPACT (Raw = 0.86; Normalized = 0.71), demonstrating the capability of oculomotor features to capture neurological changes detected by both ONSD and ImPACT. The most predictive features were found to relate to motor control and visual-motor processing. In future work, oculomotor models, linking neural structures to oculomotor function, can be built to gain extended mechanistic insights into neurophysiological changes observed through seasons of participation in contact sports.
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Affiliation(s)
- Hrishikesh M Rao
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - James R Williamson
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trina R Vian
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Joseph J Lacirignola
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced Radio Frequency Techniques & Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
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14
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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15
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Roby PR, Duquette P, Kerr ZY, Register-Mihalik J, Stoner L, Mihalik JP. Repetitive Head Impact Exposure and Cerebrovascular Function in Adolescent Athletes. J Neurotrauma 2020; 38:837-847. [PMID: 33081565 DOI: 10.1089/neu.2020.7350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to determine how subconcussive head impact exposure in high school collision sport student-athletes influenced cerebrovascular function. Transcranial Doppler was used to assess pre- to post-season changes in: (1) resting middle (MCA) and posterior cerebral arteries (PCA), (2) cerebrovascular reactivity (CVR) via breath-holding index (BHI), vasomotor reactivity response (VMRr) and overall MCA response curve, and (3) neurovascular coupling (NVC) via NVC response magnitude and overall PCA response curve. Fifty-three high school-aged athletes (age = 15.8 ± 1.2years, height = 175.8 ± 8.1cm, mass = 69.4 ± 13.5kg) were recruited into two groups (collision vs. non-collision sport). All participants completed a pre-season cerebrovascular function assessment. Following a 4- to 5-month window (118.6 ± 12.2 days), 48 athletes from the original sample (age = 16.0 ± 1.2 years, height = 175.5 ± 8.1 cm, mass = 68.6 ± 4.0 kg) repeated the cerebrovascular assessment. There were no group differences in any cerebrovascular measures at pre-season testing (p > 0.05). At post-season testing, collision sport athletes demonstrated greater positive change in BHI (t44 = -2.21, p = 0.03) while non-collision sport athletes demonstrated greater negative change in the NVC response magnitude to the reading task (t44 = 1.98, p = 0.048), and lower overall PCA response curve to the reading task (F1,2710 = 101.54, p < 0.001). All other pre- to post-season change values were non-significant (p > 0.05). Our data indicate that single-season changes in cerebrovascular outcomes may differ between collision and non-collision sport athletes. Although the clinical interpretation is still unclear, our study demonstrates that CVR and NVC assessments may be sensitive to the dynamic cerebrovascular changes occurring in adolescent athletes. Future research should continue to assess these outcomes following both subconcussive head impact exposure and throughout the recovery trajectory following concussion.
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Affiliation(s)
- Patricia R Roby
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter Duquette
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lee Stoner
- UNC Cardiometabolic Laboratory, Department of Exercise and Sport Science, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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16
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Auger J, Markel J, Pecoski DD, Leiva-Molano N, Talavage TM, Leverenz L, Shen F, Nauman EA. Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries. PLoS One 2020; 15:e0240162. [PMID: 33064732 PMCID: PMC7567382 DOI: 10.1371/journal.pone.0240162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
It has been documented that up to 22% of all soccer injuries are concussions. This is in part due to players purposely using their head to direct the ball during play. To provide a more complete understanding of head trauma in soccer athletes, this study characterized the effects of four soccer ball characteristics (size, inflation pressure, mass, velocity) on the resulting peak impact force as it relates to the potential for incurring neurophysiological changes. A total of six hundred trials were performed on size 4 and 5 soccer balls as well as a novel lightweight soccer ball. Impact force was measured with a force plate and ball velocity was determined using motion capture. These data were used, in conjunction with dimensional analysis to relate impact force to ball size, mass, velocity, and pressure. Reasonable reductions in allowable ball parameters resulted in a 19.7% decrease in peak impact force. Adjustments to ball parameters could reduce a high cumulative peak translational acceleration soccer athlete down into a previously defined safer low loading range. In addition, it was noted that water absorption by soccer balls can result in masses that substantially increase impact force and quickly surpass the NCAA weight limit for game play. Additional research is required to determine whether varying soccer ball characteristics will enable soccer players to avoid persistent neurophysiological deficits or what additional interventions may be necessary and the legal implications of these data are discussed.
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Affiliation(s)
- Joshua Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Justin Markel
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Dimitri D. Pecoski
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Nicolas Leiva-Molano
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Thomas M. Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, United States of America
| | - Larry Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, United States of America
| | - Francis Shen
- University of Minnesota Law School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Eric A. Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, United States of America
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail:
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17
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Monroe DC, Blumenfeld RS, Keator DB, Solodkin A, Small SL. One season of head-to-ball impact exposure alters functional connectivity in a central autonomic network. Neuroimage 2020; 223:117306. [PMID: 32861790 PMCID: PMC7822072 DOI: 10.1016/j.neuroimage.2020.117306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/26/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022] Open
Abstract
Repetitive head impacts represent a risk factor for neurological impairment in team-sport athletes. In the absence of symptoms, a physiological basis for acute injury has not been elucidated. A basic brain function that is disrupted after mild traumatic brain injury is the regulation of homeostasis, instantiated by activity across a specific set of brain regions that comprise a central autonomic network. We sought to relate head-to-ball impact exposure to changes in functional connectivity in a core set of central autonomic regions and then to determine the relation between changes in brain and changes in behavior, specifically cognitive control. Thirteen collegiate men's soccer players and eleven control athletes (golf, cross-country) underwent resting-state fMRI and behavioral testing before and after the season, and a core group of cortical, subcortical, and brainstem regions was selected to represent the central autonomic network. Head-to-ball impacts were recorded for each soccer player. Cognitive control was assessed using a Dot Probe Expectancy task. We observed that head-to-ball impact exposure was associated with diffuse increases in functional connectivity across a core CAN subnetwork. Increased functional connectivity between the left insula and left medial orbitofrontal cortex was associated with diminished proactive cognitive control after the season in those sustaining the greatest number of head-to-ball impacts. These findings encourage measures of autonomic physiology to monitor brain health in contact and collision sport athletes.
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Affiliation(s)
- Derek C Monroe
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States.
| | - Robert S Blumenfeld
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; Department of Psychology, California State Polytechnic University, 3801 West Temple Avenue, Pomona, CA 91768, United States
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, 163 Irvine Hall, Irvine, CA 92697- 3960, United States
| | - Ana Solodkin
- Department of Anatomy and Neurobiology, University of California-Irvine, B240 Medical Science, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
| | - Steven L Small
- Department of Neurology, University of California, Room 150 Med Surge I, Irvine, CA 92697-4275, United States; School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 W Campbell Rd, GR 41, Richardson, TX 75080, United States
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18
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Dudley J, Yuan W, Diekfuss J, Barber Foss KD, DiCesare CA, Altaye M, Logan K, Leach JL, Myer GD. Altered Functional and Structural Connectomes in Female High School Soccer Athletes After a Season of Head Impact Exposure and the Effect of a Novel Collar. Brain Connect 2020; 10:292-301. [DOI: 10.1089/brain.2019.0729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Jonathan Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jed Diekfuss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kim D. Barber Foss
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher A. DiCesare
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kelsey Logan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L. Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, USA
| | - Gregory D. Myer
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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19
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Smirl JD, Peacock D, Wright AD, Bouliane KJ, Dierijck J, Burma JS, Kennefick M, Wallace C, van Donkelaar P. An Acute Bout of Soccer Heading Subtly Alters Neurovascular Coupling Metrics. Front Neurol 2020; 11:738. [PMID: 32849205 PMCID: PMC7396491 DOI: 10.3389/fneur.2020.00738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: The current investigation examined how a bout of soccer heading may impact brain function. Design: Semi-randomized crossover cohort. Setting: Controlled soccer heading. Participants: Seven male soccer players (24.1 ± 1.5 years). Intervention: 40 successful soccer headers were performed in 20 min (25 m, launch velocity ~80 km/h). X2 xPatch recorded linear and rotational head accelerations during each impact. A contact control “sham” condition – ball made body contact, but not by the head; and a no activity time “control” condition were also completed. Main Outcome Measures: Posterior and middle cerebral artery (PCA and MCA, respectively), cerebral blood velocity (CBV) was recorded during a visual task (neurovascular coupling: NVC) alongside SCAT3 symptoms scores pre/post a controlled bout of soccer heading. Results: Cumulative linear and rotational accelerations were 1,574 ± 97.9 g and 313,761 ± 23,966 rads/s2, respectively, during heading and changes in SCAT3 symptom number (pre: 2.6 ± 3.0; post: 6.7 ± 6.2, p = 0.13) and severity (pre: 3.7 ± 3.6, post: 9.4 ± 7.6, p = 0.11) were unchanged. In the PCA, no NVC differences were observed, including: relative CBV increase (28.0 ± 7.6%, p = 0.71) and total activation (188.7 ± 68.1 cm, p = 0.93). However, MCA-derived NVC metrics were blunted following heading, demonstrating decreased relative CBV increase (7.8 ± 3.1%, p = 0.03) and decreased total activation (26.7 ± 45.3 cm, p = 0.04). Conclusion: Although an acute bout of soccer heading did not result in an increase of concussion-like symptoms, there were alterations in NVC responses within the MCA during a visual task. This suggests an acute bout of repetitive soccer heading can alter CBV regulation within the region of the brain associated with the header impacts.
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Affiliation(s)
- Jonathan D Smirl
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Dakota Peacock
- Southern Medical Program, University of British Columbia, Kelowna, BC, Canada
| | - Alexander D Wright
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Southern Medical Program, University of British Columbia, Kelowna, BC, Canada.,MD/PhD Program, University of British Columbia, Vancouver, BC, Canada.,Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin J Bouliane
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Jill Dierijck
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Health, School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Joel S Burma
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,Human Performance Laboratory, University of Calgary, Calgary, AB, Canada
| | - Michael Kennefick
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Colin Wallace
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
| | - Paul van Donkelaar
- Concussion Research Laboratory, University of British Columbia, Kelowna, BC, Canada
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20
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Mooney J, Self M, ReFaey K, Elsayed G, Chagoya G, Bernstock JD, Johnston JM. Concussion in soccer: a comprehensive review of the literature. Concussion 2020; 5:CNC76. [PMID: 33005435 PMCID: PMC7506470 DOI: 10.2217/cnc-2020-0004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussion has been examined extensively in collision sports such as football and hockey. However, historically, lower-risk contact sports such as soccer have only more recently garnered increased attention. Here, we review articles examining the epidemiology, injury mechanisms, sex differences, as well as the neurochemical, neurostructural and neurocognitive changes associated with soccer-related concussion. From 436 titles and abstracts, 121 full texts were reviewed with a total of 64 articles identified for inclusion. Concussion rates are higher during competitions and in female athletes with purposeful heading rarely resulting in concussion. Given a lack of high-level studies examining sports-related concussion in soccer, clinicians and scientists must focus research efforts on large-scale data gathering and development of improved technologies to better detect and understand concussion.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Mitchell Self
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, 1813 6th Ave S #516, Birmingham, AL 35233, USA
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21
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Nauman EA, Talavage TM, Auerbach PS. Mitigating the Consequences of Subconcussive Head Injuries. Annu Rev Biomed Eng 2020; 22:387-407. [PMID: 32348156 DOI: 10.1146/annurev-bioeng-091219-053447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.
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Affiliation(s)
- Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA; .,School of Mechanical Engineering, Purdue University, West Lafayette, Indiana 47907, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana 47907, USA
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA; .,School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University, Palo Alto, California 94304, USA
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22
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Co-localized impaired regional cerebrovascular reactivity in chronic concussion is associated with BOLD activation differences during a working memory task. Brain Imaging Behav 2020; 14:2438-2449. [PMID: 31903527 DOI: 10.1007/s11682-019-00194-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to quantify differences in blood oxygen level dependent (BOLD) activation on a working memory task, baseline cerebral blood flow (CBF0), and cerebrovascular reactivity (CVR) between participants with and without a history of concussion. A dual-echo pseudo-continuous arterial spin labelling (pCASL) sequence was performed on a group of 10 subjects with a previous concussion (126 ± 15 days prior) and on a control group (n = 10) during a visual working memory protocol. A separate dual-echo pCASL sequence was used to derive CVR and CBF0 measurements from a boxcar hypercapnic breathing protocol. Brain areas with significant activation differences on the working memory task between groups were identified and combined as an aggregate region of interest for CBF and CVR analyses. Areas of reduced BOLD activation during the working memory task in the concussed group included the ventral anterior cingulate cortex (ACC), the medial temporal gyrus (MTG), and the lateral occipital cortex in two loci. A single area of increased activation was located in the parietal operculum. Further analyses of CBF0 and CVR in these regions revealed reduced CVR in the concussed group in the MTG and ACC, while CBF0 did not differ. The differences in CVR between the two groups in these regions suggest that concussive injury may result in microvascular dysfunction. In turn, the decreased BOLD response during the task could be due to altered neurovascular coupling, rather than an impairment in neural activation alone. However, in other regions associated with working memory, unchanged CBF0 and CVR suggests that neural injury also persists after concussion. In the future, BOLD results should be normalized to CVR in order achieve a clearer understanding of the neural and vascular contributions to the differences in the signal.
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23
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McIver KG, Sankaran GN, Lee P, Bucherl S, Leiva N, Talavage TM, Leverenz L, Nauman EA. Impact attenuation of male and female lacrosse helmets using a modal impulse hammer. J Biomech 2019; 95:109313. [PMID: 31495519 DOI: 10.1016/j.jbiomech.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/20/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
It has been established that substantial negative changes in neurocognitive function can be observed in a large percentage of athletes who participate in contact sports such as soccer or football, motivating a need for improved safety systems. Head accelerations in men's lacrosse are similar to those in football and female lacrosse players experience high rates of concussions, necessitating better head protection in both sports. Previous studies have sought to evaluate the ability of modern football helmets to mitigate impacts both normal and oblique to the surface of the helmet using a system that quantifies both the input load and the resulting accelerations of a Hybrid III headform. This study quantifies the inputs and outputs of the helmet-Hybrid III headform system in order to compare the impact attenuation capability of two male and two female lacrosse helmets. Of those helmets tested, the better performing male helmet was the Schutt Stallion 650 and the better performing female helmet was the Hummingbird excepting device failure at the rear boss impact location, but football helmets still generally outperformed the lacrosse helmets tested here.
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Affiliation(s)
- Kevin G McIver
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Goutham N Sankaran
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Patrick Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Sean Bucherl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Nicolas Leiva
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Thomas M Talavage
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Larry Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN 47907, United States
| | - Eric A Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907, United States.
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24
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Jang I, Chun IY, Brosch JR, Bari S, Zou Y, Cummiskey BR, Lee TA, Lycke RJ, Poole VN, Shenk TE, Svaldi DO, Tamer GG, Dydak U, Leverenz LJ, Nauman EA, Talavage TM. Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure. NEUROIMAGE-CLINICAL 2019; 24:101930. [PMID: 31630026 PMCID: PMC6807364 DOI: 10.1016/j.nicl.2019.101930] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction. Brain volumes evidencing injury are larger in football athletes than controls. Spatial extent of decreased FA correlates with head acceleration event exposure. Spatial extent of increased MD correlates with head acceleration event exposure.
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Affiliation(s)
- Ikbeom Jang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America.
| | - Il Yong Chun
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sumra Bari
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Yukai Zou
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States of America
| | - Brian R Cummiskey
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Roy J Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Victoria N Poole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Trey E Shenk
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Diana O Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Gregory G Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Thomas M Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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