Head Impact Research Using Inertial Sensors in Sport: A Systematic Review of Methods, Demographics, and Factors Contributing to Exposure

Wearable Sensors and the Evaluation of Physiological Performance in Elite Field Hockey Players

Sports performance tracking has gained a lot of interest and widespread use in recent years, especially in elite and sub-elite sports. This makes it possible to improve the effectiveness of training, to calibrate and balance workloads according to real energy expenditure, and to reduce the likelihood of injuries due to excessive physical stress. In this context, the aim of this review was to map the scientific literature on wearable devices used in field hockey, evaluating their characteristics and the available evidence on their validity in measuring physiological and movement parameters. A systematic investigation was carried out by employing five electronic databases and search terms that incorporated field hockey, wearables, and performance analysis. Two independent reviewers conducted assessments of the 3401 titles and abstracts for inclusion, and at the end of the screening process, 102 full texts were analyzed. Lastly, a total of 23 research articles that specifically concentrated on field hockey were incorporated. The selected papers dealt with performance monitoring (6 papers), technical analysis and strategy game (6), injury prevention (1), and physiological measurements (10). To appraise the quality of the evaluations, the Oxford quality scoring system scale was employed. The extraction of information was carried out through the utilization of the participants, intervention, comparison, and outcomes (PICOS) format. The analysis encompassed research studies that implemented wearable devices during training and competitive events. Among elite field hockey competitions, GPS units were identified as the predominant wearable, followed by heart rate monitors. The intraclass correlation coefficient (ICC) related to wearable devices showed reasonably high between-trial ICCs ranging from 0.77 to 0.99. The utilization of wearable devices in field hockey primarily centers around the measurement of player activity profiles and physiological demands. The presence of discrepancies in sampling rates and performance bands makes it arduous to draw comparisons between studies. Nevertheless, this analysis attested to the fact that wearable devices are being employed for diverse applications in the realm of field hockey.

When to Pull the Trigger: Conceptual Considerations for Approximating Head Acceleration Events Using Instrumented Mouthguards

Head acceleration events (HAEs) are acceleration responses of the head following external short-duration collisions. The potential risk of brain injury from a single high-magnitude HAE or repeated occurrences makes them a significant concern in sport. Instrumented mouthguards (iMGs) can approximate HAEs. The distinction between sensor acceleration events, the iMG datum for approximating HAEs and HAEs themselves, which have been defined as the in vivo event, is made to highlight limitations of approximating HAEs using iMGs. This article explores the technical limitations of iMGs that constrain the approximation of HAEs and discusses important conceptual considerations for stakeholders interpreting iMG data. The approximation of HAEs by sensor acceleration events is constrained by false positives and false negatives. False positives occur when a sensor acceleration event is recorded despite no (in vivo) HAE occurring, while false negatives occur when a sensor acceleration event is not recorded after an (in vivo) HAE has occurred. Various mechanisms contribute to false positives and false negatives. Video verification and post-processing algorithms offer effective means for eradicating most false positives, but mitigation for false negatives is less comprehensive. Consequently, current iMG research is likely to underestimate HAE exposures, especially at lower magnitudes. Future research should aim to mitigate false negatives, while current iMG datasets should be interpreted with consideration for false negatives when inferring athlete HAE exposure.

Individualized monitoring of longitudinal heading exposure in soccer

There is growing concern that repetitive soccer headers may have negative long-term consequences on brain health. However, inconsistent and low-quality heading exposure measurements limit past investigations of this effect. Here we conducted a comprehensive heading exposure analysis across all players on a university women's soccer team for over two calendar years (36 unique athletes), quantifying both game and practice exposure during all in-season and off-season periods, with over ten thousand video-confirmed headers. Despite an average of approximately 2 headers per day, players' daily exposures ranged from 0 to 45 headers, accumulating to highly variable total exposure of 2-223 headers over each in-season/off-season period. Overall, practices and off-season periods accounted for 70% and 45% of headers, respectively. Impact sensor data showed that heading kinematics fell within a tight distribution, but sensors could not capture full heading exposure due to factors such as compliance. With first-of-its-kind complete heading exposure data, we recommend exposure assessments be made on an individual level and include practice/off-season collection in addition to games and competitive seasons. Commonly used group statistics do not capture highly variable exposures, and individualized complete heading exposure tracking needs to be incorporated in future study designs for confirming the potential brain injury risk associated with soccer heading.

Longitudinal, prospective study of head impacts in male high school football players

INTRODUCTION

Repetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players.

METHODS

In this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration.

RESULTS

4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g's higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g's higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g's higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g's higher (0.8), p<0.001].

CONCLUSION

Including screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.

Use of functional near-infrared spectroscopy to quantify neurophysiological deficits after repetitive head impacts in adolescent athletes

There is concern that repetitive head impact exposure (RHIE) may lead to neurophysiological deficits in adolescents. Twelve high school varsity soccer players (5 female) completed the King-Devick (K-D) and complex tandem gait (CTG) assessments pre- and post-season while wearing a functional near-infrared spectroscopy (fNIRS) sensor. The average head impact load (AHIL) for each athlete-season was determined via a standardised protocol of video-verification of headband-based head impact sensor data. Linear mixed effect models were used to determine the effects of AHIL and task condition (3 K-D cards or 4 CTG conditions) on the change in mean prefrontal cortical activation measured by fNIRS, and performance on K-D and CTG, from pre- to post-season. Although there was no difference in the pre- to post-season change in K-D or CTG performance, greater AHIL was associated with greater cortical activation at post-season in comparison to pre-season during the most challenging conditions of K-D (p = 0.003) and CTG (p = 0.02), suggesting that greater RHIE necessitates increased cortical activation to complete the more challenging aspects of these assessments at the same level of performance. These results describe the effect of RHIE on neurofunction and suggest the need for further study of the time course of these effects.

Padded Helmet Shell Covers in American Football: A Comprehensive Laboratory Evaluation with Preliminary On-Field Findings

Protective headgear effects measured in the laboratory may not always translate to the field. In this study, we evaluated the impact attenuation capabilities of a commercially available padded helmet shell cover in the laboratory and on the field. In the laboratory, we evaluated the padded helmet shell cover's efficacy in attenuating impact magnitude across six impact locations and three impact velocities when equipped to three different helmet models. In a preliminary on-field investigation, we used instrumented mouthguards to monitor head impact magnitude in collegiate linebackers during practice sessions while not wearing the padded helmet shell covers (i.e., bare helmets) for one season and whilst wearing the padded helmet shell covers for another season. The addition of the padded helmet shell cover was effective in attenuating the magnitude of angular head accelerations and two brain injury risk metrics (DAMAGE, HARM) across most laboratory impact conditions, but did not significantly attenuate linear head accelerations for all helmets. Overall, HARM values were reduced in laboratory impact tests by an average of 25% at 3.5 m/s (range: 9.7 to 39.6%), 18% at 5.5 m/s (range: - 5.5 to 40.5%), and 10% at 7.4 m/s (range: - 6.0 to 31.0%). However, on the field, no significant differences in any measure of head impact magnitude were observed between the bare helmet impacts and padded helmet impacts. Further laboratory tests were conducted to evaluate the ability of the padded helmet shell cover to maintain its performance after exposure to repeated, successive impacts and across a range of temperatures. This research provides a detailed assessment of padded helmet shell covers and supports the continuation of in vivo helmet research to validate laboratory testing results.

Health Detection System for Sports Dancers during Training Based on an Image Processing Technology

Dance sport is a competition of athletes for qualities such as speed, strength, endurance, flexibility, and coordination, requiring a high level of overall physical fitness. As China's sports fever continues to heat up, especially among students, the active nature of young people can lead to overenthusiasm for sports, dance, and other sports, which can lead to various physical discomforts during sports. Especially in the current sports habits of students, there is a great hidden danger of sports injuries. It is mainly due to excessive exercise, irregular exercise methods, and incomplete sports protective equipment. On this basis, this study proposes a model to further assess the health status of individuals and groups from the rate of energy consumption during exercise by building a real-time motion detection system. The development of sports health assessment systems, including the application of imaging techniques, is also analyzed. The experimental results in this article show that when the error threshold is set to 10%, the accuracy of the model is 85%, and the obtained results are ideal.

A neural network for the detection of soccer headers from wearable sensor data

To investigate the proposed association between soccer heading and deleterious brain changes, an accurate quantification of heading exposure is crucial. While wearable sensors constitute a popular means for this task, available systems typically overestimate the number of headers by poorly discriminating true impacts from spurious recordings. This study investigated the utility of a neural network for automatically detecting soccer headers from kinematic time series data obtained by wearable sensors. During 26 matches, 27 female soccer players wore head impacts sensors to register on-field impact events (> 8 g), which were labelled as valid headers (VH) or non-headers (NH) upon video review. Of these ground truth data, subsets of 49% and 21% each were used to train and validate a Long Short-Term Memory (LSTM) neural network in order to classify sensor recordings as either VH or NH based on their characteristic linear acceleration features. When tested on a balanced dataset comprising 271 VHs and NHs (which corresponds to 30% and 1.4% of ground truth VHs and NHs, respectively), the network showed very good overall classification performance by reaching scores of more than 90% across all metrics. When testing was performed on an unbalanced dataset comprising 271 VHs and 5743 NHs (i.e., 30% of ground truth VHs and NHs, respectively), as typically obtained in real-life settings, the model still achieved over 90% sensitivity and specificity, but only 42% precision, which would result in an overestimation of soccer players' true heading exposure. Although classification performance suffered from the considerable class imbalance between actual headers and non-headers, this study demonstrates the general ability of a data-driven deep learning network to automatically classify soccer headers based on their linear acceleration profiles.

Consensus Head Acceleration Measurement Practices (CHAMP): Laboratory Validation of Wearable Head Kinematic Devices

Wearable devices are increasingly used to measure real-world head impacts and study brain injury mechanisms. These devices must undergo validation testing to ensure they provide reliable and accurate information for head impact sensing, and controlled laboratory testing should be the first step of validation. Past validation studies have applied varying methodologies, and some devices have been deployed for on-field use without validation. This paper presents best practices recommendations for validating wearable head kinematic devices in the laboratory, with the goal of standardizing validation test methods and data reporting. Key considerations, recommended approaches, and specific considerations were developed for four main aspects of laboratory validation, including surrogate selection, test conditions, data collection, and data analysis. Recommendations were generated by a group with expertise in head kinematic sensing and laboratory validation methods and reviewed by a larger group to achieve consensus on best practices. We recommend that these best practices are followed by manufacturers, users, and reviewers to conduct and/or review laboratory validation of wearable devices, which is a minimum initial step prior to on-field validation and deployment. We anticipate that the best practices recommendations will lead to more rigorous validation of wearable head kinematic devices and higher accuracy in head impact data, which can subsequently advance brain injury research and management.