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Stitt D, Kabaliuk N, Alexander K, Draper N. Potential of Soft-Shelled Rugby Headgear to Lower Regional Brain Strain Metrics During Standard Drop Tests. SPORTS MEDICINE - OPEN 2024; 10:102. [PMID: 39333426 PMCID: PMC11436562 DOI: 10.1186/s40798-024-00744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/24/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND The growing concern for player safety in rugby has led to an increased focus on head impacts. Previous laboratory studies have shown that rugby headgear significantly reduces peak linear and rotational accelerations compared to no headgear. However, these metrics may have limited relevance in assessing the effectiveness of headgear in preventing strain-based brain injuries like concussions. This study used an instantaneous deep-learning brain injury model to quantify regional brain strain mitigation of rugby headgear during drop tests. Tests were conducted on flat and angled impact surfaces across different heights, using a Hybrid III headform and neck. RESULTS Headgear presence generally reduced the peak rotational velocities, with some headgear outperforming others. However, the effect on peak regional brain strains was less consistent. Of the 5 headgear tested, only the newer models that use open cell foams at densities above 45 kg/m3 consistently reduced the peak strain in the cerebrum, corpus callosum, and brainstem. The 3 conventional headgear that use closed cell foams at or below 45 kg/m3 showed no consistent reduction in the peak strain in the cerebrum, corpus callosum, and brainstem. CONCLUSIONS The presence of rugby headgear may be able to reduce the severity of head impact exposure during rugby. However, to understand how these findings relate to brain strain mitigation in the field, further investigation into the relationship between the impact conditions in this study and those encountered during actual gameplay is necessary.
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Affiliation(s)
- Danyon Stitt
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
- University of Canterbury, Sports Health and Rehabilitation Research Center (SHARRC), Christchurch, 8041, New Zealand
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand.
- University of Canterbury, Sports Health and Rehabilitation Research Center (SHARRC), Christchurch, 8041, New Zealand.
| | - Keith Alexander
- Department of Mechanical Engineering, University of Canterbury, Christchurch, 8041, New Zealand
| | - Nick Draper
- University of Canterbury, Sports Health and Rehabilitation Research Center (SHARRC), Christchurch, 8041, New Zealand
- Faculty of Health, University of Canterbury, Christchurch, 8041, New Zealand
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Krch D, Lequerica AH, Arango-Lasprilla JC, Corrigan JD. Neurobehavioral Symptoms in Spanish-Speaking Individuals With Subconcussive Injuries. J Head Trauma Rehabil 2024; 39:E399-E406. [PMID: 38456793 DOI: 10.1097/htr.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To examine whether exposure to high-risk events causing injury to the head or neck has an effect on neurobehavioral symptoms in the absence of an alteration of consciousness in Spanish-speakers. SETTING Web-based survey. PARTICIPANTS Seven hundred forty-eight individuals from Spain and Latin America, aged 18 to 65 years, with 10 years or more of education. Thirty-nine participants failed quality checks and were excluded. Seven hundred nine participants were included in the analyses. DESIGN Cross-sectional study. Subconcussive exposure was defined as endorsing exposure to one or more high-risk scenarios in the absence of any alteration of consciousness. Three injury groups were derived: No Head Injury, Subconcussive Exposure, and traumatic brain injury (TBI). The Subconcussive Exposure group was further divided into Single and Multiple Exposures. Two analyses were conducted: the effect of lifetime exposure to injury (No Head Injury, Subconcussive Exposure, TBI) on neurobehavioral symptoms; the effect of Subconcussive Exposure Frequency (No Head Injury, Single Exposure, Multiple Exposures) on neurobehavioral symptoms. MAIN MEASURES Spanish Ohio State University Traumatic Brain Injury Identification Method Self-Administered-Brief (OSU TBI-ID SAB); Neurobehavioral Symptom Inventory (NSI). RESULTS There was a significant effect for Injury group on the NSI partial eta-squared (η p2 = 0.053) and a significant effect of Exposure Frequency group on the NSI (η p2 = 0.40). Individuals with subconcussive exposures reported significantly more neurobehavioral symptoms than those with no history of head injury and significantly less symptoms than those with TBI. Individuals with multiple subconcussive exposures reported significantly more neurobehavioral symptoms than those with single and no exposure. CONCLUSION This research expands the utility of the OSU-TBI-ID SAB as a lifetime TBI history assessment tool to one capable of evaluating subconcussive exposure dosing effects in Spanish-speakers. Such an index may facilitate establishment of subconcussive exposure prevalence rates worldwide, leading to improved understanding of the chronic effects of high-risk exposures.
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Affiliation(s)
- Denise Krch
- Author Affiliations: Center for Traumatic Brain Injury Research, Kessler Foundation, East Hanover, and Department of Physical Medicine and Rehabilitation, Rutgers, New Jersey Medical School, Newark, New Jersey (Drs Krch and Lequerica); Department of Psychology, Virginia Commonwealth University, Richmond, Virginia (Dr Arango-Lasprilla); and Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio (Dr Corrigan)
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Kwiatkowski A, Weidler C, Habel U, Coverdale NS, Hirad AA, Manning KY, Rauscher A, Bazarian JJ, Cook DJ, Li DKB, Mahon BZ, Menon RS, Taunton J, Reetz K, Romanzetti S, Huppertz C. Uncovering the hidden effects of repetitive subconcussive head impact exposure: A mega-analytic approach characterizing seasonal brain microstructural changes in contact and collision sports athletes. Hum Brain Mapp 2024; 45:e26811. [PMID: 39185683 PMCID: PMC11345636 DOI: 10.1002/hbm.26811] [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: 01/19/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/27/2024] Open
Abstract
Repetitive subconcussive head impacts (RSHI) are believed to induce sub-clinical brain injuries, potentially resulting in cumulative, long-term brain alterations. This study explores patterns of longitudinal brain white matter changes across sports with RSHI-exposure. A systematic literature search identified 22 datasets with longitudinal diffusion magnetic resonance imaging data. Four datasets were centrally pooled to perform uniform quality control and data preprocessing. A total of 131 non-concussed active athletes (American football, rugby, ice hockey; mean age: 20.06 ± 2.06 years) with baseline and post-season data were included. Nonparametric permutation inference (one-sample t tests, one-sided) was applied to analyze the difference maps of multiple diffusion parameters. The analyses revealed widespread lateralized patterns of sports-season-related increases and decreases in mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) across spatially distinct white matter regions. Increases were shown across one MD-cluster (3195 voxels; mean change: 2.34%), one AD-cluster (5740 voxels; mean change: 1.75%), and three RD-clusters (817 total voxels; mean change: 3.11 to 4.70%). Decreases were shown across two MD-clusters (1637 total voxels; mean change: -1.43 to -1.48%), two RD-clusters (1240 total voxels; mean change: -1.92 to -1.93%), and one AD-cluster (724 voxels; mean change: -1.28%). The resulting pattern implies the presence of strain-induced injuries in central and brainstem regions, with comparatively milder physical exercise-induced effects across frontal and superior regions of the left hemisphere, which need further investigation. This article highlights key considerations that need to be addressed in future work to enhance our understanding of the nature of observed white matter changes, improve the comparability of findings across studies, and promote data pooling initiatives to allow more detailed investigations (e.g., exploring sex- and sport-specific effects).
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Affiliation(s)
- Anna Kwiatkowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Carmen Weidler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
- Institute of Neuroscience and Medicine 10, Research Centre JülichJülichGermany
- JARA‐BRAIN Institute Brain Structure Function Relationship, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | | | - Adnan A. Hirad
- Department of SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Department of NeuroscienceUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Del Monte Neuroscience Institute, University of RochesterNew YorkUSA
| | - Kathryn Y. Manning
- Department of RadiologyUniversity of Calgary and Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
| | - Alexander Rauscher
- Department of Radiology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Pediatrics, Division of NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Physics and AstronomyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- UBC MRI Research Centre, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jeffrey J. Bazarian
- Department of Emergency MedicineUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Douglas J. Cook
- Centre for Neuroscience Studies, Queen's UniversityKingstonOntarioCanada
- Division of Neurosurgery, Department of SurgeryQueen's UniversityKingstonOntarioCanada
| | - David K. B. Li
- Department of Radiology, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Bradford Z. Mahon
- Department of PsychologyCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
- Carnegie Mellon Neuroscience InstitutePittsburghPennsylvaniaUSA
- Department of NeurosurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ravi S. Menon
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, University of Western OntarioLondonOntarioCanada
| | - Jack Taunton
- Allan McGavin Sports Medicine Centre, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kathrin Reetz
- Department of Neurology, Medical FacultyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | - Sandro Romanzetti
- Department of Neurology, Medical FacultyRWTH Aachen UniversityAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich and RWTH Aachen UniversityAachenGermany
| | - Charlotte Huppertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical FacultyRWTH Aachen UniversityAachenGermany
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Hack L, Singh B, Binkofski F, Helmich I. Repetitive Subconcussive Head Impacts in Sports and Their Impact on Brain Anatomy and Function: A Systematic Review. Int J Sports Med 2024. [PMID: 38857880 DOI: 10.1055/a-2342-3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Repetitive subconcussive head impacts occur regularly in sports. However, the exact relationship between their biomechanical properties and their consequences on brain structure and function has not been clarified yet. We therefore reviewed prospective cohort studies that objectively reported the biomechanical characteristics of repetitive subconcussive head impacts and their impact on brain anatomy and function. Only studies with a pre- to post-measurement design were included. Twenty-four studies met the inclusion criteria. Structural white matter alterations, such as reduced fractional anisotropy and an increase in mean diffusivity values, seem to be evident in athletes exposed to repetitive subconcussive head impacts exceeding 10 g. Such changes are observable after only one season of play. Furthermore, a dose-response relationship exists between white matter abnormalities and the total number of subconcussive head impacts. However, functional changes after repetitive subconcussive head impacts remain inconclusive. We therefore conclude that repetitive subconcussive head impacts induce structural changes, but thus far without overt functional changes.
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Affiliation(s)
- Lukas Hack
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Bhagyashree Singh
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
| | - Ferdinand Binkofski
- Clinical Cognitive Sciences, University Hospital RWTH Aachen, Aachen , Germany
| | - Ingo Helmich
- Department of Motor Behavior in Sports, German Sport University Cologne, Koln, Germany
- Department of Exercise and Sport Studies, Smith College, Northampton, United States
- Department of Neurology, Psychosomatic Medicine and Psychiatry, German Sport University Cologne, Koln, Germany
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Quigley KG, Hopfe D, Fenner M, Pavilionis P, Owusu-Amankonah V, Islas A, Murray NG. Preliminary Examination of Guardian Cap Head Impact Kinematics Using Instrumented Mouthguards. J Athl Train 2024; 59:594-599. [PMID: 37734732 PMCID: PMC11220776 DOI: 10.4085/1062-6050-0136.23] [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] [Indexed: 09/23/2023]
Abstract
CONTEXT Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available. OBJECTIVE To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs. DESIGN Case series. SETTING The 2022 American football preseason. PATIENTS OR OTHER PARTICIPANTS Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards. MAIN OUTCOME MEASURE(S) Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance. RESULTS No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P = .20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P = .51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P = .72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P = .32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P = .29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P = .32) between sessions for the 7 players who completed all 6 workouts. CONCLUSIONS These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.
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Affiliation(s)
| | - Dustin Hopfe
- Neuromechanics Laboratory, School of Public Health, and
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McAlister KL, Mack WJ, Bir C, Baron DA, Som C, Li K, Chavarria-Garcia A, Sawardekar S, Baron D, Toth Z, Allem C, Beatty N, Nakayama J, Kelln R, Zaslow T, Bansal R, Peterson BS. Longitudinal, prospective study of head impacts in male high school football players. PLoS One 2023; 18:e0291374. [PMID: 37682984 PMCID: PMC10490840 DOI: 10.1371/journal.pone.0291374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
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.
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Affiliation(s)
- Kelsey L. McAlister
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Cynthia Bir
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States of America
| | - David A. Baron
- Western University, Pomona, CA, United States of America
| | - Christine Som
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Karen Li
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Anthony Chavarria-Garcia
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Siddhant Sawardekar
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - David Baron
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Zachary Toth
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Courtney Allem
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Nicholas Beatty
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Junko Nakayama
- Crescenta Valley High School, La Crescenta, CA, United States of America
| | - Ryan Kelln
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Tracy Zaslow
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
| | - Ravi Bansal
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Bradley S. Peterson
- Institute for the Developing Mind, Children’s Hospital, Los Angeles, CA, United States of America
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Sundaram V, Sundar V, Pearce AJ. Biomechanical characteristics of concussive and sub-concussive impacts in youth sports athletes: A systematic review and meta-analysis. J Sports Sci 2023:1-15. [PMID: 37393593 DOI: 10.1080/02640414.2023.2231317] [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: 02/02/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
This study aimed to quantitatively investigate and report the biomechanical characteristics of concussive and sub-concussive impacts in youth sports. A systematic search was conducted in September 2022 to identify biomechanical impact studies in athletes ≤18 years of age. Twenty-six studies met the inclusion criteria for quantitative synthesis and analysis. DerSimonian Laird random effects model was used to pool data across the included studies. The pooled estimate of mean peak linear and rotational acceleration of concussive impacts in male youth athletes was 85.56 g (95% CI 69.34-101.79) and 4505.58 rad/s2 (95% CI 2870.28-6140.98), respectively. The pooled estimate of mean peak linear and rotational acceleration of sub-concussive impacts in youth athletes was 22.89 g (95% CI 20.69-25.08) and 1290.13 rad/s2 (95% CI 1050.71-1529.55), respectively. A male vs female analysis in sub-concussive impacts revealed higher linear and rotational acceleration in males and females, respectively. This is the first study to report on impact data in both sexes of youth athletes. Disparity in kinematic impact values suggests future research should aim for standardised measures to reduce heterogeneity in data. Despite this, the data reveals notable impact data that youth athletes are exposed to, suggesting modifications may be required to reduce long-term neurological risks.
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Affiliation(s)
- Vasanth Sundaram
- Department of Sports Biomechanics and Kinesiology, Tamil Nadu Physical Education and Sports University, Chennai, India
| | - Viswanath Sundar
- Physical Education and Sports Science, Visva-Bharati University, West Bengal, India
| | - Alan J Pearce
- College of Science, Health, and Engineering, La Trobe University, Bundoora, Melbourne, Australia
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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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Kercher KA, Steinfeldt JA, Rettke DJ, Zuidema TR, Walker MJ, Martinez Kercher VM, Silveyra P, Seo DC, Macy JT, Hulvershorn LA, Kawata K. Association Between Head Impact Exposure, Psychological Needs, and Indicators of Mental Health Among U.S. High School Tackle Football Players. J Adolesc Health 2023; 72:502-509. [PMID: 36610880 PMCID: PMC10033334 DOI: 10.1016/j.jadohealth.2022.11.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players. METHODS This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes. RESULTS A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (β = -0.035, SE = 0.008, p = < .001), fewer anxiety symptoms (β = -0.021, SE = 0.008, p = .010), and greater thriving scores (β = 0.278, SE = 0.040, p = < .001) at postseason. DISCUSSION This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.
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Affiliation(s)
- Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jesse A Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Devin J Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Taylor R Zuidema
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Miata J Walker
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Vanessa M Martinez Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jonathan T Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana; Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Pavlovic N, Clermont C, Cairns J, Williamson RA, Emery CA, Stefanyshyn D. Differences in head impact biomechanics between playing positions in Canadian high school football players. J Sports Sci 2023; 40:2697-2703. [PMID: 36862832 DOI: 10.1080/02640414.2023.2184824] [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: 03/04/2023]
Abstract
The objective of this study was to compare head impact magnitudes and time between impacts among positions in Canadian high-school football. Thirty nine players from two high-school football teams were recruited and assigned a position profile: Profile 1 (quarterback, receiver, defensive back, kicker), Profile 2 (linebacker, running back), and Profile 3 (linemen). Players wore instrumented mouthguards to measure peak magnitudes of linear and angular acceleration and velocity for each head impact throughout the season. A principal component analysis reduced the dimensionality of biomechanical variables, resulting in one principal component (PC1) score assigned to every impact. Time between impacts was calculated by subtracting the timestamps of subsequent head impacts within a session. Significant differences in PC1 scores and time between impacts occurred between playing position profiles (ps<0.001). Post-hoc comparisons determined that PC1 was greatest in Profile 2, followed by Profiles 1 and 3. Time between impacts was lowest in Profile 3, followed by Profiles 2 and 1. This study delivers a new method of reducing the multidimensionality of head impact magnitudes and suggests different Canadian high-school football playing positions experience different head impact magnitudes and frequencies, which is important for monitoring concussion and repetitive head impact exposure.
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Affiliation(s)
- Nina Pavlovic
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Christian Clermont
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Joshua Cairns
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Rylen A Williamson
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Darren Stefanyshyn
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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11
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Wilkerson GB, Colston MA, Acocello SN, Hogg JA, Carlson LM. Subtle impairments of perceptual-motor function and well-being are detectable among military cadets and college athletes with self-reported history of concussion. Front Sports Act Living 2023; 5:1046572. [PMID: 36761780 PMCID: PMC9905443 DOI: 10.3389/fspor.2023.1046572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction A lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC). Methods The cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3-96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest. Results Logistic regression modeling of VR Dispersion (range: 1.5-21.8), SFWI (range: 44-100), and an interaction between them provided 81% HxC classification accuracy (Model χ 2[2] = 26.03, p < .001; Hosmer & Lemeshow χ 2[8] = 1.86, p = .967; Nagelkerke R 2 = .427; Area Under Curve = .841, 95% CI: .734, .948). Binary modeling that included VR Dispersion ≥3.2 and SFWI ≤86 demonstrated 75% sensitivity and 86% specificity with both factors positive (Odds Ratio = 17.6, 95% CI: 5.0, 62.1). Discussion/Conclusion Detection of subtle indicators of altered brain processes that might otherwise remain unrecognized is clearly important for both short-term and long-term clinical management of concussion. Inconsistency among neck, upper extremity, and lower extremity responses to different types of moving visual stimuli, along with survey responses suggesting suboptimal well-being, merit further investigation as possible clinical indicators of persisting effects of concussion that might prove to be modifiable.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Marisa A Colston
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Shellie N Acocello
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Jennifer A Hogg
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Lynette M Carlson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
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12
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The Effects of Attention-Deficit/Hyperactivity Disorder Symptoms on the Association between Head Impacts and Post-Season Neurocognitive and Behavioral Outcomes. J Int Neuropsychol Soc 2023; 29:24-34. [PMID: 35105403 DOI: 10.1017/s1355617721001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Having attention-deficit/hyperactivity disorder (ADHD) is a risk factor for concussion that impacts concussion diagnosis and recovery. The relationship between ADHD and repetitive subconcussive head impacts on neurocognitive and behavioral outcomes is less well known. This study evaluated the role of ADHD as a moderator of the association between repetitive head impacts on neurocognitive test performance and behavioral concussion symptoms over the course of an athletic season. METHOD Study participants included 284 male athletes aged 13-18 years who participated in high school football. Parents completed the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) ratings about their teen athlete before the season began. Head impacts were measured using an accelerometer worn during all practices and games. Athletes and parents completed behavioral ratings of concussion symptoms and the Attention Network Task (ANT), Digital Trail Making Task (dTMT), and Cued Task Switching Task at pre- and post-season. RESULTS Mixed model analyses indicated that neither head impacts nor ADHD symptoms were associated with post-season athlete- or parent-reported concussion symptom ratings or neurocognitive task performance. Moreover, no relationships between head impact exposure and neurocognitive or behavioral outcomes emerged when severity of pre-season ADHD symptoms was included as a moderator. CONCLUSION Athletes' pre-season ADHD symptoms do not appear to influence behavioral or neurocognitive outcomes following a single season of competitive football competition. Results are interpreted in light of several study limitations (e.g., single season, assessment of constructs) that may have impacted this study's pattern of largely null results.
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13
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The Effects of Preparedness and Activity on Head Impacts in Lacrosse Athletes. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2023. [DOI: 10.1123/ijatt.2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Considering the frequency and magnitude of head impacts occurring during sport participation is important to guide prevention initiatives. Our purpose was to compare magnitude and frequency of lacrosse players’ head impacts based on anticipation level and impact activity. Lacrosse athletes (16 men, 15 women) wore xPatch sensors during games and practices that measured impact magnitude (linear and rotational accelerations) and frequency of video verified head impacts. The interaction between impact activity and preparedness was not significant, multivariate: F(8, 1,730) = ;1.03, p = ;.41, η2 = ;.01. Having a detailed understanding of the characteristics of head impacts could allow for focused interventions to reduce injury risk.
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14
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Kercher KA, Steinfeldt JA, Macy JT, Seo DC, Kawata K. Drill Intensity and Head Impact Exposure in Adolescent Football. Pediatrics 2022; 150:189733. [PMID: 36226553 PMCID: PMC9675985 DOI: 10.1542/peds.2022-057725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to examine head-impact exposure by intensity level and position group, and to test the hypothesis that there would be an increase in cumulative head-impact exposure between drill intensities after controlling for duration in each level with air recording the lowest frequency and magnitude and live recording the highest: air < bags < control < thud < live. METHODS We conducted a prospective, multisite study in 1 season with players from 3 high school football teams (n = 74). Each player wore a sensor-installed mouthguard, which monitored head-impact frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Practice drills and games were categorized by level of contact. RESULTS A total of 7312 impacts were recorded with a median of 67 (interquartile range:128) impacts per player. After controlling for duration, increases in head-impact outcomes by level of contact were observed (air < bags = control < thud = live). Live drills had higher cumulative head-impact frequency (45.4 ± 53.0 hits) and magnitude (PLA: 766.3 ± 932.9 g; PRA: 48.9 ± 61.3 kilorad/s2) per player than other levels (P < .0001). In comparison, air drills had the lowest cumulative frequency (4.2 ± 6.9 hits) and magnitude (PLA: 68.0 ± 121.6 g; PRA: 6.4 ± 13.2 kilorad/s2). CONCLUSIONS These data support the levels-of-contact system as a practical approach to limiting head-impact exposure in tackle football. Our findings are clinically important, because data have begun to suggest the relationship between chronic head-impact exposure and decline in brain health. Since head-impact exposure was influenced by levels of contact, regulation of the duration of certain drill intensities (eg, thud, live) may associate with reduced head-impact exposure in high school football.
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Affiliation(s)
- Kyle A. Kercher
- Department of Kinesiology, Indiana University, Bloomington, Indiana
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology School of Education, Indiana University, Bloomington, Indiana
| | - Jonathan T. Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Dong-Chul Seo
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington, Indiana,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana
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15
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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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16
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Stitt D, Kabaliuk N, Alexander K, Draper N. Drop Test Kinematics Using Varied Impact Surfaces and Head/Neck Configurations for Rugby Headgear Testing. Ann Biomed Eng 2022; 50:1633-1647. [PMID: 36002780 DOI: 10.1007/s10439-022-03045-5] [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: 06/16/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
World Rugby employs a specific drop test method to evaluate headgear performance, but almost all researchers use a different variation of this method. The aim of this study was, therefore, to quantify the differences between variations of the drop testing method using a Hybrid III headform and neck in the following impact setups: (1) headform only, with a flat steel impact surface, approximating the World Rugby method, (2 and 3) headform with and without a neck, respectively, onto a flat MEP pad impact surface, and (4) headform and neck, dropped onto an angled MEP pad impact surface. Each variation was subject to drop heights of 75-600 mm across three orientations (forehead, side, and rear boss). Comparisons were limited to the linear and rotational acceleration and rotational velocity for simplicity. Substantial differences in kinematic profile shape manifested between all drop test variations. Peak accelerations varied highly between variations, but the peak rotational velocities did not. Drop test variation also significantly changed the ratios of the peak kinematics to each other. This information can be compared to kinematic data from field head impacts and could inform more realistic impact testing methods for assessing headgear.
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Affiliation(s)
- Danyon Stitt
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,Sport Health and Rehabilitation Research Centre (SHARRC), University of Canterbury, Christchurch, New Zealand
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand. .,Sport Health and Rehabilitation Research Centre (SHARRC), University of Canterbury, Christchurch, New Zealand.
| | - Keith Alexander
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,Sport Health and Rehabilitation Research Centre (SHARRC), University of Canterbury, Christchurch, New Zealand
| | - Nick Draper
- Faculty of Health, University of Canterbury, Christchurch, New Zealand.,Sport Health and Rehabilitation Research Centre (SHARRC), University of Canterbury, Christchurch, New Zealand
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17
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Oldham JR, Howell D, Lanois C, Berkner P, Iverson GL, Mannix R, Meehan W. Neurocognitive functioning and symptoms across levels of collision and contact in male high school athletes. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328469. [PMID: 35477889 DOI: 10.1136/jnnp-2021-328469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We sought to determine whether male collision sport athletes perform worse on computerised neurocognitive assessments and report higher symptom burdens than athletes in contact (but not collision) sports and athletes in non-contact sports. METHODS This cross-sectional study used data collected by the Massachusetts Concussion Management Coalition on high school boys who underwent computerised neurocognitive testing between 2009 and 2018. We divided sports participation in three different sport types: (1) collision, (2) contact, non-collision and (3) non-contact. Our outcomes included the four computerised neurocognitive composite scores (verbal memory, visual memory, visual motor speed and reaction time) and the total symptom score. The independent variable was sport type (collision, contact, non-contact), adjusted for age, concussion history and comorbidities. RESULTS Of the 92 979 athletes (age: 15.59±2.08 years) included in our study, collision sport athletes performed minimally but significantly worse than other athletes on neurocognitive composite scores (verbal memory: β=-1.64, 95% CI -1.85 to -1.44; visual memory: β=-1.87, 95% CI -2.14 to -1.60; visual motor speed: β=-2.12, 95% CI -2.26 to -1.97; reaction time: β=0.02, 95% CI 0.02 to 0.02). Collision and contact sport athletes also had slightly but significantly lower total symptom scores (collision: 3.99±7.17; contact: 3.78±6.81; non-contact: 4.32±7.51, p<0.001, η2=0.001) than non-contact sport athletes. CONCLUSION There are minimal observed differences in performance on neurocognitive assessments between collision sport, contact sport and non-contact sport athletes. The repetitive subconcussive head impacts associated with collision sport participation do not appear to negatively affect self-reported symptoms or neurocognitive functioning in current youth athletes.
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Affiliation(s)
- Jessie R Oldham
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David Howell
- Children's Hospital Colorado Sports Medicine Center, Aurora, Colorado, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Corey Lanois
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Paul Berkner
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Rebekah Mannix
- Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - William Meehan
- Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
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18
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Vike NL, Bari S, Susnjar A, Lee T, Lycke RJ, Auger J, Music J, Nauman E, Talavage TM, Rispoli J. American football position-specific neurometabolic changes in high school athletes - a magnetic resonance spectroscopic study. J Neurotrauma 2022; 39:1168-1182. [PMID: 35414265 DOI: 10.1089/neu.2021.0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Reports estimate between 1.6-3.8 million sports-related concussions occur annually, with 30% occurring in youth male American football athletes. Many studies report neurophysiological changes in these athletes, but the exact reasons for these changes remain elusive. Investigation of injury mechanics highlights a need to address how player position might impact these changes. Here, 55 high school American football athletes (20 linemen; 35 non-linemen) underwent magnetic resonance spectroscopy four times over the course of a football season (once prior to the season (Pre), twice during (In1, In2), and once following (Post)) to quantify metabolites (N-acetyl aspartate, choline, creatine, myo-inositol, and glutamate/glutamine) in the dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1). Head acceleration events (HAEs) were monitored at each practice and game. Spectroscopic and HAE data were analyzed by imaging session and player position. Linear regression analyses were conducted between metabolite levels and HAEs, and metabolite levels in football athletes were compared to age-and gender-matched non-contact athletes. Across-season (i.e., between Pre and In1, In2, Post), different DLPFC and M1 metabolites decreased (p<0.05) according to player position (i.e., linemen vs. non-linemen). The majority of regression results involved DLPFC metabolites in linemen, where metabolite levels were higher, from Pre to Post, with increasing HAE load. Comparisons with control athletes revealed higher metabolite levels in football athletes both before and after the season. This study highlights the importance of player position when conducting analyses on American football athletes and demonstrates elevated DLPFC and M1 brain metabolites in football athletes compared to control athletes at both Pre and Post, suggesting potential HAE-related neurocompensatory mechanisms.
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Affiliation(s)
- Nicole L Vike
- Northwestern University, 3270, Chicago, Illinois, United States.,Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Sumra Bari
- Northwestern University, 3270, Chicago, Illinois, United States.,Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Antonia Susnjar
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Taylor Lee
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Roy J Lycke
- Purdue University, 311308, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States;
| | - Joshua Auger
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Jacob Music
- Purdue University, 311308, West Lafayette, Indiana, United States;
| | - Eric Nauman
- Purdue University, School of Mechanical Engineering, West Lafayette, Indiana, United States.,University of Cincinnati, 2514, Cincinnati, Ohio, United States;
| | - Thomas M Talavage
- Purdue University, 311308, West Lafayette, Indiana, United States.,University of Cincinnati, 2514, Cincinnati, Ohio, United States;
| | - Joseph Rispoli
- Purdue University, 311308, West Lafayette, Indiana, United States;
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19
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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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20
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Vale A, Post A, Cournoyer J, Hoshizaki TB, Gilchrist MD. Influence of play type on the magnitude and number of head impacts sustained in youth American football. Comput Methods Biomech Biomed Engin 2021; 25:1195-1210. [PMID: 34788175 DOI: 10.1080/10255842.2021.2003345] [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: 10/19/2022]
Abstract
The magnitude and number of head impacts experienced by young American football players are associated with negative brain health outcomes and may be affected by play-type strategies. The purpose of this research was to examine how play type affects the magnitude and number of head impacts in youth American tackle football. Head impacts were recorded for 30 games in the 5-9 age category and 30 games in the 9-14 age category. Impacts using physical and finite element models were conducted to determine the brain strain. Run plays had a higher head impact frequency in both age groups (p < 0.05). This increase in head impacts was consistent for all positions (p < 0.05), except wide receiver, and offensive line and defensive back in the 9-14 age group (p > 0.05). Both age groups experienced significantly different magnitude proportions with higher numbers of very low and low strain magnitude impacts during run plays (p < 0.05), and a higher proportion of moderate magnitude impacts in the 5-9 age category (p < 0.05). This data can be used to inform and educate teams and coaches and influence decisions around the use of runs and passing plays that may lead to a decrease in head impacts.
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Affiliation(s)
- Adam Vale
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Janie Cournoyer
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael D Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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21
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Narad ME, Epstein J, Peugh J, Barber Foss KD, Diekfuss JA, Bonnette S, Orban S, Yuan W, Dudley J, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer J, Avedesian JM, Slutsky-Ganesh AB, Lloyd RS, Howell D, Myer GD. The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial. J Neurotrauma 2021; 39:49-57. [PMID: 34779241 DOI: 10.1089/neu.2021.0078] [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: 11/12/2022] Open
Abstract
This prospective longitudinal trial aimed to 1) determine the role of head impact exposure on behavioral/cognitive outcomes, and 2) assess the protective effect(s) of a jugular vein compression (JVC) collar on behavioral/cognitive outcomes following one season of high-school football. Participants included 284 male high-school football players aged 13-18 years enrolled from seven midwestern high-schools. Schools were allocated to the JVC collar intervention(four teams, 140 players) or non-collar/no intervention control (three teams, 144 players) condition. Head impact exposure was measured throughout the season using CSx accelerometers. Outcome measures included post season parent and adolescent report on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN) and Post-Concussion Symptom Inventory (PCSI), as well as adolescent performance on Attention Network Task (ANT), digital Trail Making Task (dTMT), and Cued Switching task. No significant effect of head impact exposure or JVC collar use on post-season SWAN or PCSI scores or performance on dTMT and Cued Switching task were noted. There was no effect of head impact exposure on ANT performance; however, the JVC collar group had greater post-season Alerting network scores than the non-collar group (p=.026, d=.22). Findings provide preliminary evidence that the JVC collar may provide some protection to the alerting attention system. These findings should be interpreted cautiously as a greater understanding of the long-term sequalae of head impact exposure and the role of cumulative head impact exposure behavioral/cognitive outcomes is required.
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Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, 3333 Burnet Ave, mlc 10006, Cincinnati, Ohio, United States, 45229;
| | - Jeffery Epstein
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, United States;
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, 2518, Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, United States;
| | - Kim D Barber Foss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Jed A Diekfuss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Scott Bonnette
- Cincinnati Children's Hospital Medical Center, 2518, The SPORT Center, Division of Sports Medicine, Cincinnati, Ohio, United States;
| | - Sarah Orban
- University of Tampa, Department of psychology, Tampa, FL, United States;
| | - Weihong Yuan
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnew Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Jonathan Dudley
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnet Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Christopher A DiCesare
- University of Michigan, 1259, Department of Mechanical engineering, Ann Arbor, Michigan, United States;
| | - Danielle L Reddington
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | - Wen Zhong
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Jessica Shafer
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Alexis B Slutsky-Ganesh
- The University of North Carolina at Greensboro, Department of Kinesiology, Greensboro, North Carolina, United States;
| | - Rhodri S Lloyd
- Cardiff Metropolitan University, 11352, Cardiff, Cardiff, United Kingdom of Great Britain and Northern Ireland.,AUT University, Auckland, New Zealand.,Waikato Institute of Technology, 3715, Hamilton, New Zealand;
| | - David Howell
- University of Colorado Denver School of Medicine, 12225, Department of Orthopedics , Aurora, Colorado, United States;
| | - Greg D Myer
- Emory University School of Medicine, 12239, Atlanta, Georgia, United States.,the Micheli Center for Sports Injury Prevention, Waltham, Ma, United States;
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22
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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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Lee TA, Lycke RJ, Lee PJ, Cudal CM, Torolski KJ, Bucherl SE, Leiva-Molano N, Auerbach PS, Talavage TM, Nauman EA. Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football. Clin J Sport Med 2021; 31:e245-e250. [PMID: 32032162 DOI: 10.1097/jsm.0000000000000778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The goal of this pilot study was to evaluate the number of head acceleration events (HAEs) based on position, play type, and starting stance. DESIGN Prospective cohort study. SETTING Postcollegiate skill development camp during practice sessions and 1 exhibition game. PARTICIPANTS Seventy-eight male adult North American football athletes. INDEPENDENT VARIABLES A position was assigned to each participant, and plays in the exhibition game were separated by play type for analysis. During the exhibition game, video data were used to determine the effects of the starting position ("up" in a 2-point stance or "down" in a 3- or 4-point stance) on the HAEs experienced by players on the offensive line. MAIN OUTCOME MEASURES Peak linear acceleration and number of HAEs greater than 20 g (g = 9.81 m/s2) were measured using an xPatch (X2 Biosystems, Seattle, WA). RESULTS Four hundred thirty-seven HAEs were recorded during practices and 272 recorded during the exhibition game; 98 and 52 HAEs, the greatest number of HAEs by position in the game, were experienced by the offensive and defensive linemen, respectively. Linebackers and tight ends experienced high percentages of HAEs above 60 g. Offensive line players in a down stance had a higher likelihood of sustaining a HAE than players in an up stance regardless of the type of play (run vs pass). CONCLUSIONS Changing the stance of players on the offensive line and reducing the number of full-contact practices will lower HAEs.
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Affiliation(s)
- Taylor A Lee
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Roy J Lycke
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Patrick J Lee
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Caroline M Cudal
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Kelly J Torolski
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Sean E Bucherl
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Nicolas Leiva-Molano
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Paul S Auerbach
- Military/Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Department of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana; and
| | - Eric A Nauman
- Department of Mechanical Engineering, Purdue University, West Lafayette, Indiana
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana
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24
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Owens TS, Calverley TA, Stacey BS, Iannatelli A, Venables L, Rose G, Fall L, Tsukamoto H, Berg RMG, Jones GL, Marley CJ, Bailey DM. Contact events in rugby union and the link to reduced cognition: evidence for impaired redox-regulation of cerebrovascular function. Exp Physiol 2021; 106:1971-1980. [PMID: 34355451 DOI: 10.1113/ep089330] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/13/2021] [Indexed: 01/25/2023]
Abstract
NEW FINDINGS What is the central question of this study? How does recurrent contact incurred across a season of professional rugby union impact molecular, cerebrovascular and cognitive function? What is the main findings and its importance? A single season of professional rugby union increases systemic oxidative-nitrosative stress (OXNOS) confirmed by a free radical-mediated suppression in nitric oxide bioavailability. Forwards encountered a higher frequency of contact events compared to backs, exhibiting elevated OXNOS and lower cerebrovascular function and cognition. Collectively, these findings provide mechanistic insight into the possible cause of reduced cognition in rugby union subsequent to impairment in the redox regulation of cerebrovascular function. ABSTRACT Contact events in rugby union remain a public health concern. We determined the molecular, cerebrovascular and cognitive consequences of contact events during a season of professional rugby. Twenty-one male players aged 25 (mean) ± 4 (SD) years were recruited from a professional rugby team comprising forwards (n = 13) and backs (n = 8). Data were collected across the season. Pre- and post-season, venous blood was assayed for the ascorbate free radical (A•- , electron paramagnetic resonance spectroscopy) and nitric oxide (NO, reductive ozone-based chemiluminescence) to quantify oxidative-nitrosative stress (OXNOS). Middle cerebral artery velocity (MCAv, Doppler ultrasound) was measured to assess cerebrovascular reactivity (CVR), and cognition was assessed using the Montreal Cognitive Assessment (MoCA). Notational analysis determined contact events over the season. Forwards incurred more collisions (Mean difference [MD ] 7.49; 95% CI, 2.58-12.40; P = 0.005), tackles (MD 3.49; 95% CI, 0.42-6.56; P = 0.028) and jackals (MD 2.21; 95% CI, 0.18-4.24; P = 0.034). Forwards suffered five concussions while backs suffered one concussion. An increase in systemic OXNOS, confirmed by elevated A•- (F2,19 = 10.589, P = 0.004) and corresponding suppression of NO bioavailability (F2,19 = 11.492, P = 0.003) was apparent in forwards and backs across the season. This was accompanied by a reduction in cerebral oxygen delivery ( c D O 2 , F2,19 = 9.440, P = 0.006) and cognition (F2,19 = 4.813, P = 0.041). Forwards exhibited a greater decline in the cerebrovascular reactivity range to changes in PETCO2 ( CV R C O 2 RANG compared to backs (MD 1.378; 95% CI, 0.74-2.02; P < 0.001).
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Affiliation(s)
- Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Thomas A Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Angelo Iannatelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Lucy Venables
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - George Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Lewis Fall
- Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, UK
| | - Hayato Tsukamoto
- Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Ronan M G Berg
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gareth L Jones
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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25
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Rose SC, Yeates KO, Nguyen JT, Ercole PM, Pizzimenti NM, McCarthy MT. Subconcussive Head Impacts and Neurocognitive Function Over 3 Seasons of Youth Football. J Child Neurol 2021; 36:768-775. [PMID: 33834862 DOI: 10.1177/08830738211004490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the association between repetitive subconcussive head impacts and neurobehavioral outcomes in youth tackle football players. METHODS Using helmet-based sensors, we measured head impacts for 3 consecutive seasons of play in 29 male players age 9-11. Cumulative impact g's were calculated. Players completed a battery of outcome measures before and after each season, including neuropsychological testing, vestibular-ocular sensitivity, and self- and parent-reported measures of symptoms and attention-deficit hyperactivity disorder (ADHD). RESULTS Average cumulative impact over 3 seasons was 13 900g. High-intensity hits predicted worse change for self-reported social adjustment (P = .001). Cumulative impact did not predict change in any of the outcome measures. History of ADHD, anxiety, and depression predicted worse change for self-reported symptoms and social adjustment, independent of head impacts. When players were stratified into 3 groups based on cumulative impact across all 3 seasons, differences in outcome measures existed prior to the start of the first season. These differences did not further increase over the course of the 3 seasons. CONCLUSION Over 3 consecutive seasons of youth tackle football, we found no association between cumulative head impacts and neurobehavioral outcomes. Larger sample sizes and longer follow-up times would further assist in characterizing this relationship.
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Affiliation(s)
- Sean C Rose
- Division of Child Neurology, 2647Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, 2129University of Calgary, Calgary, Alberta, Canada
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26
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Walter AE, Wilkes JR, Arnett PA, Miller SJ, Sebastianelli W, Seidenberg P, Slobounov SM. The accumulation of subconcussive impacts on cognitive, imaging, and biomarker outcomes in child and college-aged athletes: a systematic review. Brain Imaging Behav 2021; 16:503-517. [PMID: 34308510 DOI: 10.1007/s11682-021-00489-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
Examine the effect of subconcussive impact accumulation on cognitive/functional, imaging, and biomarker outcomes over the course of a single season, specifically in contact sport athletes at collegiate level or younger. Systematic review following PRISMA guidelines and using Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence and Newcastle Ottawa Assessment Scale. PubMed MEDLINE, PsycInfo, SPORT-Discus, Web of Science. Original research in English that addressed the influence of subconcussive impacts on outcomes of interest with minimum preseason and postseason measurement in current youth, high school, or college-aged contact sport athletes. 796 articles were initially identified, and 48 articles were included in this review. The studies mostly involved male football athletes in high school or college and demonstrated an underrepresentation of female and youth studies. Additionally, operationalization of previous concussion history and concussion among studies was very inconsistent. Major methodological differences existed across studies, with ImPACT and diffusion tensor imaging being the most commonly used modalities. Biomarker studies generally showed negative effects, cognitive/functional studies mostly revealed no effects, and advanced imaging studies showed generally negative findings over the season; however, there was variability in the findings across all types of studies. This systematic review revealed growing literature on this topic, but inconsistent methodology and operationalization across studies makes it challenging to draw concrete conclusions. Overall, cognitive measures alone do not seem to detect changes across this timeframe while imaging and biomarker measures may be more sensitive to changes following subconcussive impacts.
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Affiliation(s)
- Alexa E Walter
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA.
| | - James R Wilkes
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
| | - Peter A Arnett
- Department of Psychology, Penn State University, University Park, PA, 16802, USA
| | - Sayers John Miller
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
| | - Wayne Sebastianelli
- Deparetment of Orthopaedics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Peter Seidenberg
- Department of Orthopaedics and Rehabilitation and Family and Community Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Penn State University, 25 Recreation Hall, University Park, PA, 16802, USA
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27
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Rajič Bumber J, Pilipović K, Janković T, Dolenec P, Gržeta N, Križ J, Župan G. Repetitive Traumatic Brain Injury Is Associated With TDP-43 Alterations, Neurodegeneration, and Glial Activation in Mice. J Neuropathol Exp Neurol 2021; 80:2-14. [PMID: 33212475 DOI: 10.1093/jnen/nlaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Increasing evidence points to a relationship between repetitive mild traumatic brain injury (mTBI), the Tar DNA binding protein 43 (TDP-43) pathology and some neurodegenerative diseases, but the underlying pathophysiological mechanisms are still unknown. We examined TDP-43 regulation, neurodegeneration, and glial responses following repetitive mTBI in nontransgenic mice and in animals with overexpression of human mutant TDP-43 protein (TDP-43G348C). In the frontal cortices of the injured nontransgenic animals, early TDP-43 cytoplasmatic translocation and overexpression of the protein and its pathological forms were detected. In the injured animals of both genotypes, neurodegeneration and pronounced glial activity were detected in the optic tract. In TDP-43G348C mice, these changes were significantly higher at day 7 after the last mTBI compared with the values in the nontransgenic animals. Results of this study suggest that the changes in the TDP-43 regulation in the frontal cortices of the nontransgenic animals were a transient stress response to the brain injury. Repetitive mTBI did not produce additional TDP-43 dysregulation or neurodegeneration or pronounced gliosis in the frontal cortex of TDP-43G348C mice. Our research also suggests that overexpression of mutated human TDP-43 possibly predisposes the brain to more intense neurodegeneration and glial activation in the optic tract after repetitive mTBI.
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Affiliation(s)
- Jelena Rajič Bumber
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Kristina Pilipović
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tamara Janković
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Petra Dolenec
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nika Gržeta
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Jasna Križ
- Department of Psychiatry and Neuroscience, Faculty of Medicine, University of Laval, Quebec, QC, Canada
| | - Gordana Župan
- From the Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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28
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Espinoza TR, Hendershot KA, Liu B, Knezevic A, Jacobs BB, Gore RK, Guskiewicz KM, Bazarian JJ, Phelps SE, Wright DW, LaPlaca MC. A Novel Neuropsychological Tool for Immersive Assessment of Concussion and Correlation with Subclinical Head Impacts. Neurotrauma Rep 2021; 2:232-244. [PMID: 34223554 PMCID: PMC8240822 DOI: 10.1089/neur.2020.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mild traumatic brain injury (mTBI) remains a diagnostic challenge and therefore strategies for objective assessment of neurological function are key to limiting long-term sequelae. Current assessment methods are not optimal in austere environments such as athletic fields; therefore, we developed an immersive tool, the Display Enhanced Testing for Cognitive Impairment and mTBI (DETECT) platform, for rapid objective neuropsychological (NP) testing. The objectives of this study were to assess the ability of DETECT to accurately identify neurocognitive deficits associated with concussion and evaluate the relationship between neurocognitive measures and subconcussive head impacts. DETECT was used over a single season of two high school and two college football teams. Study participants were instrumented with Riddell Head Impact Telemetry (HIT) sensors and a subset tested with DETECT immediately after confirmed impacts for different combinations of linear and rotational acceleration. A total of 123 athletes were enrolled and completed baseline testing. Twenty-one players were pulled from play for suspected concussion and tested with DETECT. DETECT was 86.7% sensitive (95% confidence interval [CI]: 59.5%, 98.3%) and 66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying athletes with concussions (15 of 21). Weak but significant correlations were found between complex choice response time (processing speed and divided attention) and both linear (Spearman rank correlation coefficient 0.262, p = 0.02) and rotational (Spearman coefficient 0.254, p = 0.03) acceleration on a subset of 76 players (113 DETECT tests) with no concussion symptoms. This study demonstrates that DETECT confers moderate to high sensitivity in identifying acute cognitive impairment and suggests that football impacts that do not result in concussion may negatively affect cognitive performance immediately following an impact. Specificity, however, was not optimal and points to the need for additional studies across multiple neurological domains. Given the need for more objective concussion screening in triage situations, DETECT may provide a solution for mTBI assessment.
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Affiliation(s)
- Tamara R Espinoza
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kristopher A Hendershot
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian Liu
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - Andrea Knezevic
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Breanne B Jacobs
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, North Carolina, USA
| | - Jeffery J Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Shean E Phelps
- Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA
| | - David W Wright
- Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michelle C LaPlaca
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, Georgia, USA
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29
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Repeatability and Biofidelity of a Physical Surrogate Neck Model Fit to a Hybrid III Head. Ann Biomed Eng 2021; 49:2957-2972. [PMID: 33999296 DOI: 10.1007/s10439-021-02786-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
In helmet impact testing, parameters including acceleration and velocity are measured using instrumented head-neck models that are meant to be mechanically realistic (i.e. biofidelic) stand-ins, or surrogates, for humans. Currently available models of the human neck are designed primarily for application in automotive crash testing, and their applicability in assessment of helmets is often questioned. The object of the present work is to document the mechanical design, repeatability, and biofidelity in low speed impact of a new neck model that we apply with a Hybrid III head. Focusing on Hybrid III head kinematics measured during impacts at 2 to 6 m/s, the co-efficient of variance of repeated measures of kinematics was generally less than 10%. Differences in kinematics between identical copies of the neck was less than 20% when tested with helmets, and less than 7% when the head was not helmeted. In parallel testing using a Hybrid III head-neck, the co-efficient of variance in repeated measures was less than 4% and the kinematics significantly differed from those measured using the new neck. CORAplus scores for the new neck were approximately 0.70 when compared against data for human subjects with passive neck muscles experiencing impact at 2 m/s.
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30
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Chen Y, Herrold AA, Walter AE, Reilly JL, Seidenberg PH, Nauman EA, Talavage T, Vandenbergh DJ, Slobounov SM, Breiter HC. Brain Perfusion Bridges Virtual-Reality Spatial Behavior to TPH2 Genotype for Head Acceleration Events. J Neurotrauma 2021; 38:1368-1376. [PMID: 33413020 DOI: 10.1089/neu.2020.7016] [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: 11/13/2022] Open
Abstract
Neuroimaging demonstrates that athletes of collision sports can suffer significant changes to their brain in the absence of concussion, attributable to head acceleration event (HAE) exposure. In a sample of 24 male Division I collegiate football players, we examine the relationships between tryptophan hydroxylase 2 (TPH2), a gene involved in neurovascular function, regional cerebral blood flow (rCBF) measured by arterial spin labeling, and virtual reality (VR) motor performance, both pre-season and across a single football season. For the pre-season, TPH2 T-carriers showed lower rCBF in two left hemisphere foci (fusiform gyrus/thalamus/hippocampus and cerebellum) in association with higher (better performance) VR Reaction Time, a dynamic measure of sensory-motor reactivity and efficiency of visual-spatial processing. For TPH2 CC homozygotes, higher pre-season rCBF in these foci was associated with better performance on VR Reaction Time. A similar relationship was observed across the season, where TPH2 T-carriers showed improved VR Reaction Time associated with decreases in rCBF in the right hippocampus/amygdala, left middle temporal lobe, and left insula/putamen/pallidum. In contrast, TPH2 CC homozygotes showed improved VR Reaction Time associated with increases in rCBF in the same three clusters. These findings show that TPH2 T-carriers have an abnormal relationship between rCBF and the efficiency of visual-spatial processing that is exacerbated after a season of high-impact sports in the absence of diagnosable concussion. Such gene-environment interactions associated with behavioral changes after exposure to repetitive HAEs have been unrecognized with current clinical analytical tools and warrant further investigation. Our results demonstrate the importance of considering neurovascular factors along with traumatic axonal injury to study long-term effects of repetitive HAEs.
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Affiliation(s)
- Yufen Chen
- Center for Translational Imaging, Department of Radiology, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amy A Herrold
- Edward Hines Jr., VA Hospital, Research Service, Hines, Illinois, USA.,Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexa E Walter
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - James L Reilly
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Peter H Seidenberg
- Departments of Orthopedics and Rehabilitation and Family and Community Medicine, College of Medicine, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Eric A Nauman
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Thomas Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - David J Vandenbergh
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA.,Penn State Neuroscience Institute, Pennsylvania State University, University Park, Pennsylvania, USA.,Molecular, Cellular, and Integrative Biosciences Program, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Semyon M Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Hans C Breiter
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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31
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Antonoff DG, Goss J, Langevin TL, Renodin C, Spahr L, McDevitt J, Langford D, Rosene JM. Unexpected Findings from a Pilot Study on Vision Training as a Potential Intervention to Reduce Subconcussive Head Impacts during a Collegiate Ice Hockey Season. J Neurotrauma 2021; 38:1783-1790. [PMID: 33446039 DOI: 10.1089/neu.2020.7397] [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] [Indexed: 11/12/2022] Open
Abstract
Player-to-player contact is the most frequent head impact mechanism in collegiate ice hockey. Training with three-dimensional multiple-object tracking (3D-MOT) could potentially reduce the quantity and severity of head impacts by enhancing player anticipation of these impacts. The purpose of this study was to evaluate the efficacy of 3D-MOT training to reduce the numbers of head impacts sustained by National Collegiate Athletic Association Division III men's and women's ice hockey players. Collegiate men's and women's ice hockey players (N = 33; men = 17, women = 16) were randomly assigned to a 3D-MOT group (n = 17) or a control (C) group (n = 16). Head impacts were monitored during practices and games, and 3D-MOT training occurred twice per week for 12 weeks throughout one regular season. 3D-MOT forwards sustained head impacts with greater mean peak linear acceleration (3D-MOT = 41.33 ± 28.54 g; C = 38.03 ± 24.30 g) and mean peak rotational velocity (3D-MOT = 13.59 ± 8.18 rad.sec-1; C = 12.47 ± 7.69 rad.sec-1) in games, and greater mean peak rotational velocity in practices versus C forwards (3D-MOT = 11.96 ± 6.77 rad.sec-1; C = 10.22 ± 6.95 rad.sec-1). Conversely, 3D-MOT defensemen sustained head impacts with a mean peak rotational velocity less than that of C defensemen (3D-MOT = 11.54 ± 6.76 rad.sec-1; C = 13.65 ± 8.43 rad.sec-1). There was no significant difference for all other parameters analyzed between 3D-MOT and C groups. Player position may play an important role in future interventions to reduce head impacts in collegiate ice hockey.
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Affiliation(s)
- Daniel G Antonoff
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
| | - Jordan Goss
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
| | - Taylor L Langevin
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
| | - Christina Renodin
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
| | - Lee Spahr
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
| | - Jane McDevitt
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Dianne Langford
- Department of Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
| | - John M Rosene
- Department of Exercise and Sport Performance, University of New England, Biddeford, Maine, USA
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Macy JT, Kercher K, Steinfeldt JA, Kawata K. Fewer US Adolescents Playing Football and Public Health: A Review of Measures to Improve Safety and an Analysis of Gaps in the Literature. Public Health Rep 2021; 136:562-574. [PMID: 33602026 DOI: 10.1177/0033354920976553] [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: 11/17/2022] Open
Abstract
Physical activity during adolescence is associated with positive health outcomes, yet only 26% of US middle and high school students report daily physical activity. Moreover, the number of high school students playing a sport is declining, with the largest decline in football. One reason for this decline in playing football may be increased attention to the risk of head injury. For public health, the decline is alarming because football offers a physical activity opportunity for millions of young people every year. In response, efforts have been made to institute measures to enhance the safety of football. The objective of this topical review was to review these measures and the data supporting their effectiveness. We conducted a search of scientific literature supplemented by a web search to identify safety measures. We used the Indiana University library electronic database, PubMed, and web browser searches with specific search terms. In addition to peer-reviewed studies, we searched news stories and reports from sport-related organizations. We summarized the measures and evaluations of effectiveness and categorized the measures by type (game rules, practice guidelines, equipment innovations, strategic initiatives) and target age group (elementary/middle school, high school, college, professional). We found that attempts are being made to improve the safety of football at all levels. However, many measures lack scientific evidence to support their effectiveness. Therefore, researchers need to systematically evaluate safety measures. By implementing evidence-based interventions, we can balance the public health risk of playing football versus the public health risk of continued declines in participation.
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Affiliation(s)
- Jonathan T Macy
- 1771 Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Kyle Kercher
- 1771 Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Jesse A Steinfeldt
- Department of Counseling Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA.,Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
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33
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Langevin TL, Antonoff D, Renodin C, Shellene E, Spahr L, Marsh WA, Rosene JM. Head impact exposures in women's collegiate rugby. PHYSICIAN SPORTSMED 2021; 49:68-73. [PMID: 32419585 DOI: 10.1080/00913847.2020.1770568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women's rugby season. Methods: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR]. Results: Players sustained 120 head impacts ≥15 g (18.1 g - 78.9 g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2 g, and PRV of 13.5 rad.sec-1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8 g and PRV of 15.7 rad.sec-1. Four concussions were reported and monitored. Conclusion: The incidence and magnitude of head impacts in collegiate level women's rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.
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Affiliation(s)
- Taylor L Langevin
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Daniel Antonoff
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Christina Renodin
- Medical student, University of New England College of Osteopathic Medicine , Biddeford, ME, USA
| | - Erin Shellene
- Department of Athletics, University of New England , Biddeford, ME, USA
| | - Lee Spahr
- Department of Exercise and Sport Performance, University of New England , Biddeford, ME, USA
| | - Wallace A Marsh
- Associate Dean, University of New England College of Pharmacy , Portland, ME, USA
| | - John M Rosene
- Department of Exercise and Sport Performance, University of New England , Biddeford, ME, USA
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34
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Effect of subconcussive impacts on functional outcomes over a single collegiate football season. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220983165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context In collision sports, particularly American football, athletes can accumulate thousands of subconcussive impacts, or head acceleration events (HAEs), across a single season; however, the short-term consequences of these impacts are not well understood. Objective To investigate the effects of the accumulation of impacts during practices on cognitive functions over a single football season. Design Prospective observational study. Setting Athletic training room and University laboratory. Participants Twenty-three NCAA Football Bowl Subdivision players. Main outcome measures Helmet accelerometers during practices and virtual reality testing (VR; balance, reaction time, spatial memory) before and after the season. Results Preseason had the majority of ≥80 G impacts while during the season had the majority of ≥25 G to <80 G impacts and positional differences showed that linemen had the majority of both types. Virtual reality analysis revealed that scores significantly decreased after the season for spatial navigation ( p < 0.05) but not for balance or reaction time. Significant correlations ( p < 0.05) were found between cognitive measures and player demographic variables. Conclusions Even in the absence of clinical symptoms and concussion diagnosis, repetitive impacts may cause cognitive alterations. Documenting the distribution of impact quantity and intensity as a function of time and position may be considered by coaches and clinicians to reduce the accumulation of impacts in athletes exposed in contact sports.
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Balagopal R, Won M, Patel SS, Chuang AZ, Sereno AB. Heading-Related Slowing by Twenty-Four Hours in Youth Athletes. J Neurotrauma 2020; 37:2664-2673. [PMID: 32799741 DOI: 10.1089/neu.2020.7085] [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: 10/23/2022] Open
Abstract
Research suggests cumulative effects of repetitive head impacts (RHIs) on brain structure, especially with younger age of first exposure. Further, recent evidence suggests no immediate cognitive changes with increased RHIs but impairments across a sports season. The aim was to examine more closely the short-term time course of behavioral effects of exposure to RHI. Across 2 years, 18 female adolescent soccer players were tested on ProPoint (sensorimotor) and AntiPoint (cognitive) tasks with reaction time (RT) being the main outcome measure. The athletes were tested before and after workout with ball heading (immediate effect), as well as 24 h after workout (24 h effect) throughout two consecutive seasons. The number of headers performed 24 h before workout, during workout, and season average per workout were recorded. The athletes showed a decrease in ProPoint and AntiPoint RTs immediately after a workout, with no change or decrease in RTs with increasing RHIs. However, increasing RHIs during workout increased RTs in both tasks when tested 24 h later. The athletes also showed an increase in AntiPoint RTs with increasing season average RHIs. Our findings show a complex time course of effects of RHIs on sensorimotor and cognitive performance in adolescent athletes, with exposure to RHIs associated with no change or immediate benefits and then deficits by 24 h. Pathophysiological changes associated with exercise and traumatic brain injury can account for the sensorimotor and cognitive performance changes occurring within 24 h after RHIs.
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Affiliation(s)
- Radhika Balagopal
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Biological Sciences, University of California, Santa Barbara, California, USA
| | - Michelle Won
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Neurobiology and Anatomy, Texas A&M College of Medicine, Bryan, Texas, USA
| | - Saumil S Patel
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Alice Z Chuang
- Department of Ophthalmology and Visual Science, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Anne B Sereno
- Department of Neurobiology and Anatomy, McGovern Medical School, UTHealth, Houston, Texas, USA.,Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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36
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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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37
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Kawata K, Steinfeldt JA, Huibregtse ME, Nowak MK, Macy JT, Kercher K, Rettke DJ, Shin A, Chen Z, Ejima K, Newman SD, Cheng H. Association Between Proteomic Blood Biomarkers and DTI/NODDI Metrics in Adolescent Football Players: A Pilot Study. Front Neurol 2020; 11:581781. [PMID: 33304306 PMCID: PMC7701105 DOI: 10.3389/fneur.2020.581781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
While neuroimaging and blood biomarker have been two of the most active areas of research in the neurotrauma community, these fields rarely intersect to delineate subconcussive brain injury. The aim of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football players at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players were enrolled in the study. MRI measures and blood samples were obtained during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Five players were ineligible for MRIs, and three serum samples were excluded due to hemolysis, resulting in 17 completed set of diffusion metrics and blood biomarker levels for association analysis. Our permutation-based regression model revealed that serum tau levels were significantly associated with MD and NDI in various axonal tracts; specifically, elevated serum tau levels correlated to elevated MD (p = 0.0044) and reduced NDI (p = 0.016) in the corpus callosum and surrounding white matter tracts (e.g., longitudinal fasciculus). Additionally, there was a negative association between NfL and ODI in the focal area of the longitudinal fasciculus. Our data suggest that high school football players may develop axonal microstructural abnormality in the corpus callosum and surrounding white matter tracts, such as longitudinal fasciculus. A future study is warranted to determine the longitudinal multimodal relationship in response to repetitive exposure to sports-related head impacts.
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Affiliation(s)
- Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, United States
| | - Megan E. Huibregtse
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Madeleine K. Nowak
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Jonathan T. Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Kyle Kercher
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Devin J. Rettke
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Zhongxue Chen
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Sharlene D. Newman
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
- Alabama Life Research Institute, University of Alabama, Tuscaloosa, AL, United States
| | - Hu Cheng
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
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38
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Rowson B, Duma SM. A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies. Ann Biomed Eng 2020; 48:2734-2750. [PMID: 33200263 DOI: 10.1007/s10439-020-02684-w] [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] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
This review paper summarizes the scientific advancements in the field of concussion biomechanics in American football throughout the past five decades. The focus is on-field biomechanical data collection, and the translation of that data to injury metrics and helmet evaluation. On-field data has been collected with video analysis for laboratory reconstructions or wearable head impact sensors. Concussion biomechanics have been studied across all levels of play, from youth to professional, which has allowed for comparison of head impact exposure and injury tolerance between different age groups. In general, head impact exposure and injury tolerance increase with increasing age. Average values for concussive head impact kinematics are lower for youth players in both linear and rotational acceleration. Head impact data from concussive and non-concussive events have been used to develop injury metrics and risk functions for use in protective equipment evaluation. These risk functions have been used to evaluate helmet performance for each level of play, showing substantial differences in the ability of different helmet models to reduce concussion risk. New advances in head impact sensor technology allow for biomechanical measurements in helmeted and non-helmeted sports for a more complete understanding of concussion tolerance in different demographics. These sensors along with advances in finite element modeling will lead to a better understanding of the mechanisms of injury and human tolerance to head impact.
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Affiliation(s)
- Bethany Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
| | - Stefan M Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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39
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Lee T, Lycke R, Auger J, Music J, Dziekan M, Newman S, Talavage T, Leverenz L, Nauman E. Head acceleration event metrics in youth contact sports more dependent on sport than level of play. Proc Inst Mech Eng H 2020; 235:208-221. [PMID: 33183139 DOI: 10.1177/0954411920970812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of the study was to evaluate how repetitive head traumas sustained by athletes in contact sports depend on sport and level of play. A total of 16 middle school football players, 107 high school football players, and 65 high school female soccer players participated. Players were separated into levels of play: middle school (MS), freshman (FR), junior varsity (JV), junior varsity-varsity (JV-V), and varsity (V). xPatch sensors were used to measure peak translational and angular accelerations (PTA and PAA, respectively) for each head acceleration event (HAE) during practice and game sessions. Data were analyzed using a custom MATLAB program to compare metrics that have been correlated with functional neurological changes: session metrics (median HAEs per contact session), season metrics (total HAEs, cumulative PTA/PAA), and regressions (cumulative PTA/PAA versus total HAEs, total HAEs versus median HAEs per contact session). Football players had greater session (p<.001) and season (p<.001) metrics than soccer players, but soccer players had a significantly greater player average PAA per HAE than football players (p<.001). Middle school football players had similar session and season metrics to high school level athletes. In conclusion, sport has a greater influence on HAE characteristics than level of play.
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Affiliation(s)
- Taylor Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Roy Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Joshua Auger
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Jacob Music
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Michael Dziekan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Thomas Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
| | - Larry Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Eric Nauman
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.,Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, USA
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40
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Nowak MK, Bevilacqua ZW, Ejima K, Huibregtse ME, Chen Z, Mickleborough TD, Newman SD, Kawata K. Neuro-Ophthalmologic Response to Repetitive Subconcussive Head Impacts: A Randomized Clinical Trial. JAMA Ophthalmol 2020; 138:350-357. [PMID: 32053162 DOI: 10.1001/jamaophthalmol.2019.6128] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Subconcussive head impacts have emerged as a complex public health concern. The oculomotor system is sensitive to brain trauma; however, neuro-ophthalmologic response to subconcussive head impacts remains unclear. Objective To examine whether subconcussive head impacts cause impairments in neuro-ophthalmologic function as measured by the King-Devick test (KDT) and oculomotor function as measured by the near point of convergence. Design, Setting, and Participants In this randomized clinical trial, adult soccer players were randomized into either a heading group or kicking (control) group. The heading group executed 10 headers with soccer balls projected at a speed of 25 mph. The kicking-control group followed the same protocol but with 10 kicks. Peak linear and rotational head accelerations were assessed with a triaxial accelerometer. The KDT speed and error and near point of convergence were assessed at baseline (preheading or prekicking) and at 0, 2, and 24 hours after heading or kicking. Exposures Ten soccer-ball headings or kicks. Main Outcomes and Measures The primary outcome was the group-by-time interaction of KDT speed at 0 hours after heading or kicking. The secondary outcomes included KDT speed at 2 hours and 24 hours after heading or kicking, KDT error, and near point of convergence. Results A total of 78 individuals enrolled (heading group, n = 40; kicking-control group, n = 38). Eleven individuals (heading group: 4 women; mean [SD] age, 22.5 [1.0] years; kicking-control group, 3 women and 4 men; mean [SD] age, 20.9 [1.1] years) voluntarily withdrew from the study. Data from 67 participants with a mean (SD) age of 20.6 (1.7) years were eligible for analysis (heading, n = 36; kicking-control, n = 31). Mean (SD) peak linear accelerations and peak rotational accelerations per impact for the heading group were 33.2 (6.8) g and 3.6 (1.4) krad/s2, respectively. Conversely, soccer kicking did not induce a detectable level of head acceleration. Both groups showed improvements in KDT speed (heading group: 0 hours, -1.2 [95% CI, -2.2 to -0.1] seconds; P = .03; 2 hours, -1.3 [95% CI, -2.6 to 0] seconds; P = .05; 24 hours, -3.2 [95% CI, -4.3 to -2.2] seconds; P < .001; kicking-control group: 0 hours, -3.3 [95% CI, -4.1 to -2.5] seconds; P < .001; 2 hours, -4.1 [95% CI, -5.1 to -3.1] seconds; P < .001; 24 hours, -5.2 [95% CI, -6.2 to -4.2] seconds; P < .001). Group differences occurred at all postintervention points; the kicking-control group performed KDT faster at 0 hours (-2.2 [95% CI, -0.8 to -3.5] seconds; P = .001), 2 hours (-2.8 [95% CI, -1.2 to -4.4] seconds; P < .001), and 24 hours after the intervention (-2.0 [95% CI, -0.5 to -3.4] seconds; P = .007) compared with those of the heading group. Conclusions and Relevance These data support the hypothesis that neuro-ophthalmologic function is affected, at least in the short term, by subconcussive head impacts that may affect some individuals in some contact sports. Further studies may help determine if these measures can be a useful clinical tool in detecting acute subconcussive injury. Trial Registration ClinicalTrials.gov Identifier: NCT03488381.
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Affiliation(s)
- Madeleine K Nowak
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington
| | - Zachary W Bevilacqua
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington
| | - Megan E Huibregtse
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington
| | - Zhongxue Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington
| | - Timothy D Mickleborough
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University College of Arts and Sciences, Bloomington.,Program in Neuroscience, Indiana University College of Arts and Sciences, Bloomington
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington.,Program in Neuroscience, Indiana University College of Arts and Sciences, Bloomington
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41
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Cassoudesalle H, Petit A, Chanraud S, Petit H, Badaut J, Sibon I, Dehail P. Changes in resting-state functional brain connectivity associated with head impacts over one men's semi-professional soccer season. J Neurosci Res 2020; 99:446-454. [PMID: 33089563 DOI: 10.1002/jnr.24742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
Soccer, as a contact sport, exposes players to repetitive head impacts, especially through heading the ball. The question of a long-term brain cumulative effect remains. Our objective was to determine whether exposure to head impacts over one soccer season was associated with changes in functional brain connectivity at rest, using magnetic resonance imaging (MRI). In this prospective cohort study, 10 semi-professional men soccer players, aged 18-25 years, and 20 age-matched men athletes without a concussion history and who do not practice any contact sport were recruited in Bordeaux (France). Exposure to head impacts per soccer player during competitive games over one season was measured using video analysis. Resting-state functional magnetic resonance imaging data were acquired for both groups at two times, before and after the season. With a seed-based analysis, resting-state networks that have been intimately associated with aspects of cognitive functioning were investigated. The results showed a mean head impacts of 42 (±33) per soccer player over the season, mainly intentional head-to-ball impacts and no concussion. No head impact was found among the other athletes. The number of head impacts between the two MRI acquisitions before and after the season was associated with increased connectivity within the default mode network and the cortico-cerebellar network. In conclusion, our findings suggest that the brain functioning changes over one soccer season in association with exposure to repetitive head impacts.
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Affiliation(s)
- Hélène Cassoudesalle
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Adrien Petit
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sandra Chanraud
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Hervé Petit
- "Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
| | - Jérôme Badaut
- Brain Molecular Imaging Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Igor Sibon
- Neuroimaging and Human Cognition Group, UMR-CNRS 5287 - INCIA, Bordeaux, France
| | - Patrick Dehail
- Physical and Rehabilitation Medicine Department, University Hospital of Bordeaux, Bordeaux, France.,"Handicap, Activity, Cognition & Health" Team, INSERM, BPH, U1219, University of Bordeaux, Bordeaux, France
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42
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Diekfuss JA, Yuan W, Barber Foss KD, Dudley JA, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer JL, Leach JL, Bonnette S, Logan K, Epstein JN, Clark J, Altaye M, Myer GD. The effects of internal jugular vein compression for modulating and preserving white matter following a season of American tackle football: A prospective longitudinal evaluation of differential head impact exposure. J Neurosci Res 2020; 99:423-445. [PMID: 32981154 DOI: 10.1002/jnr.24727] [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] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/17/2023]
Abstract
The purpose of this clinical trial was to examine whether internal jugular vein compression (JVC)-using an externally worn neck collar-modulated the relationships between differential head impact exposure levels and pre- to postseason changes in diffusion tensor imaging (DTI)-derived diffusivity and anisotropy metrics of white matter following a season of American tackle football. Male high-school athletes (n = 284) were prospectively assigned to a non-collar group or a collar group. Magnetic resonance imaging data were collected from participants pre- and postseason and head impact exposure was monitored by accelerometers during every practice and game throughout the competitive season. Athletes' accumulated head impact exposure was systematically thresholded based on the frequency of impacts of progressively higher magnitudes (10 g intervals between 20 to 150 g) and modeled with pre- to postseason changes in DTI measures of white matter as a function of JVC neck collar wear. The findings revealed that the JVC neck collar modulated the relationships between greater high-magnitude head impact exposure (110 to 140 g) and longitudinal changes to white matter, with each group showing associations that varied in directionality. Results also revealed that the JVC neck collar group partially preserved longitudinal changes in DTI metrics. Collectively, these data indicate that a JVC neck collar can provide a mechanistic response to the diffusion and anisotropic properties of brain white matter following the highly diverse exposure to repetitive head impacts in American tackle football. Clinicaltrials.gov: NCT# 04068883.
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Affiliation(s)
- Jed A Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim D Barber Foss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan A Dudley
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher A DiCesare
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Danielle L Reddington
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Wen Zhong
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katharine S Nissen
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica L Shafer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelsey Logan
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffery N Epstein
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Joseph Clark
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Departments of Pediatrics and Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory D Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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43
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Kercher K, Steinfeldt JA, Macy JT, Ejima K, Kawata K. Subconcussive head impact exposure between drill intensities in U.S. high school football. PLoS One 2020; 15:e0237800. [PMID: 32797073 PMCID: PMC7428124 DOI: 10.1371/journal.pone.0237800] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
USA Football established five levels-of-contact to guide the intensity of high school football practices. The objective of this study was to examine head impact frequency and magnitude by levels-of-contact to determine which drills had the greatest head impact exposure. Our primary hypothesis was that there would be an incremental increase in season-long head impact exposure between levels-of-contact: air<bags<control<thud<live. This observational study included 24 high-school football players during all 46 practices, 1 scrimmage, 9 junior varsity and 10 varsity games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational acceleration (PRA). Practice/game drills were filmed and categorized into five levels-of-contact (air, bags, control, thud, live), and head impact data were assigned into one of five levels-of-contact. Player position was categorized into lineman, hybrid, and skill. A total of 6016 head impacts were recorded during 5 levels-of-contact throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in a near incremental manner (air<bags<control = thud<live), where live drills had significantly higher cumulative frequency (113.7±17.8 hits/player) and magnitude [2,657.6±432.0 g (PLA), and 233.9 ± 40.1 krad/s2 (PRA)] than any other levels-of-contact, whereas air drills showed the lowest cumulative frequency (7.7±1.9 hits/player) and magnitude [176.9±42.5 g (PLA), PRA 16.7±4.2 krad/s2 (PRA)]. There was no significant position group difference in cumulative head impact frequency and magnitude in a season. Although there was no difference in average head impact magnitude across five levels-of-contact and by position group PLA (18.2–23.2g) and PRA (1.6–2.3krad/s2) per impact], high magnitude (60-100g and >100g) head impacts were more frequently observed during live and thud drills. Level-of-contact influences cumulative head impact frequency and magnitude in high-school football, with players incurring frequent, high magnitude head impacts during live, thud, and control. It is important to consider level-of-contact to refine clinical exposure guidelines to minimize head impact burden in high-school football.
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Affiliation(s)
- Kyle Kercher
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Jesse A. Steinfeldt
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana, United States of America
| | - Jonathan T. Macy
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States of America
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, Indiana, United States of America
- * E-mail:
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44
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Post A, Karton C, Thevenot O, Hoshizaki TB, Robidoux M, Gilchrist MD. Comparison of frequency and magnitude of head impacts experienced by Peewee boys and girls in games of youth ice hockey. Comput Methods Biomech Biomed Engin 2020; 24:1-13. [PMID: 32787715 DOI: 10.1080/10255842.2020.1805442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In youth ice hockey, girls are reported to suffer more concussions than boys, peaking around 13-14 years old, which may be related to differences in the level of brain trauma experienced by the players. The purpose of this research was to describe the differences in brain trauma characteristics, specifically the magnitude and frequency of head impacts between Peewee boys and girls from playing ice hockey. Thirty games of Peewee boys and Peewee girl's ice hockey were recorded to document the head impact events. These events were reconstructed using physical and computational techniques to estimate the strain to the brain tissue. The results found that Peewee boys experienced more head impacts than girls, specifically from the shoulder, ice, boards, and fist/punches (p < 0.05). The boys also experienced more medium strain category impacts (p < 0.05). These results identify that Peewee boys and girls engage in ice hockey differently, which affects the risk of brain trauma likely to be encountered while during game play, suggesting that the increased rate of concussion for girls may not be related to impact magnitudes within the sport but increased reporting of symptoms of concussion or gender differences in brain tissue response to an impact.
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Affiliation(s)
- Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Canada.,School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
| | - Clara Karton
- Human Kinetics, University of Ottawa, Ottawa, Canada
| | | | | | | | - Michael D Gilchrist
- Human Kinetics, University of Ottawa, Ottawa, Canada.,School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
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45
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Champagne AA, Coverdale NS, Germuska M, Bhogal AA, Cook DJ. Changes in volumetric and metabolic parameters relate to differences in exposure to sub-concussive head impacts. J Cereb Blood Flow Metab 2020; 40:1453-1467. [PMID: 31307284 PMCID: PMC7308522 DOI: 10.1177/0271678x19862861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/11/2019] [Indexed: 01/15/2023]
Abstract
Structural and calibrated magnetic resonance imaging data were acquired on 44 collegiate football players prior to the season (PRE), following the first four weeks in-season (PTC) and one month after the last game (POST). Exposure data collected from g-Force accelerometers mounted to the helmet of each player were used to split participants into HIGH (N = 22) and LOW (N = 22) exposure groups, based on the frequency of impacts sustained by each athlete. Significant decreases in grey-matter volume specific to the HIGH group were documented at POST (P = 0.009), compared to baseline. Changes in resting cerebral blood flow (CBF0), corrected for partial volume effects, were observed within the HIGH group, throughout the season (P < 0.0001), suggesting that alterations in perfusion may follow exposure to sub-concussive collisions. Co-localized significant increases in cerebral metabolic rate of oxygen consumption (CMRO2|0) mid-season were also documented in the HIGH group, with respect to both PRE- and POST values. No physiological changes were observed in the LOW group. Therefore, cerebral metabolic demand may be elevated in players with greater exposure to head impacts. These results provide novel insight into the effects of sub-concussive collisions on brain structure and cerebrovascular physiology and emphasize the importance of multi-modal imaging for a complete characterization of cerebral health.
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Affiliation(s)
- Allen A Champagne
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
| | - Nicole S Coverdale
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
| | - Mike Germuska
- Cardiff University Brain Research
Imaging Center, Cardiff University, Cardiff, UK
| | - Alex A Bhogal
- Department of Radiology, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen’s
University, Kingston, ON, Canada
- Department of Surgery, Queen’s
University, Kingston, ON, Canada
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46
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Rebchuk AD, Brown HJ, Koehle MS, Blouin JS, Siegmund GP. Using Variance to Explore the Diagnostic Utility of Baseline Concussion Testing. J Neurotrauma 2020; 37:1521-1527. [PMID: 31928134 DOI: 10.1089/neu.2019.6829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The Graded Symptom Checklist (GSC), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and King-Devick Test (KDT) are considered important components of concussion assessment. Whether baseline testing improves the diagnostic utility of these tests remains unclear. We performed an observational cohort study to investigate the within-subject and between-subjects variability of these tests over repeated assessments during two football seasons to examine whether baseline testing reduces variability in test performance. Thirty-five male collegiate football players completed weekly clinical concussion assessments over two seasons. Within-subject (week-to-week) and between-subjects (player-to-player) variability for each test were compared using a bootstrap analysis. Within-subject and between-subjects proportions of overall variance for each test score were calculated. Mixed-model analyses were used to quantify practice effects resulting from repeated testing. For the GSC and BESS, within-subject and between-subjects variability did not significantly differ. For the KDT, the proportion of within-subject variance (20.2%) was significantly less than the between-subjects variance (79.8%). For SAC, however, the proportion of within-subject variance (66.8%) was significantly greater than the between-subjects variance (33.8%). A small, but significant, practice effect was observed for the BESS and KDT tests. When athletes are evaluated during a football season for concussion using the GSC, SAC, and BESS, comparing their scores to baseline performance is likely no more beneficial than comparing them to normative population data for identifying neurological changes associated with concussion. For the KDT, comparison to baseline testing is likely beneficial because of significantly higher between-subjects variability.
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Affiliation(s)
- Alexander D. Rebchuk
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harrison J. Brown
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S. Koehle
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Sport and Exercise Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Sébastien Blouin
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Computing, Information and Cognitive Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gunter P. Siegmund
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- MEA Forensic Engineers and Scientists, Richmond, British Columbia, Canada
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47
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Chen W, Post A, Karton C, Gilchrist MD, Robidoux M, Hoshizaki TB. A comparison of frequency and magnitude of head impacts between Pee Wee And Bantam youth ice hockey. Sports Biomech 2020; 22:728-751. [PMID: 32538288 DOI: 10.1080/14763141.2020.1754450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this research was to compare the frequency and magnitude of head impact events between Pee Wee and Bantam ice hockey players. Videos of Pee Wee and Bantam boys' ice hockey were analysed to determine the frequency and type of head impact events. The head impact events were then reconstructed in the laboratory using physical and finite element models to determine the magnitude of strain in the brain tissues. The results showed that Pee Wee boys experienced more head impacts from elbows and boards, while Bantam players had more head impacts to the glass. Pee Wee and Bantam players experienced similar frequency and magnitudes of very low, low, and medium and above (med+) levels of strain to the brain. This research suggests to ice hockey leagues and coaches that to reduce the incidence of these levels of brain trauma, consideration must be given to either reducing the level of contact along the boards or the removal of body checking. In addition, companies who innovate in ice hockey should develop protective devices and equipment strategies that aim to reduce the risk of head injury from shoulder and glass impacts for Bantam players.
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Affiliation(s)
- Wesley Chen
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Clara Karton
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael D. Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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48
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Leiva-Molano N, Rolley RJ, Lee T, McIver KG, Sankaran G, Meyer JJ, Adams DE, Breedlove E, Talavage TM, Nauman EA. Evaluation of Impulse Attenuation by Football Helmets in the Frequency Domain. J Biomech Eng 2020; 142:061012. [PMID: 32060521 DOI: 10.1115/1.4046363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 11/08/2022]
Abstract
Design of helmets used in contact sports has been driven by the necessity of preventing severe head injuries. Manufacturing standards and pass or fail grading systems ensure protective headgear built to withstand large impacts, but design standards do no account for impacts resulting in subconcussive episodes and the effects of cumulative impacts on its user. Thus, it is important to explore new design parameters, such as the frequency-domain measures of transmissibility and mechanical impedance that are based on energy absorption from a range of impact loads. Within the experimentally determined frequency range of interest (FROI), transmissibilities above unity were found in the 0-40 Hz range with the magnitude characteristics varying considerably with impact location. A similar variability with location was observed for the mechanical impedance, which ranged from 9 N/m to 50 N/m. Additional research is required to further understand how changes in the components or materials of the components will affect the performance of helmets, and how they may be used to reduce both transmissibility and dynamic impedance.
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Affiliation(s)
- Nicolas Leiva-Molano
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
| | - Robert J Rolley
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Taylor Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Kevin G McIver
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Goutham Sankaran
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Janette J Meyer
- Laboratory for Systems Integrity and Reliability, Vanderbilt University, Nashville, TN 37228
| | - Douglas E Adams
- Laboratory for Systems Integrity and Reliability, Vanderbilt University, Nashville, TN 37228
| | - Evan Breedlove
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907
| | - Thomas M Talavage
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907; School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907; School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907
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49
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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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50
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Meng Y, Mabry S, Stewart P, Cannon K, Liu L, Bolding M, Zhang L, Adams ML. Correlating the passive response of eye and brain to head impact using MEMS IMUs on 3D-printed human head phantom. Physiol Meas 2020; 41:035005. [PMID: 32084659 DOI: 10.1088/1361-6579/ab78bd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Yuan Meng
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL 36849, United States of America
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