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Parker TD, Zimmerman KA, Laverse E, Bourke NJ, Graham NSN, Mallas EJ, Heslegrave A, Zetterberg H, Kemp S, Morris HR, Sharp DJ. Active elite rugby participation is associated with altered precentral cortical thickness. Brain Commun 2023; 5:fcad257. [PMID: 38025272 PMCID: PMC10667029 DOI: 10.1093/braincomms/fcad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
There is growing concern that elite rugby participation may negatively influence brain health, but the underlying mechanisms are unclear. Cortical thickness is a widely applied biomarker of grey matter structure, but there is limited research into how it may be altered in active professional rugby players. Cross-sectional MRI data from 44 active elite rugby players, including 21 assessed within 1 week of head injury, and 47 healthy controls were analysed. We investigated how active elite rugby participation with and without sub-acute traumatic brain injury influenced grey matter structure using whole cortex and region of interest cortical thickness analyses. Relationships between cortical thickness and biomarkers of traumatic brain injury, including fractional anisotropy, plasma neurofilament light and glial fibrillary acidic protein, were also examined. In whole-cortex analyses, precentral cortical thickness in the right hemisphere was lower in rugby players compared with controls, which was due to reductions in non-injured players. Post hoc region of interest analyses showed non-injured rugby players had reduced cortical thickness in the inferior precentral sulcal thickness bilaterally (P = 0.005) and the left central sulcus (P = 0.037) relative to controls. In contrast, players in the sub-acute phase of mild traumatic brain injury had higher inferior precentral sulcal cortical thickness in the right hemisphere (P = 0.015). Plasma glial fibrillary acidic protein, a marker of astrocyte activation, was positively associated with right inferior precentral sulcal cortical thickness in injured rugby players (P = 0.0012). Elite rugby participation is associated with localized alterations in cortical thickness, specifically in sulcal motor regions. Sub-acute changes after mild traumatic brain injury are associated with evidence of astrocytic activation. The combination of cortical thickness and glial fibrillary acidic protein may be useful in understanding the pathophysiological relationship between sporting head injury and brain health.
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Affiliation(s)
- Thomas D Parker
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | | | - Niall J Bourke
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Neil S N Graham
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | - Emma-Jane Mallas
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | - Amanda Heslegrave
- UCL Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1N 3BG, UK
- UKDRI Fluid Biomarker Laboratory, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- UCL Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1N 3BG, UK
- UKDRI Fluid Biomarker Laboratory, London, WC1N 3BG, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Mölndal, 431 41, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, 413 45, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Simon Kemp
- Rugby Football Union, Twickenham Stadium, Twickenham, Middlesex TW2 7BA, UK
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Huw R Morris
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
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Jones CM, Austin K, Augustus SN, Nicholas KJ, Yu X, Baker C, Chan EYK, Loosemore M, Ghajari M. An Instrumented Mouthguard for Real-Time Measurement of Head Kinematics under a Large Range of Sport Specific Accelerations. SENSORS (BASEL, SWITZERLAND) 2023; 23:7068. [PMID: 37631606 PMCID: PMC10457941 DOI: 10.3390/s23167068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Head impacts in sports can produce brain injuries. The accurate quantification of head kinematics through instrumented mouthguards (iMG) can help identify underlying brain motion during injurious impacts. The aim of the current study is to assess the validity of an iMG across a large range of linear and rotational accelerations to allow for on-field head impact monitoring. METHODS Drop tests of an instrumented helmeted anthropometric testing device (ATD) were performed across a range of impact magnitudes and locations, with iMG measures collected concurrently. ATD and iMG kinematics were also fed forward to high-fidelity brain models to predict maximal principal strain. RESULTS The impacts produced a wide range of head kinematics (16-171 g, 1330-10,164 rad/s2 and 11.3-41.5 rad/s) and durations (6-18 ms), representing impacts in rugby and boxing. Comparison of the peak values across ATD and iMG indicated high levels of agreement, with a total concordance correlation coefficient of 0.97 for peak impact kinematics and 0.97 for predicted brain strain. We also found good agreement between iMG and ATD measured time-series kinematic data, with the highest normalized root mean squared error for rotational velocity (5.47 ± 2.61%) and the lowest for rotational acceleration (1.24 ± 0.86%). Our results confirm that the iMG can reliably measure laboratory-based head kinematics under a large range of accelerations and is suitable for future on-field validity assessments.
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Affiliation(s)
- Chris M. Jones
- Sports and Wellbeing Analytics, Swansea SA7 0AJ, UK; (K.A.)
- Institute of Sport and Exercise Health (ISEH), Division Surgery Interventional Science, University College London, London W1T 7HA, UK
| | - Kieran Austin
- Sports and Wellbeing Analytics, Swansea SA7 0AJ, UK; (K.A.)
- Institute of Sport, Nursing and Allied Health, University of Chichester, Chichester PO19 6PE, UK
| | - Simon N. Augustus
- Department of Applied and Human Sciences, Kingston University London, London KT1 2EE, UK
| | | | - Xiancheng Yu
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Claire Baker
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Emily Yik Kwan Chan
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
| | - Mike Loosemore
- Institute of Sport and Exercise Health (ISEH), Division Surgery Interventional Science, University College London, London W1T 7HA, UK
- English Institute of Sport, Manchester M11 3BS, UK
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (X.Y.)
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Menghani RR, Das A, Kraft RH. A sensor-enabled cloud-based computing platform for computational brain biomechanics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107470. [PMID: 36958108 DOI: 10.1016/j.cmpb.2023.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Driven by the risk of repetitive head trauma, sensors have been integrated into mouthguards to measure head impacts in contact sports and military activities. These wearable devices, referred to as "instrumented" or "smart" mouthguards are being actively developed by various research groups and organizations. These instrumented mouthguards provide an opportunity to further study and understand the brain biomechanics due to impact. In this study, we present a brain modeling service that can use information from these sensors to predict brain injury metrics in an automated fashion. METHODS We have built a brain modeling platform using several of Amazon's Web Services (AWS) to enable cloud computing and scalability. We use a custom-built cloud-based finite element modeling code to compute the physics-based nonlinear response of the intracranial brain tissue and provide a frontend web application and an application programming interface for groups working on head impact sensor technology to include simulated injury predictions into their research pipeline. RESULTS The platform results have been validated against experimental data available in literature for brain-skull relative displacements, brain strains and intracranial pressure. The parallel processing capability of the platform has also been tested and verified. We also studied the accuracy of the custom head surfaces generated by Avatar 3D. CONCLUSION We present a validated cloud-based computational brain modeling platform that uses sensor data as input for numerical brain models and outputs a quantitative description of brain tissue strains and injury metrics. The platform is expected to generate transparent, reproducible, and traceable brain computing results.
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Affiliation(s)
- Ritika R Menghani
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, 16802, USA
| | - Anil Das
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, 16802, USA
| | - Reuben H Kraft
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, 16802, USA; Department of Biomedical Engineering, The Pennsylvania State University, University Park, 16802, USA; Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, 16802, USA.
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Williams EMP, Petrie FJ, Pennington TN, Powell DRL, Arora H, Mackintosh KA, Greybe DG. Sex differences in neck strength and head impact kinematics in university rugby union players. Eur J Sport Sci 2021; 22:1649-1658. [PMID: 34463209 DOI: 10.1080/17461391.2021.1973573] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Globally, over three million women participate in rugby union, yet injury prevention and training strategies are predominantly based on androcentric data. These strategies may have limited generalisability to females, given the cervical spine is more susceptible to whiplash and less adept at resisting inertial loading. A total of 53 university rugby union players (25 female, 28 male, 20.7 ± 1.8 years) had their isometric neck strength measured. Bespoke instrumented mouthguards were used to record the magnitude of head impact events in six female and seven male competitive matches. Mean female maximal isometric neck strength was 47% lower than male. Independent samples Mann-Whitney U tests showed no significant differences for peak linear head acceleration (female: median 11.7 g, IQR 7.9 g; male: median 12.5 g, IQR 7.0 g p=.23) or peak rotational head acceleration (female: median 800.2 rad·s-2, IQR 677.7 rad·s-2; male: median 849.4 rad·s-2, IQR 479.8 rad·s-2; p=.76), despite the mean male body mass being 24% greater than female. Coded video analysis revealed substantial differences in head-impact mechanisms; uncontrolled whiplash dominated >50% of all recorded female impact events and <0.5% in males. Direct head-to-ground impacts comprised 26.1% of female and 9.7% of male impacts, with whiplash occurring in 78.0% and 0.5%, respectively. Overall, the data provided in this study do not support the generalisation of male-derived training and injury-prevention data to female rugby athletes. These results suggest a considerable research effort is required to identify specific weakness of female rugby players and derive appropriate training, injury prevention and return to play protocols.
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Affiliation(s)
- Elisabeth M P Williams
- 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
| | - Thomas N Pennington
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - David R L Powell
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Hari Arora
- ZCCE, Faculty of Science and Engineering, Swansea University, Wales, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
| | - Desney G Greybe
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Wales, UK
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Stitt D, Draper N, Alexander K, Kabaliuk N. Laboratory Validation of Instrumented Mouthguard for Use in Sport. SENSORS 2021; 21:s21186028. [PMID: 34577235 PMCID: PMC8472105 DOI: 10.3390/s21186028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Concussion is an inherent risk of participating in contact, combat, or collision sports, within which head impacts are numerous. Kinematic parameters such as peak linear and rotational acceleration represent primary measures of concussive head impacts. The ability to accurately measure and categorise such impact parameters in real time is important in health and sports performance contexts. The purpose of this study was to assess the accuracy of the latest HitIQ Nexus A9 instrumented mouthguard (HitIQ Pty. Ltd. Melbourne Australia) against reference sensors in an aluminium headform. The headform underwent drop testing at various impact intensities across the NOCSAE-defined impact locations, comparing the peak linear and rotational acceleration (PLA and PRA) as well as the shapes of the acceleration time-series traces for each impact. Mouthguard PLA and PRA measurements strongly correlated with (R2 = 0.996 and 0.994 respectively), and strongly agreed with (LCCC = 0.997) the reference sensors. The root mean square error between the measurement devices was 1 ± 0.6g for linear acceleration and 47.4 ± 35 rad/s2 for rotational acceleration. A Bland-Altman analysis found a systematic bias of 1% for PRA, with no significant bias for PLA. The instrumented mouthguard displayed high accuracy when measuring head impact kinematics in a laboratory setting.
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Affiliation(s)
- Danyon Stitt
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
| | - Nick Draper
- School of Health Sciences, University of Canterbury Christchurch, Christchurch 8041, New Zealand
- Correspondence: ; Tel.: +64-3-369-3878
| | - Keith Alexander
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8041, New Zealand; (D.S.); (K.A.); (N.K.)
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Wright F, Docherty PD, Williams E, Greybe D, Arora H, Kabaliuk N. An in-silico study of the effect of non-linear skin dynamics on skin-mounted accelerometer inference of skull motion. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sliwkanich L, Ouanounou A. Mouthguards in dentistry: Current recommendations for dentists. Dent Traumatol 2021; 37:661-671. [PMID: 34019343 DOI: 10.1111/edt.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
Properly fitted mouthguards reduce the risk and severity of orofacial injury, to both hard and soft tissues, preventing thousands of dollars of trauma management. In this review, findings from recent research will be evaluated to discuss the strengths and limitations of the different types of mouthguards, including their indications by sport. Design, ideal dimensions, and other characteristics will also be explored. Additionally, patient education and motivation will be examined, with a focus on the dentist's role in this regard. Finally, in addition to proper oral hygiene, the importance of proper mouthguard maintenance and evaluation will be discussed. This review will therefore be able to act as a guide for dentists looking to provide patients of all ages with personal protective equipment and stay up-to-date on recent developments in this branch of the sports dentistry field.
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Affiliation(s)
- Laura Sliwkanich
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Aviv Ouanounou
- Department of Clinical Sciences (pharmacology & Preventive Dentistry), Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Using Wearable Sensors and a Convolutional Neural Network for Catch Detection in American Football. SENSORS 2020; 20:s20236722. [PMID: 33255462 PMCID: PMC7727841 DOI: 10.3390/s20236722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Abstract
Highly efficient training is a must in professional sports. Presently, this means doing exercises in high number and quality with some sort of data logging. In American football many things are logged, but there is no wearable sensor that logs a catch or a drop. Therefore, the goal of this paper was to develop and verify a sensor that is able to do exactly that. In a first step a sensor platform was used to gather nine degrees of freedom motion and audio data of both hands in 759 attempts to catch a pass. After preprocessing, the gathered data was used to train a neural network to classify all attempts, resulting in a classification accuracy of 93%. Additionally, the significance of each sensor signal was analysed. It turned out that the network relies most on acceleration and magnetometer data, neglecting most of the audio and gyroscope data. Besides the results, the paper introduces a new type of dataset and the possibility of autonomous training in American football to the research community.
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